Total Hip Prostheses in Standing, Sitting and Squatting Positions: An Overview of Our 8 Years Practice Using the EOS Imaging Technology

Jean-Yves Lazennec 1, 2, 3, Marc-Antoine Rousseau 2, 4, Adrien Brusson 3, Dominique Folinais 5, Maria Amel 3, Ian Clarke 6, Aidin Eslam Pour*, 7
1 Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital, Assistance Publique – Hopitaux de Paris, UPMC, 47-83 Boulevard de l’hôpital, 75013 Paris, France
2 BiomechanicsLab (LBM), Arts et Metiers Paris-Tech, Paris, France
3 Department of Anatomy, UPMC, 105 Boulevard de l’hôpital, 75013 Paris, France
4 Department of Orthopaedic and Trauma Surgery, Avicenne Hospital, Assistance Publique – Hopitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny, France
5 RIM Maussins-Nollet 114 rue Nollet 75017 Paris, France
6 Loma Linda University Medical Center, Director Peterson Research Center at Loma Linda University, California, USA
7 Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA

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© Lazennec et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, Box 5328, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5328, USA; Tel: 734-936-5780; E-mail:


More total hip arthroplasty (THA) is performed worldwide and especially in younger and more active patients compared to earlier decades. One of the focuses of THA research in the future will be on optimizing the radiological follow-up of these patients using 2D and 3D measurements of implants position while reducing the radiation dose delivered.

Low-dose EOS® imaging is an innovative slot-scanning radiograph system providing valuable information in patient functional positions (standing, sitting and even squatting positions). EOS has been proven accurate and reliable without significant inconvenience caused by the metallic artifacts of implants. The ability to obtain precise data on implant orientation according to the patient posture opens new perspectives for a comprehensive analysis of the pelvic frontal and sagittal balance and its potential impact on implants function and failures.

We report our 8 years experience on our first 300 THA patients using this technology routinely for pre and post op evaluation. Our results will be compared and confronted with the actual literature about this innovative technology. We shall especially emphasize our experience about patients with abnormal posture and the evolution of the subject over time, because the phenomenon of an aging spine is frequently associated with the process of aging hips.

Keywords: cup anteversion, femoral offset, EOS imaging, hip spine relation, limb length, pelvic obliquity, pelvic tilt, sagittal balance, sitting position, standing position, pelvic rotation, total hip arthroplasty (THA)..