Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty.

PURPOSE: The purpose of this study was to evaluate the validity of commercially available planning software on plain radiographs after THA compared to CT scans as the gold standard. PATIENTS AND METHODS: In a prospective clinical study, anteroposterior (AP) radiographs and three-dimensional CT scans (3D-CT) were obtained for 121 patients, who underwent minimally invasive, cementless THA with a straight tapered stem, in a lateral decubitus position. For measuring SV, we used digital planning software (TraumaCad 2.0, BrainLAB Feldkirchen, Germany). Two independent raters repeated the analysis after a six-week interval. Radiological measurements were compared with 3D-CT measurements by an independent, blinded external institute. This investigation was approved by the local ethics commission (no. 10 -121- 0263) and is a secondary analysis of a larger project (DRKS00 000 739, German Clinical Trials Register May-02 - 2011). RESULTS: The radiograph measurements showed very high intra- and interrater agreement. The intra-class correlation (ICC) of the intrarater agreement was 0.97 for rater 1 and 0.98 for rater 2. The intrarater reliability was 0.99 using the mean values of both rater measurements. The mean difference between the average radiograph measurement and the 3D-CT-based measurement was 0.41° (SD 11.24°) (range: -33.85°-22.50°; 95 % limits of agreement: -21.63 - 22.45), but there was no correlation found between both methods. CONCLUSION: Measuring stem version with the help of commercially available digital planning software on plain radiographs after THA has high intra- and interrater reliability but clinically inacceptable validity and reliability when compared to 3D-CT scans. KEY POINTS: • Measuring stem torsion after THA on plain radiographs with digital planning software is not valid. Citation Format: • Worlicek M, Weber M, Zeman F et al. Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty. Fortschr Röntgenstr 2016; 188: 763 - 767.

Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?

PURPOSE: The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice. MATERIALS AND METHODS: We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane. RESULTS: The mean difference between the radiographic and the 3D-CT measurements was - 1.4°â€Š±â€Š3.9° for inclination and 0.8°±â€Š7.9° for anteversion with excellent correlation for inclination (r = 0.81, p < 0.001) and moderate correlation for anteversion (r = 0.65, p < 0.001). The intraclass correlation coefficient for measurements on radiographs ranged from 0.98 (95 %-CI: 0.98; 0.99) for the first observer to 0.94 (95 %-CI: 0.92; 0.96) for the second observer. The interrater reliability was 0.96 (95 %-CI: 0.93; 0.98) for inclination and 0.93 (95 %-CI: 0.85; 0.96) for anteversion. CONCLUSION: The largest errors in measurements were associated with an extraordinary pelvic tilt. In order to get a valuable measurement for measuring cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future. KEY POINTS: • Measuring acetabular cup orientation on anteroposterior radiographs of the hip after THA is a helpful procedure in everyday clinical practice as a first-line imaging modality• CT remains the golden standard to accurately determine acetabular cup position.• Future measuring on radiographs for cup orientation after THA should account for integration of the pelvic tilt in order to maximize the measurement accuracy. Citation Format: • Craiovan B, Weber M, Worlicek M et al. Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?. Fortschr Röntgenstr 2016; 188: 574 - 581.

Splanchnic sympathectomy prevents translocation and spreading of E coli but not S aureus in liver cirrhosis.

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is mainly caused by bacterial translocation of enteric Gram-negative bacteria, predominantly Escherichia coli. The sympathetic nervous system (SNS) is activated in advanced cirrhosis, particularly in the splanchic circulation, and exerts potent immunosuppressive actions. However, the role of splanchnic SNS activity in bacterial translocation and bacterial spreading in cirrhosis remains unclear. METHODS: E coli or Stapylococcus aureus (10(6) CFU) were given intraperitoneally. After 6 h, mesenteric lymph nodes (MLN), liver, spleen, lung and peripheral blood were harvested from ascitic cirrhotic rats (LC) and healthy controls with and without splanchnic sympathectomy (SE). The bacterial tissue burden was determined by standard microbiological culture techniques. In vitro phagocytic activity of peritoneal polymorphonuclear leucocytes was assessed by FACS analysis. RESULTS: Under basal conditions SE reduced bacterial translocation to MLN in LC rats from 45% to 17%. LC rats had a marked increase in bacteraemia after E coli and S aureus challenge and an increased incidence and degree of E coli translocation to MLN, liver, spleen and lung compared with control rats. SE prevented bacteraemia in LC rats after E coli but not after S aureus challenge. Prior SE abolished the difference in incidence as well as the bacterial tissue burden in each organ after E coli application in LC rats, being no longer significantly different from control rats with or without SE. The protective effects of SE against E coli were associated with a greater influx of mononuclear cells into the peritoneal cavity and increased phagocytic activity of peritoneal polymorphonuclear leucocytes. CONCLUSIONS: In cirrhosis with bacterial peritonitis, hyperactivity of the splanchnic sympathetic nervous system contributes to the translocation of E coli but not S aureus to MLN and extraintestinal sites. This indicates a key role for sympathetic drive in the impairment in host defence against Gram-negative bacteria in cirrhosis.