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Zhai H, Huang J, Li L, Tao H, Wang J, Li K, Shao M, Cheng X, Wang J, Wu X, Wu C, Zhang X, Wang H, Xiong Y. Deep learning-based workflow for hip joint morphometric parameter measurement from CT images. Phys Med Biol 2023; 68:225003. [PMID: 37852280 DOI: 10.1088/1361-6560/ad04aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective.Precise hip joint morphometry measurement from CT images is crucial for successful preoperative arthroplasty planning and biomechanical simulations. Although deep learning approaches have been applied to clinical bone surgery planning, there is still a lack of relevant research on quantifying hip joint morphometric parameters from CT images.Approach.This paper proposes a deep learning workflow for CT-based hip morphometry measurement. For the first step, a coarse-to-fine deep learning model is designed for accurate reconstruction of the hip geometry (3D bone models and key landmark points). Based on the geometric models, a robust measurement method is developed to calculate a full set of morphometric parameters, including the acetabular anteversion and inclination, the femoral neck shaft angle and the inclination, etc. Our methods were validated on two datasets with different imaging protocol parameters and further compared with the conventional 2D x-ray-based measurement method.Main results. The proposed method yields high bone segmentation accuracies (Dice coefficients of 98.18% and 97.85%, respectively) and low landmark prediction errors (1.55 mm and 1.65 mm) on both datasets. The automated measurements agree well with the radiologists' manual measurements (Pearson correlation coefficients between 0.47 and 0.99 and intraclass correlation coefficients between 0.46 and 0.98). This method provides more accurate measurements than the conventional 2D x-ray-based measurement method, reducing the error of acetabular cup size from over 2 mm to less than 1 mm. Moreover, our morphometry measurement method is robust against the error of the previous bone segmentation step. As we tested different deep learning methods for the prerequisite bone segmentation, our method produced consistent final measurement results, with only a 0.37 mm maximum inter-method difference in the cup size.Significance. This study proposes a deep learning approach with improved robustness and accuracy for pelvis arthroplasty planning.
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Affiliation(s)
- Haoyu Zhai
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Jin Huang
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Lei Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116024, People's Republic of China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiao Tong University Shcool of Medicine, Shanghai 200011, People's Republic of China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiaotong University School of Medicine Department of Orthopaedics & Bone and Joint Research Center, Shanghai 200011, People's Republic of China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Moyu Shao
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Xiaomin Cheng
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Jing Wang
- Xi'an JiaoTong University. School of Chemical Engineering and Technology, Xi'an 710049, People's Republic of China
| | - Xiang Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Chuan Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Xiao Zhang
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Hongkai Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
- Liaoning Key Laboratory of Integrated Circuit and Biomedical Electronic System, Dalian 116024, People's Republic of China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
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Cho BW, Kwon HM, Park JY, Park KK, Kim T, Lee WS. Sex differences in the anatomy of the anterior-superior acetabular rim in relation to pincer-type femoroacetabular impingement in Koreans: a three-dimensional quantitative analysis. J Orthop Surg Res 2023; 18:161. [PMID: 36864441 PMCID: PMC9983210 DOI: 10.1186/s13018-023-03526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE The aim of this study was to compare the anatomical structures of the acetabular rim around the anterior inferior iliac spine (AIIS) ridge that indicate anterior focal coverage of acetabulum between the sexes using a three-dimensional (3D) model. METHODS 3D models of 71 adults (38 men and 33 women) with normal hip joints were used. Based on the location of the inflection point (IP) of the acetabular rim around the AIIS ridge, the patients were classified into anterior and posterior types, and the ratios thereof for each sex were compared. Coordinates for the IP, the most anterior point (MAP), and the most lateral point (MLP) were obtained and compared between the sexes and between anterior and posterior types. RESULTS Coordinates for IPs in men were located anterior and inferior to those in women. MAP coordinates for men were located inferior to those for women, and MLP coordinates for men were located lateral and inferior to those for women. Comparing AIIS ridge types, we noted that coordinates for IPs of the anterior type were located medial, anterior, and inferior to those of the posterior type. Meanwhile, MAP coordinates of the anterior type were located inferior to those of the posterior type, and MLP coordinates of the anterior type were located lateral and inferior to those of the posterior type. CONCLUSION Anterior focal coverage of the acetabulum appears to differ between the sexes, and this difference may affect the development of pincer-type femoroacetabular impingement (FAI). Additionally, we found that anterior focal coverage differs according to anterior or posterior positioning of the bony prominence around the AIIS ridge, which may affect development of FAI.
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Affiliation(s)
- Byung Woo Cho
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Jun Young Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do Republic of Korea
| | - Kwan Kyu Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Taehyun Kim
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea.
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Roos BD, Roos MV, Camisa Júnior A, Lima EMU, Tisatto DL, Argoud MC. Pelvic Bone Deformity and Its Correlation with Acetabular Center-edge Angle. Rev Bras Ortop 2020; 55:239-246. [PMID: 32346202 PMCID: PMC7186067 DOI: 10.1055/s-0039-3400516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022] Open
Abstract
Objective The purpose of the present study was to evaluate the pelvic bone deformities and its correlation with the acetabular center-edge (CE) angle. Methods Between August 2014 and April 2015, we prospectively evaluated patients aged between 20 and 60 years old. The exclusion criteria were: metabolic disease, previous hip or spine surgery, radiograph showing hip arthrosis ≥ Tönnis two, severe hip dysplasia, global acetabular overcoverage, acetabular crossover sign, hip deformities from slipped capital femoral epiphysis (SCFE) or Leg-Perthes-Calveé, and bad quality radiographs. At anteroposterior (AP) pelvic radiographs, we have evaluated: the CE angle, the acetabular index (IA), the acetabular crossover sign, the vertical and horizontal superior and inferior pelvic axis (H1: Horizontal line 1, superior pelvic axis; H2: Horizontal line 2, superior pelvic axis; V1: Vertical line, superior pelvic axis; HR: Horizontal line, inferior pelvic axis; VR: Vertical line, inferior pelvic axis). The superior and inferior pelvic axis were considered asymmetric when there was a difference ≥ 5 mm between both sides. Patients were divided into two groups: control and group 1. Results A total of 228 patients (456 hips) were evaluated in the period. According to the established criteria, 93 patients were included. The mean age was 39.9 years old (20 to 60 years old, standard deviation [SD] = 10,5), and the mean CE angle in the right hip was 31.5° (20 o to 40°), and in the left 32.3° (20 o to 40°). The control group had 38 patients, with asymmetric H1 in 4 cases (10.5%), H2 in 5 (13.1%), V1 in 7 (18.4%), HR in 5 (13.1%) and VR in 1 (2.63%). Group 1 had 55 patients, with asymmetric H1 in 24 cases (43.6%), H2 in 50 (90.9%), V1 in 28 (50.9%), HR in 16 (29.09%) and VR in 8 (14.5%). Comparing both groups, there was statistical significance for H1, H2 and V1 asymmetry ( p < 0.001). Conclusion In the present paper, we observed the correlation between variation in the acetabular CE angle and asymmetry of the superior hemipelvis. The present authors believe that a better understanding of the pelvic morphologic alterations allows a greater facility in the diagnosis of hip articular deformities.
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Affiliation(s)
- Bruno Dutra Roos
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
| | - Milton Valdomiro Roos
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
| | - Antero Camisa Júnior
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
| | - Ezequiel Moreno Ungaretti Lima
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
| | - Darby Lira Tisatto
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
| | - Marcel Cruz Argoud
- Grupo de Quadril do Hospital Ortopédico de Passo Fundo, Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS, Brasil
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Yang P, Fan H, Wang X, Xu S, Yang L, Chen G. The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study. Medicine (Baltimore) 2020; 99:e19068. [PMID: 32028429 PMCID: PMC7015654 DOI: 10.1097/md.0000000000019068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients' age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.
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Affiliation(s)
| | - Huaquan Fan
- Centre for Joint Surgery, Southwest Hospital
| | - Xin Wang
- Radiology Department, Southwest Hospital
| | - Senlin Xu
- Pathology Department, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Centre for Joint Surgery, Southwest Hospital
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Chhabra A, Nordeck S, Wadhwa V, Madhavapeddi S, Robertson WJ. Femoroacetabular impingement with chronic acetabular rim fracture - 3D computed tomography, 3D magnetic resonance imaging and arthroscopic correlation. World J Orthop 2015; 6:498-504. [PMID: 26191497 PMCID: PMC4501936 DOI: 10.5312/wjo.v6.i6.498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/13/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement (FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI.
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Pullen WM, Henebry A, Gaskill T. Variability of acetabular coverage between supine and weightbearing pelvic radiographs. Am J Sports Med 2014; 42:2643-8. [PMID: 25214530 DOI: 10.1177/0363546514548854] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiographic measures of acetabular coverage are essential screening tools used to characterize bony structure contributing to femoroacetabular impingement (FAI). Small changes in pelvic tilt result in altered radiographic measures of acetabular coverage. Positional changes in pelvic tilt are known to occur between the supine and weightbearing positions. It is unclear whether alteration of pelvic tilt between these positions is clinically sufficient to influence measures of acetabular coverage. PURPOSE/HYPOTHESIS To determine whether, and to what degree, imaging position (supine vs weightbearing) is capable of altering several measures of acetabular orientation: pubic symphysis to sacrococcygeal distance (PSSC), angle of Sharp (SA), Tönnis angle (TA), percentage of acetabular crossover (CO), and lateral center-edge angle of Wiberg (LCEA). The hypothesis was that imaging position would significantly alter all measures of acetabular orientation. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A total of 50 consecutive symptomatic hips referred to a single provider for FAI were evaluated with standardized supine and weightbearing anteroposterior pelvic radiographs. Two independent reviewers blinded to patient positioning reviewed each radiograph at 2 separate time points. Mean measurements in each position were compared by use of paired Student t tests, and a Bonferroni-adjusted significance level of P = .01 was used to represent significance. RESULTS Statistically significant differences between the supine and weightbearing radiographs were identified for PSSC and all measures of acetabular coverage (P < .003). The mean PSSC decreased between the supine and weightbearing positions by an average of 13.4 mm (P < .001), thereby resulting in decreased mean LCEA, TA, SA, and CO of 1.2°, 1.3°, 0.8°, and 6.3%, respectively (P < .002). The change in positional pelvic tilt was not uniformly predictable and accounted for large measurement changes in some individuals. PSSC also demonstrated considerable inter- and intrasubject variability but averaged 55.8 mm supine and 44.9 mm weightbearing for females and 37.0 mm supine and 20.6 mm weightbearing for males. CONCLUSION In this study of nonarthritic adult patients with hip pain, the data indicate that positional changes are capable of significantly altering pelvic tilt and radiographic measures of acetabular coverage. It appears that the weightbearing position typically, but not universally, correlates with additional posterior pelvic tilt and decreased measures of acetabular coverage. Individual positional variability can contribute to large-magnitude changes in radiographic acetabular measures.
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Affiliation(s)
- W Michael Pullen
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew Henebry
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Trevor Gaskill
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
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Harris-Hayes M, Commean PK, Patterson JD, Clohisy JC, Hillen TJ. Bony abnormalities of the hip joint: a new comprehensive, reliable and radiation-free measurement method using magnetic resonance imaging. J Hip Preserv Surg 2014; 1:62-70. [PMID: 25558377 PMCID: PMC4280561 DOI: 10.1093/jhps/hnu009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To develop comprehensive and reliable radiation-free methods to quantify femoral and acetabular morphology using MRI. METHODS 32 hips (16 subjects, 6 with intra-articular hip disorder (IAHD); 10 controls) were included. A 1.5T magnetic resonance system was used to obtain 3D fat suppressed gradient echo images at the pelvis and distal femora. After acquisition, pelvic images were post-processed to correct for coronal, axial and sagittal rotation. Measurements performed included acetabular version (AV), femoral version (FV), lateral center edge angle (LCEA), femoral neck angle (FNA) and alpha angle (AA) at 3, 2, 1 and 12 o'clock. Two experienced raters, a musculoskeletal radiologist and an orthopaedic physical therapist, and a novice rater, a research assistant, completed reliability testing. Raters measured all hips twice with minimum 2 weeks between sessions. Intraclass Correlation Coefficients were used to determine rater reliability; standard error of measurements was reported to estimate the reasonable limits of the expected error in the different raters' scores. RESULTS Interrater reliability was good to excellent for all raters for AV, FV, FNA, and LCEA (ICCs: 0.82-0.98); good to excellent between experienced raters (ICCs: 0.78-0.86) and poor to good between novice and experienced raters (ICCs: 0.23-0.78) for AA. Intrarater reliability was good to excellent for all raters for AV, FV and FNA (ICCs: 0.93-0.99); for one experienced and novice rater for LCEA (ICCs: 0.84-0.89); moderate to excellent for the experienced raters for AA (ICCs: 0.72-0.89). Intrarater reliability was poor for the second experienced rater for LCEA (ICC: 0.56), due to a single measurement error and for the novice rater for AA (ICCs: 0.17-0.38). CONCLUSION We described MRI methods to comprehensively assess femoral and acetabular morphology. Measurements such as AV, FV and FNA and the LCEA can be made reliably by both experienced and novice raters, however the AA measurement was reliable only among experienced raters.
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Affiliation(s)
- Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108, United States,
| | - Paul K Commean
- Electronic Radiology Lab in Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, St Louis, 63110, MO United States
| | - Jacqueline D Patterson
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108, United States
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid, Suite 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, United States
| | - Travis J Hillen
- Department of Radiology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8131, St Louis, MO 63110, United States
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Abstract
BACKGROUND Radiographic indices of acetabular coverage are crucial to objectively characterize femoroacetabular impingement and plan bony decompression. It is established that changes in pelvic inclination result in alterations of acetabular crossover; however, it is unclear what influence this has on other measures of acetabular anatomy. HYPOTHESIS The objective of the present study was to determine if, and to what degree, a variation in pelvic tilt alters 4 measures of acetabular anatomy: the angle of Sharp, Tönnis angle, percentage of acetabular crossover, and lateral center edge angle (LCEA). The hypothesis was that pelvic tilt would significantly alter all measures of acetabular coverage. STUDY DESIGN Descriptive laboratory study. METHODS Fluoroscopic images of 8 adult hemipelvises were obtained at 7 positions of rotation in the sagittal plane to investigate the change of each measurement in response to pelvic orientation. Two reviewers obtained measurements from each image at 2 separate time points. RESULTS Each increment of pelvic inclination resulted in increased measures of acetabular coverage for all measurements, whereas each increment of decreased pelvic inclination resulted in decreased measures of acetabular coverage for all measurements. Significant differences in the measured LCEA, acetabular crossover, and Tönnis angle were identified at each increment of tilt as compared with neutral radiographs. No significant differences could be identified for the angle of Sharp. CONCLUSION Pelvic tilt significantly alters the measures of LCEA, crossover, and Tönnis angle in this cadaveric study. Pelvic inclination results in increased measures of acetabular coverage, whereas decreasing inclination decreases each measure. CLINICAL RELEVANCE Given the known individual and positional pelvic tilt variability, standing anteroposterior pelvic radiographs may provide a more physiological representation of acetabular coverage in the young adult population.
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Affiliation(s)
- Andrew Henebry
- Trevor Gaskill, Naval Medical Center Portsmouth, Department of Orthopaedic Surgery, 620 John Paul Jones Circle, Portsmouth, VA 23708.
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Diaz-Ledezma C, Novack T, Marin-Peña O, Parvizi J. The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement. Bone Joint J 2013; 95-B:893-9. [PMID: 23814239 DOI: 10.1302/0301-620x.95b7.31109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI.
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Affiliation(s)
- C Diaz-Ledezma
- Rothman Institute at Thomas Jefferson University, Sheridan Building, 10th Floor, 125 South 9th Street, Philadelphia, Pennsylvania 19107, USA.
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