EBRA-CUP:

1. EBRA-CUP: A METHODS FOR MIGRATION MEASUREMENT OF ACETABULAR COMPONENTS OF THRs IN DIGITAL STANDARD RADIOGRAPHS PETER MAYRHOFER, revisited April 2012 Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

2. EBRA INSTALLATIONS • EUROPE • Belgium (1) • Austria (8) • Belgium (1) • Denmark (5) • France (5) • Germany (23) • Greece (3) • Italy (2) • Netherlands (1) • Norway (1) • Sweden (2) • Switzerland (5) • United Kingdom (13) • OUTSIDE EUROPE • San Francisco, US • Los Angeles, US • New Orleans, US • Memphis Arlington, US • New York, US • Cleveland Ohio, US • Ottawa, Canada • Montreal, Canada • Tokyo (2), Japan • Osaka, Japan • Adelaide, Australia • Melbourne, Australia • Shanghai, China April 2012: 84 Installations EBRA has become an International Standard. Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

3. EARLY MIGRATION > 1mm IS PREDICTIVE FOR PROSTHETIC LOOSENING! J Bone Joint Surg Br. 1996 May;78(3):422-26. Early migration predicts late aseptic failure of hip sockets. Krismer M, Stockl B, Fischer M, Bauer R, Mayrhofer P, Ogon M. J Bone Joint Surg Br. 1999 Mar;81(2):273-80. The prediction of failure of the stem in THR by measurement of early migration using EBRA-FCA. Einzel-Bild-Roentgen-Analyse-femoral component analysis. Krismer M, Biedermann R, Stockl B, Fischer M, Bauer R, Haid C. EBRA ENABLES QUALITY CONTROL FOR IMPLANT DESIGN &SURGICAL TECHNIQUE Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

4. Migration is only measurable in serial radiographs of the same patient whose position (exterior orientation) is never exactly the same. mm time EBRA requires at least 4 x-rays per series! Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

5. EBRA-CUP REQUIRES FULL SIZED AP PELVIS RADIOGRAPHS OF SIZE 430 x 350 mm digitized with film scanner or retrieved from PACS system including a scale for calibration! Resolution min. 75dpi Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

6. EBRA-FCA ALSO ACCEPTS HIP RADIOGRAPHS NOT SHOWING THE WHOLE PELVIS. As the image is calibrated by the true head size, no scale is needed. Resolution min. 75dpi Tip of stem must be visible! Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

7. EBRA RSA • 1 standard x-ray • per observation • no ball markers • retrospective studies • 2 special x-rays • per observation • markers required • prospective studies Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

8. EBRA-CUP PARAMETERS head & cup x-migration y-migration z-migration not possible y z cup inclination & anteversion x Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

9. X-ray focus EXACT INTRINSIC ORIENTATION IS UNKNOWN IN STANDARD X-RAY Focus-film-distance and position of central beam have to be assessed approximatively. film plane principal point Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

10. film center approximative principal point EBRA - LANDMARKS Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

11. focus 3D-METHOD EBRA-CUP spatial parameter of migration cup reference plane principal point film reference line Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

12. ERRORS CAUSED BY CHANGES OF INTRINSIC ORIENTATION 1300mm 900mm Focus variation within cuboid 60 x 110 x 400 mm affects parameters of migration in a magnitude of only 0.01 mm(experimental study based on 78 radiographs) Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

13. COMPENSATION OF ERRORS • by use of an approximative intrinsic orientation bound to pelvic contours (based on study of 78 random x-rays) • by use of variable reference planes passing through the x-ray focus Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

14. EXTRINSIC ORIENTATION VARIES REMARKABLY Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

15. ERRORS CAUSED BY CHANGES OF EXTERIOR ORIENTATION Rotations of the pelvic bone cause remarkable errors up to 7 mm of simulated migration! Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

16. COMPENSATION OF ERRORS • by use of a comparability strategy which compares radiographs with respect to similar conditions at exposure • migration is measured only in pairs of comparable radiographs • overlapping trends are weighted and averaged Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

17. EBRA COMPARABILITY ALGORITHM non comparable x-ray raw data migration smoothed data time Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

18. ACCURACY TESTS • zero migration experiment (27 x-rays) • 33 pairs of x-rays taken within 1 month • comparison with RSA (T. Ilchman et al.) J Arthroplasty. 1992 Jun;7(2):121-27. Measurement accuracy in acetabular cup migration. A comparison of four radiologic methods versus roentgen stereophotogrammetric analysis. Ilchmann T, Franzen H, Mjoberg B, Wingstrand H. Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

19. EBRA - ACCURACY MIGRATION MEASUREMENT • medio-lateral mig: 0.8 mm (95% CI) • cranial migration: 1.0 mm (95% CI) ANGULAR MEASUREMENT • cup anteversion: 3.3° • cup inclination: 2.5° Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria

20. EBRA GRAPHICS PROGRAM PRINTER EXCEL Department of Engineering Mathematics, Geometry and Computer Science, University of Innsbruck, Austria