A new understanding of radiographic landmarks of the greater trochanter that indicate correct femoral rotation for measurement of femoral offset

Abstract

Objectives: To establish and validate a novel method for aligning femoral rotation to accurately measure femoral offset for preoperative templating and component sizing, and to identify the physical location of two radiographic lines utilized in the described method. Materials and methods: Cadaveric proximal femurs were skeletonized and mounted to a biaxial load frame. Two radiographic lines along the greater trochanter were identified fluoroscopically. The femurs were rotated, and images were taken when the lines appeared superimposed, then in 2-degree increments to 10° of internal and external rotation, and at 30°. Radiographic femoral offset was calculated at each angle, and the maximum and aligned offsets were compared. Bone was removed until the radiographic lines disappeared, then a metal wire was inserted in place of the bone to confirm that the lines reappeared. Results: The physical locations of the radiographic landmarks were on the anterior and posterior aspects of the greater trochanter. The mean true femoral offset was 38.2 mm (range, 30.5–46.3 mm). The mean aligned femoral offset was 37.3 mm (range, 29.3–46.3 mm), a 2.4% underestimation. The mean angle between aligned and true offset was 3.6° of external rotation (range, 10°ER-8°IR). Intra-rater intraclass correlation coefficient was 0.991. Conclusion: Alignment of the radiographic lines created by the anterior and posterior aspects of the greater trochanter is a reliable and accurate rotational positioning method for measuring true femoral offset when using plain films or fluoroscopy, which can aid surgeons with preoperative templating and intraoperative component placement for total hip arthroplasty.