Reliability of the Sundsvall Method for Femoral Offset Evaluation

Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement and inter-observer reliability of the Sundsvall method of hip offset measurement.

Four hundred and ninety-nine THA patients at a single tertiary academic institution were retrospectively reviewed. Preoperative hip offset was measured on anteroposterior radiographs of the pelvis on the operative and contralateral side. Hip offset was also measured postoperatively on the operative side. Hip offset was measured using the Sundsvall method as the distance between the femoral axis and midline of the pelvis at the height of the lateral most point of the greater trochanter. All measurements were completed by two raters. Intra-class correlation coefficients (ICC) and Pearson's correlation coefficients were used to evaluate agreement and inter-observer reliability between two raters.

There was excellent agreement between raters for preoperative hip offset measurement with an ICC of 0.91 (confidence interval [CI] 0.90-0.93, P<0.01) and R=0.92. There was excellent agreement between raters for postoperative hip offset with an ICC of 0.93 (CI 0.92-0.94, P<0.01) and R=0.93.

This study confirms the inter-observer agreement and reliability of the Sundsvall method of hip offset measurement. With its high agreement and reliability, the Sundsvall method is an easy and reliable way to measure hip offset that can be applied in future clinical and research settings.