ACCURATE AND PRECISE HIP JOINT DIMENSION PREDICTION TECHNIQUE

USING 2 DIMENSIONAL RONTGEN

Nurani Indra Sari
Mechanical Engineering Departemen, Faculty of Engineering, Universitas Diponegoro
Jl. Prof. Sudharto, Kampus UNDIP Tembalang, Semarang 50275

Abstrac
This hip joint prediction technique aims to estimate get a footage with minimum magnification spacing
on a 2 dimensional x-ray device. This research is related to the analysis of X-ray joint with 10% magnification.
More specifically this study discusses the taking of X-ray photographs with 10% magnification along with the
correction factor analysis that occurs to estimate the exact implant size before the Hemiarthoplasty
The minimum distance set as far as 100 cm from the film screen to the part to be x-rayed, the distance
will result in a minimum magnification factor of 10%. 10% magnification is considered the minimum
magnification value nearest to the original.
The next technique is to analyze the results of X-rays by using a formula that has been found to
minimize the resulting errors, resulting in accurate results in determining the estimated size of the implant to be
installed
Keyword: Accurate and precise hip joint dimension prediction technique

INTRODUCTION
Hip templating is a process in the size and position of implants prior to arthroplasty surgery.
Traditionally, pre-operative hip templating is done by placing an example of implant on a plain X-ray AP photo.
This becomes difficult and inaccurate because of the approximate 3-dimensional object in a 2-dimensional
Radiograph. In addition to the existence of factors of magnification and distortion are difficult to control often
occur the difference between the head of femur Rontgen pre-operative with the head of the intra operative femur
is the size of the head of the femur obtained after surgery. Therefore, inter-optimal and sub-optimal intra-
observer reliability and appropriate implant size are difficult to estimate.
Based on previous research, there are still some shortcomings such as the influence of magnification
factor that can not be eliminated, it is very in the size of the decision using the implant size that will be installed.
This is because the use of X-ray tools that are still relatively simple ie 2D Rontgen tool and not yet
integrated with the computer, so that the magnification factor obtained is quite large. This can be minimized by
setting the smallest magnification reference of 10% measured by a distance of 100 cm from the screen to the
intended part, but it has not been able to produce accurate and precise results, as evidenced by an eror that
occurs about 30%.
Referring to this case, an additional analysis is required to minimize or eliminate the correction factor
that occurs so that the implant dimension can be estimated early on.
The purpose of this study is to develop a technique for predicting the dimensions of artificial hip joints
accurately and precisely by using a 2 Dimensional Radiometer tool.
METODOLOGY
In this research the following stages are done, see Figure 11
 Mulai

Penentuan tugas perancangan

Studi Literatur dan pengumpulan paten

tentang Hip Joint Templating dan Sinar X

Analisa Faktor Koreksi pada hasil Foto

Rontgen dengan Magnifikasi 10%

Pembuatan Paten tentang hip joint

templating

Konsultasi dengan dosen pembimbing

Tidak

Sesuai Kriteria

Ya

Pembuatan Laporan

Selesai

Figure 1 Flow Chart of Research

The design task begins with determining the problem that will be the title of design tasks related to the
research being conducted by researchers in the engineering design laboratory and tribology. The problem is
there is a deviation from the X-ray images with 10% magnification with the actual results post-operation. First,
collect references used for reference and references on hip joint templating, patent collection of X-rays, as well
as references to the magnification factor. References used in the form of books, journals and patents both
nationally and internationally.
The next stage is to do a correction factor analysis of 10% magnification X-ray to get real magnification
estimates. The next step is to calculate the BMI (Body Mass Index) as an additional consideration to estimate
the exact implant size, especially for patients with abnormal BMI. The next stage is to analyze the relationship
between actual magnetic estimates and the patient's BMI to determine the range of implant size should be
provided by a doctor at the time of hemiarthoplasty surgery.
After all stages and analysis results are completed, the next step is to arrange the patent on hip joint
templating and report design task that contains the result of correction factor of X-ray photograph with 10%
magnification. The process of making this report is done consultation and guidance to the supervisor so that the
report of this design task can be solved correctly.
 Pasien datang

Rawat Jalan Tidak Pasien Rawat Inap

Ya

Pengantar pemeriksaan
Poliklikik / Rujukan

Permintaan Pemeriksaan

Instalasi Radiologi

Tindakan Foto

Processing

Dokter radiologi

Pergantian Hip Joint

Tidak Rawat Jalan

Ya

Operasi
Arthoplasty

Figure 2 Patient flow chart of patient examination

Figure 3 Projection beam x ray on AP pelvis Rays. (Merrill's, 2003)

Figure 4 AP pelvis Rays in internal rotation position of 15 º with 10% magnification assumption on Rontgen
preoperative.
 Figure 5 Measurement of preoperative dimensions
RESULT AND DISCUSSION
Measurement Result
Figure 6 shows the data of measurements of preoperative and intraoperative X-rays of the femur head
diameter, where there is a difference between the preoperative X-rays measurement of 48 mm while
intraoperative results of 41 mm.

Figure 6 Comparison of femoral head size on AP Preoperative pelvis Rontgen with measurement of

intraoperative femur head diameter.

Based on Table 4.2 it can be seen that the minimum diameter of the femur head on the preoperative X-

ray is 37 cm, the minimum diameter of the femur head on the preoperative Rontgen with 10% magnification of

33.3 cm. While the maximum femur head diameter on the preoperative rongen of 51 cm, large preoperative

femur head diameter with 10% magnification of 45.9 cm and large intraoperative maximum femur head

diameter of 48 cm. The average diameter of the femur head on the preoperative X-ray of 43.91 cm, the average

diameter of the femur head in the preoperative Rontgen with 10% magnification of 39.52 cm and the large

diameter of the intraoperative mean femur head of 42.02 cm.

 Tabel 4.2 Large and Large Intraoperative X-ray Measurement Results Femur Head Diameter

measurement Preoperative Magnification 10 % Intraoperative

(mm) (mm) (mm)
Minimum 37 33,3 37
Maximum 51 45,9 48
average 43,91 39,52 42,02

Figure 4.2 shows the actual magnification ratios (X-rays of intraoperative measures) distinguished by Sex, Side
and BMI.

Real magnification based on Sex, Side and

%LILA
8.82
10.00 5.97
8.00 3.93 4.66 3.94
6.00 2.99
4.00
2.00
0.00
Left

Normoweight
Male

Right
Female

Overweight

Sex Side %LILA

Figure 4.2 Graphic Comparison of True Magnification (X-ray of intraoperative measurements) Based on Sex,
Side and BMI.
Calculation of Prediction of Magnification, Intraoperative and Range Implant
Magnification prediction
10
𝑃𝑀 =
𝑃𝑟𝑜 − 𝑃𝑟𝑜𝑚 10%
PM = Magnification prediction
Pro = Preoperative
Prom 10% = Preoperative
a. Intraoperative prediction
𝑃𝑀
𝑃𝐼 = 𝑃𝑟𝑜 −
2
PI = Intraoperative
Pro = Preoperative
PM = Magnification prediction
b. Patient implant range with BMI
1. Range implant for 20<BMI<25
𝑃𝑀
𝑃𝐼 = 𝑃𝑟𝑜 −
2
2. Range implant for BMI > 25
 𝑃𝑀
𝑃𝐼 = [𝑃𝑟𝑜 − ] ± (𝐵𝑀𝐼 − 24)
2
3. Range implant for BMI< 20
𝑃𝑀
𝑃𝐼 = [𝑃𝑟𝑜 − ] ± (𝐵𝑀𝐼 − 17,5)
2
Based on the results of research and also calculations that have been done then obtained data on the comparison
of large dimensions preoperative, preoperative 10% with intraoperatifnya results, the data presented in Figure

Measurement of femoral head diameter

60 51
45.9 48
50 43.7 42.3
39 37 39.33
40 35.1
30
20
10
0
1 2 3

preoperatif preoperatif magnifikasi 10% intraoperatif

4.3.
Figure 4.3 Measurement of femoral head diameter
In Figure 4.3 the sample used is no1 maximum diameter femur head, no 2 diameter minimum femur head
and no 3 mean diameter of femur head. In the picture shows that there is still a deviation between the
preoperative dimension, preoperative 10% with intraoperative dimension. This is due to the absence of
dimensional deviation although it has been minimized with the smallest magnification of 10%. The amount of
deviation or error that occurs is about 30% of the actual dimension.
So additional analysis is required to reduce or eliminate the correction factor. Be aware of the formula
obtained then the comparison of large dimensions of preoperative, intraoperative implant size estimation and
intraoperative femur head presented in Figure 4.4

Measurement of femur head

diameter using formula
60 51 48 48
39 43.7 42.3 42.3
37 37
40

20

0
1 2 3

preoperatif perkiraan implant intraoperatif

.
Figure 4.4 Measurement of femur head diameter using formula
In Figure 4.4 the sample used is no1 maximum diameter of the femur head, no 2 minimum diameter of the
femur head and no 3 the average diameter of the femur head. In the figure it is seen that using the formula is
proven to reduce the errors that occur, so it can be predicted the size of the implant that will be installed and the
same size intraoperatifnya.
CONCLUSION
Based on the results of measurements made on the artificial human skeleton can be concluded that the
distance of 100 cm is considered as the ideal distance to get preoperative value x-ray images with 10%
magnification, and the influence of BMI in irregularities x-ray images. The invention of the formula of
correction factor analysis to obtain an intraoperative estimate of hip and approximate implant range to be
prepared at the time of operation
Advise
Need for further research on the use of 2-dimensional X-ray tool in Indonesia. There needs to be additional
research on existing formulas to produce more accurate output. The existing formula can be developed into the
form of software so it is easier to use
DAFTAR PUSTAKA