Vital protocols for PolyWare™ measurement reliability and accuracy

Background and objective: PolyWare™ software (PW) has been exclusively used in the majority of polyethylene wear studies of total hip arthroplasty (THA). PW measurements can be significantly inaccurate and unrepeatable, depending on imaging conditions or subjective manipulation choices. In this regard, this study aims to shed light on the conditions needed to achieve the best accuracy and reliability of PW measurements. Methods: The experiment looked at how PW fluctuated based on several measurement conditions. x-ray images of in-vitro THA prostheses were acquired under a clinical x-ray scanning condition. A linear wear rate of 6.67 mm was simulated in combination with an acetabular lateral inclination of 36.6° and anteversion of 9.0°. Results: Among all the imported x-ray images, those with a resolution of 1,076 × 1,076 exhibited the best standard deviation in wear measurements as small as 0.01 mm and the lowest frequencies of blurriness. The edge detection area specified as non-square and off the femoral head center exhibited the most blurriness. The x-ray image that scans a femoral head eccentrically placed by 15 cm superior to the x-ray beam center led to a maximum acetabular anteversion measurement error of 5.3°. Conclusion: Because PW has been the only polyethylene wear measurement tool used, identifying its sources of error and devising a countermeasure are of the utmost importance. The results call for PW users to observe the following measurement protocols: (1) the original x-ray image must be a 1,076 × 1,076 square; (2) the edge detection area must be specified as a square with edge lengths of 5 times the diameter of the femoral head, centered at the femoral head center; and (3) the femoral head center or acetabular center must be positioned as close to the center line of the x-ray beam as possible when scanning.