Automatic measurement of acetabular cup anteversion angle using an accurate recognition technology based on improved Otsu algorithm and feature point_Journal of Biomedical Engineering

Authors：

LIU Qian ^1,2 , MA Yunqing ³ , WU Bo ⁴ , ZHANG Yao ² , QI Jingwen ^1,2 ,  MEI Yuqian ^1,2

1. School of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan 637100, P. R. China;
2. School of Medical Imaging, Mudanjiang Medical University, Mudanjiang, Heilongjiang 157001, P. R. China;
3. Department of Joint Surgery, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing 100048, P. R. China;
4. Academic Affairs Office, North Sichuan Medical College, Nanchong, Sichuan 637100, P. R. China;

Corresponding author：

MEI Yuqian, Email: mei.yuqian@nsmc.edu.cn

Keywords：

Anteversion angle; Total hip arthroplasty; Acetabular cup; Anteroposterior radiographs of the hip joint

DOI：

10.7507/1001-5515.202404045

Video：

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The orientation of the acetabular cup in hip joint anteroposterior radiograph is a key factor in evaluating the postoperative outcomes of total hip arthroplasty (THA). Currently, measurement of the acetabular cup anteversion angle primarily relies on manual drawing of auxiliary lines by orthopedic surgeons and calculations using scientific calculators. This study proposes an automated computer-aided measurement method for the acetabular cup anteversion angle based on hip joint anteroposterior radiograph. The proposed method segments hip prosthesis images using an improved Otsu algorithm, identifies feature points at the acetabular cup opening by combining circle-fitting theory and the cup’s geometric characteristics, and fits an ellipse to the cup opening to calculate the anteversion angle. A total of 104 hip joint anteroposterior radiographs, including 71 right-sided and 81 left-sided prostheses, were analyzed. Two orthopedic surgeons independently measured the postoperative anteversion angles, and the results were compared with computer-generated measurements for correlation analysis. Spearman and Pearson correlation analyses demonstrated significant correlations between the proposed method and manual measurements for both the right group (r = 0.795, P < 0.01) and the left group (r = 0.859, P < 0.01). This method provides a reliable reference for orthopedic surgeons to assess postoperative prognosis.

1.	Manouras L, Bastian J D, Beckmann N A, et al. The top three burning questions in total hip arthroplasty. Medicina, 2023, 59(4): 655.
2.	Goldman A H, Sierra R J, Trousdale R T, et al. The Lawrence D. Dorr surgical techniques & technologies award: why are contemporary revision total hip arthroplasties failing? an analysis of 2500 cases. Journal of Arthroplasty, 2019, 34(7S): S11-S16.
3.	Murphy W S, Yun H H, Hayden B, et al. The safe zone range for cup anteversion is narrower than for inclination in THA. Clinical Orthopaedics Related Ressearch, 2018, 476(2): 325-335.
4.	Danoff J R, Bobman J T, Cunn G, et al. Redefining the acetabular component safe zone for posterior approach total hip arthroplasty. Journal of Arthroplasty, 2016, 31(2): 506-511.
5.	Lewinnek G E. Dislocations after total hip-replacement arthroplasties. Journal of Bone and Joint Surgery-American Volume, 1978, 60(2): 217-220.
6.	张海峰, 宋翠荣, 赵文涛, 等. 髋关节外展角度对股骨颈应力分布的影响. 生物医学工程学杂志, 2016, 33(2): 274-278.
7.	Di Maro A, Creaco S, Albini M, et al. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskeletal Disorders, 2022, 23(1): 101.
8.	Imai N, Miyasaka D, Ibuchi S, et al. The long-term efficacy of computed tomography-navigated total hip arthroplasty: an 18-year follow-up study. Journal Clinical Medicine, 2024, 13(5): 1374.
9.	Murray D W. The definition and measurement of acetabular orientation. J Bone Joint Surg Br, 1993, 75(2): 228-232.
10.	Ackland M K, Bourne W B, Uhthoff H K. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg Br, 1986, 68(3): 409-413.
11.	Hassan D M, Johnston G H, Dust W N, et al. Radiographic calculation of anteversion in acetabular prostheses. Journal of Arthroplasty, 1995, 10(3): 369-372.
12.	Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg Br, 1999, 81(3): 431-435.
13.	Liaw C K, Hou S M, Yang R S, et al. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clinical Orthopaedics Related Ressearch, 2006, 451: 134-139.
14.	Widmer K H. A simplified method to determine acetabular cup anteversion from plain radiographs. Journal of Arthroplasty, 2004, 19(3): 387-390.
15.	Woo R Y, Morrey B F. Dislocations after total hip arthroplasty. J Bone Joint Surg Br, 1982, 64(9): 1295-1306.
16.	Kosiyatrakul A, Luenam S, Chotanaphuti T. Measurement of acetabular cup anteversion with the circle theorem. Journal of The Medical Association of Thailand, 2009, 92(Suppl 6): S128-S133.
17.	Amirouche F, Solitro G F, Chandrasekaran S, et al. Validating a modified circle theorem method for the measurement of acetabular cup anteversion on plain radiography with intra-operative data from robotic assisted total hip arthroplasty. Journal of Arthroplasty, 2016, 31(1): 323-329.
18.	李栋, 苏秀云, 王华琼, 等. 基于髋关节正位X线片可测量髋臼假体方位. 分子影像学杂志, 2018, 41(4): 452-456.
19.	Otsu N. A threshold selection method from gray-level histograms. IEEE Transactions on Systems Man Cybernetics-Systems, 2007, 9(1): 62-66.
20.	Zurmühle C A, Zickmantel B, Christen M, et al. Image-less THA cup navigation in clinical routine setup: individual adjustments, accuracy, precision, and Robustness. Medicina (Kaunas). 2022, 58(6): 832.
21.	Fabeck L, Farrokh D, Tolley M, et al. A method to measure acetabular cup anteversion after total hip replacement. Acta Orthopaedica Belgica, 1999, 65(4): 485-491.
22.	Wu T Y, Yang R S, Fuh C S, et al. THR simulator--the software for generating radiographs of THR prosthesis. BMC Musculoskeletal Disorders, 2009, 10: 8.
23.	Song S K, Choi W K, Jung S H, et al. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations. Journal of Orthopaedic Research, 2021, 39(4): 806-812.
24.	Min Lee J, Baek S H, Soo Lee Y. Vital protocols for PolyWare™ measurement reliability and accuracy. Frontiers in Surgery, 2022, 9: 997848.
25.	Park Y S, Shin W C, Lee S M, et al. The best method for evaluating anteversion of the acetabular component after total hip arthroplasty on plain radiographs. Journal of Orthopaedic Surgery and Research, 2018, 13(1): 66.
26.	Chen W C, Wu T Y, Chi K Y, et al. Laser projector method for measuring postoperative acetabular anteversion after total hip replacement. Frontiers in Surgery, 2022, 9: 1033453.

1. Manouras L, Bastian J D, Beckmann N A, et al. The top three burning questions in total hip arthroplasty. Medicina, 2023, 59(4): 655.
2. Goldman A H, Sierra R J, Trousdale R T, et al. The Lawrence D. Dorr surgical techniques & technologies award: why are contemporary revision total hip arthroplasties failing? an analysis of 2500 cases. Journal of Arthroplasty, 2019, 34(7S): S11-S16.
3. Murphy W S, Yun H H, Hayden B, et al. The safe zone range for cup anteversion is narrower than for inclination in THA. Clinical Orthopaedics Related Ressearch, 2018, 476(2): 325-335.
4. Danoff J R, Bobman J T, Cunn G, et al. Redefining the acetabular component safe zone for posterior approach total hip arthroplasty. Journal of Arthroplasty, 2016, 31(2): 506-511.
5. Lewinnek G E. Dislocations after total hip-replacement arthroplasties. Journal of Bone and Joint Surgery-American Volume, 1978, 60(2): 217-220.
6. 张海峰, 宋翠荣, 赵文涛, 等. 髋关节外展角度对股骨颈应力分布的影响. 生物医学工程学杂志, 2016, 33(2): 274-278.
7. Di Maro A, Creaco S, Albini M, et al. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskeletal Disorders, 2022, 23(1): 101.
8. Imai N, Miyasaka D, Ibuchi S, et al. The long-term efficacy of computed tomography-navigated total hip arthroplasty: an 18-year follow-up study. Journal Clinical Medicine, 2024, 13(5): 1374.
9. Murray D W. The definition and measurement of acetabular orientation. J Bone Joint Surg Br, 1993, 75(2): 228-232.
10. Ackland M K, Bourne W B, Uhthoff H K. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg Br, 1986, 68(3): 409-413.
11. Hassan D M, Johnston G H, Dust W N, et al. Radiographic calculation of anteversion in acetabular prostheses. Journal of Arthroplasty, 1995, 10(3): 369-372.
12. Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg Br, 1999, 81(3): 431-435.
13. Liaw C K, Hou S M, Yang R S, et al. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clinical Orthopaedics Related Ressearch, 2006, 451: 134-139.
14. Widmer K H. A simplified method to determine acetabular cup anteversion from plain radiographs. Journal of Arthroplasty, 2004, 19(3): 387-390.
15. Woo R Y, Morrey B F. Dislocations after total hip arthroplasty. J Bone Joint Surg Br, 1982, 64(9): 1295-1306.
16. Kosiyatrakul A, Luenam S, Chotanaphuti T. Measurement of acetabular cup anteversion with the circle theorem. Journal of The Medical Association of Thailand, 2009, 92(Suppl 6): S128-S133.
17. Amirouche F, Solitro G F, Chandrasekaran S, et al. Validating a modified circle theorem method for the measurement of acetabular cup anteversion on plain radiography with intra-operative data from robotic assisted total hip arthroplasty. Journal of Arthroplasty, 2016, 31(1): 323-329.
18. 李栋, 苏秀云, 王华琼, 等. 基于髋关节正位X线片可测量髋臼假体方位. 分子影像学杂志, 2018, 41(4): 452-456.
19. Otsu N. A threshold selection method from gray-level histograms. IEEE Transactions on Systems Man Cybernetics-Systems, 2007, 9(1): 62-66.
20. Zurmühle C A, Zickmantel B, Christen M, et al. Image-less THA cup navigation in clinical routine setup: individual adjustments, accuracy, precision, and Robustness. Medicina (Kaunas). 2022, 58(6): 832.
21. Fabeck L, Farrokh D, Tolley M, et al. A method to measure acetabular cup anteversion after total hip replacement. Acta Orthopaedica Belgica, 1999, 65(4): 485-491.
22. Wu T Y, Yang R S, Fuh C S, et al. THR simulator--the software for generating radiographs of THR prosthesis. BMC Musculoskeletal Disorders, 2009, 10: 8.
23. Song S K, Choi W K, Jung S H, et al. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations. Journal of Orthopaedic Research, 2021, 39(4): 806-812.
24. Min Lee J, Baek S H, Soo Lee Y. Vital protocols for PolyWare™ measurement reliability and accuracy. Frontiers in Surgery, 2022, 9: 997848.
25. Park Y S, Shin W C, Lee S M, et al. The best method for evaluating anteversion of the acetabular component after total hip arthroplasty on plain radiographs. Journal of Orthopaedic Surgery and Research, 2018, 13(1): 66.
26. Chen W C, Wu T Y, Chi K Y, et al. Laser projector method for measuring postoperative acetabular anteversion after total hip replacement. Frontiers in Surgery, 2022, 9: 1033453.

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