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BACKGROUND: Lower-limb discrepancy following total hip arthroplasty is the third-most common reason for patient dissatisfaction in orthopaedic surgery. Therefore, accurate planning and evaluation methods are mandatory. The main aim of this study was to evaluate the reliability of the EOS™ system by establishing and comparing the reproducibility of lower-limb automatic and manual 3D measurements. We hypothesized that the reproducibility of the lower-limb measurements is similar regardless of the method used and with an agreement higher than 0.95 for the length parameters. MATERIALS AND METHODS: This study utilized an EOS radiological database of 112 patients. Two independent observers performed two rounds of lower-limb measurements twice, either in manual 3D or automatic 3D mode. The intra- and inter-observer reproducibility was evaluated by the calculation of the intra-class coefficient for each measurement method. The methods were then compared. RESULTS: The intra- and inter-observer reproducibility for length measurements found with the manual and automatic 3D methods was always > 0.98. There was no significant difference in the reproducibility between the two measurement modes, with the exception of the offset, hip-knee-shaft, and neck-shaft angles. CONCLUSION: Our results indicate a very good reproducibility of EOS™ length measurement, regardless of the method used. Automated 3D mode is preferred for the collection of angular and offset measurements. Furthermore, manual mode measurements are not affected by surgical history. Level of evidence IV.

Original publication




Journal article


Musculoskelet surg

Publication Date





165 - 171


Leg length discrepancy, Reproducibility, Total hip arthroplasty, X-ray analysis, Anthropometry, Arthroplasty, Replacement, Hip, Automation, Databases, Factual, Humans, Imaging, Three-Dimensional, Leg Length Inequality, Observer Variation, Postoperative Complications, Radiography, Interventional, Reproducibility of Results, Retrospective Studies