1. EBRAGRAF – User Instructions Peter Mayrhofer, April 2001, rev. February 2006 Dept.of Engineering Mathematics, Geometry and Computer Science University of Innsbruck, Austria

2. EBRA-CUP measurement program Datafile *.dat EBRAGRAF graphics program One patient‘s x-ray series DATAFLOW

3. Display of patient‘s data Select time limit (in months) up to which serial radiographs are compared Scale ordinate of diagrams Select DAT-file Dual comparability checks rotations around x- AND y- axis (will exclude more x-rays!). Map shows comparisons EBRAGRAF Main Window SIMUL-Graphics is a way-oriented display of migration showing a variable cup-symbol (not in scale!) moving according to x- & y-directed migration and varying according to inclination & anteversion of the cup. Select comparability limit (in mm) up to which comparable x-rays may differ

4. Angular values in degrees 1° Ascending curve = cranial migration 1 year 1mm Wear-x Wear-y Descending curve = medial migration 1mm cup head

5. KEEP IN MIND ! EBRA-Migration < 1mm is not significant.

6. EBRA - Wear Calculation Wear is NOT computed as the difference between head- and cup-migration! EBRA uses the projections of head- and cup-center in the film plane to analyse wear according to the method of Scheier/Sandel. Scheier, H. ans Sandel, J. (1976): Wear affecting the plastic cup in metal plastic endoprostheses, in Total Hip Prostheses (edited by Gschwend, N.G. and Debrunner, H.U.), pp. 186-190. Huber, Bern. This way of wear calculation proved to be more accurate in comparison to RSA.

7. EBRA - Results in Table Switch for cup-symbol in SIMUL-GraphicsExport data to EXCELL Dots mark excluded x-rays Flag (0/1) for continuity of diagram Flag = 1 means interrupted curve! Absolute values for angles Relative values for migration

8. NOTICE ! In case of bad comparability EBRAGRAF - migration diagrams may be disconnected, i.e. may have gaps or be cut off at the beginning or the end. Such diagrams (usual percentage =12% with comparability limit=3mm) could become continuous again if new x-rays are added to the series. There are x-ray series even NOT EVALUABLE by EBRA because of too bad comparability! Especially if the number of x-rays per series is near the required minimum of 4.

9. Disconnected Diagram Gap will close with either higher comp. limit or addition of new comparable radiographs.

10. Symbol will be rotated according to inclination and anteversion Set scale and origin position in main window 1mm Use buttons below to get tables Cup symbol may be switched off in Main Window or selectively in Tables Window Head-migration: continuous line, cup-migration: dashed line A utility for visualization of migration pattern Vector oriented migration diagram

11. Assessing the quality of a series not comparable x-comparability y-comparability comparable The smoother the graph the better the series!

12. WARNING ! The DAT-file produced by the EBRA-CUP measurement program must not contain double data records for reanalysed x-rays. If any x-ray measurement is to be repeated after having saved this x-ray to the DAT-file, the corresponding data record has to be deleted manually from the DAT-file!

13. Data record for one x-ray in datafile *.dat

14. Interpretation of diagrams Reliable EBRA-results depend mainly on precise landmark setting with the EBRA-CUP measurement program. But also a correct reading of the EBRAGRAF output is very important. The following examples should help you to avoid frequently made mistakes.

15. Example 1 No significant migration of head and cup! Measured migration within the inaccuracy of the method - The implant seems to be stable. 2,5° change of anteversion 0,7mm lateralisation of head

16. Example 2 Comparability map showing the number of comparisons per interval of time 1mm medialisation of head and cup Rotation of cup Results not unusual!

17. Example 3 MISTAKE: The series was measured twice, but the data records were written to the same DAT- file! In case of reinput chose a different file name for saving or delete the old data records manually.