JOA - 2026-09-21 - Journal Article
Assessment of Acetabular Component Anteversion Following Total Hip Arthroplasty: Current Imaging Techniques and Limitations.
Edelstein A, Smitterberg CW, Amanatullah DF, Chen AF, Mont MA
Topics
Key Takeaway
No single radiographic technique demonstrates clear superiority for acetabular anteversion measurement, and CT-based assessment requires whole-pelvis imaging to establish an accurate pelvic reference plane.
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Summary
This narrative review evaluated radiographic (Woo and Morrey, Lewinnek, Liaw, Widmer) and CT-based techniques for measuring acetabular component anteversion and inclination after THA, emphasizing precision, repeatability, and the influence of spino-pelvic mechanics. Evidence on radiographic technique superiority is conflicting, with some studies showing reasonable correlation between radiographic and CT-based measurements. CT offers superior reproducibility in patients with abnormal spino-pelvic mechanics or malpositioned components, but only when whole-pelvis imaging is used to define an appropriate pelvic reference frame.
Key Limitation
As a narrative review without systematic search methodology or meta-analytic synthesis, the conclusions on relative technique accuracy are not supported by pooled quantitative evidence and are susceptible to author selection bias.
Original Abstract
BACKGROUND
Accurate measurement of acetabular component position is crucial for evaluating instability, impingement, accelerated wear, pain, and component failure after total hip arthroplasty (THA). Acetabular anteversion remains difficult to accurately determine, even though inclination is readily evaluated on radiographs. Numerous radiographic and computed tomography (CT)-based techniques have been described, each with distinct advantages and limitations.
METHODS
The commonly used radiographic and CT-based techniques for assessing acetabular component anteversion and inclination after THA were evaluated by a narrative review of the literature. Measurement technique, precision, repeatability, technological constraints, and the impact of pelvic position and spino-pelvic mechanics were emphasized.
IMAGING TECHNIQUES AND EVIDENCE
The Woo and Morrey, Lewinnek, Liaw, and Widmer radiographic techniques are frequently used. While there is conflicting information regarding the superiority of any one of these radiographic techniques, some studies have shown reasonable correlation between radiographic and CT-based assessments. In patients who have abnormal spino-pelvic mechanics or component malposition, CT-based examination may offer more accuracy and reproducibility. However, as unilateral hip CT scans do not sufficiently establish the pelvic reference plane required for accurate determination of version or inclination, proper CT assessment necessitates imaging of the complete pelvis.
CONCLUSIONS
After THA, acetabular component position can be evaluated using a variety of imaging techniques. While radiographs remain the most widely available modality, CT may provide the most reproducible assessment of component orientation when whole-pelvis imaging is obtained using an appropriate pelvic reference frame. Understanding the strengths and limitations of each approach is essential when evaluating painful, unstable, or mechanically failing THA.