A review of plain radiographic methods for measuring femoral version after total hip arthroplasty and validation of modified Budin's method in Indian population

Anurag Mittal; Nitish Kumar; Bobby Nandimandalam; Amite Pankaj

doi:10.1016/j.jcot.2020.10.019

A review of plain radiographic methods for measuring femoral version after total hip arthroplasty and validation of modified Budin's method in Indian population

J Clin Orthop Trauma. 2020 Oct 13:15:104-109. doi: 10.1016/j.jcot.2020.10.019. eCollection 2021 Apr.

Authors

Anurag Mittal¹, Nitish Kumar², Bobby Nandimandalam³, Amite Pankaj⁴

Affiliations

¹ Guru Teg Bahadur Hospital, Dilshad Garden, 110095, GTB, Delhi, India.
² AIIMS, Gorakhpur, D34 Arya Nagar Apartments, IP Extension, Patparganj, Delhi, 92, AIIMS, Gorakhpur, UP, India.
³ AIIMS, Rishikesh, AIIMS Rishikesh, Fortis Hospital, Shalimar Bagh, New Delhi, 110088, India.
⁴ Fortis Hospital, Shalimar Bagh, New Delhi, 110088, India.

Abstract

Background: Multiple plain radiographic methods; cross table radiographic method, modified Budin method, projected neck-shaft angle method, and trans lateral decubitus view method using Ogata-Goldsand formula, have been described in literature for measurement of femoral stem version (FSV) after total hip arthroplasty (THA).

Purpose: To review these multiple radiographic methods and also determine validity and accuracy of modified Budin method in Indian population.

Patients and methods: A literature search for different methods described for FSV measurement was performed and these methods were reviewed. In addition, for validation of modified Budin method in Indian population, data was collected for 36 THAs prospectively. A posteroanterior radiograph with patient sitting in 90° hip flexion and 30° abduction was taken 3 weeks and 6 weeks after surgery for calculating the FSV using modified Budin method. At 3 weeks, a CT scan was also done for version measurement. Intra and interobserver reliability, and reproducibility of radiographic FSV measurement, and the correlation between CT scan and radiographic FSV measurement were statistically calculated.

Results: All the reviewed studies demonstrated that their method is comparable to CT method for FSV measurement, except FSV measured on cross table radiographic view. However, there were only one or at most two studies of every method described except for modified Budin technique. The mean FSV in our prospective case series using 'modified Budin' method was 11.6° which was comparable to the mean of CT scan version measurement (12.3°). The mean difference was 0.7° which was not statistically significant (p value > 0.05). In addition, there was high intra-class correlation coefficient in radiographic FSV for both intra- and inter-observer reliability.

Conclusion: Multiple methods have been described and validated in literature, however, the 'modified Budin' view have proved multiple times to have excellent reliability and validity for easy measurement of FSV.

Keywords: Femoral stem version; Modified budin method; Total hip arthroplasty.