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Schwarz TJ, Maderbacher G, Leiss F, Grifka J, Kappenschneider T, Knebl M. Three-dimensional acetabular reorientation during periacetabular osteotomy: an intraoperative navigation method using an external fixator for periacetabular osteotomy. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05590-1. [PMID: 39313642 DOI: 10.1007/s00402-024-05590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 09/16/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Bernese periacetabular osteotomy (PAO) is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection or changes in acetabular version resulting in residual dysplasia or femoroacetabular impingement. Thus, we wanted to develop a simple and straightforward navigation method that provides information about acetabular correction in all three planes during surgery. METHOD Intraoperatively, acetabular coordinates are shown in coronal, sagittal, and transverse plane by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the mobilized acetabular fragment with two Schanz screws. The application and fixation of the external fixator on the pelvis are demonstrated in this article. We used this analog navigation method on 27 PAOs, where we mainly performed a lateral rotational correction. The pre- and postoperative radiographs of these 27 hips were analyzed regarding the radiological hip parameters, taking into account the pelvic tilt. RESULTS The mean preoperative lateral center edge angle (LCEA) of the 27 PAOs improved from 16° (+-6) to a mean of 34° (+-6°) and the mean acetabular index (AI) was corrected from 15° (+-4) to 2° (+-4). This implements highly physiologic postoperative values for lateral coverage in this population. In this case series, no postoperative acetabular retroversion was measured in any of the 27 PAOs. CONCLUSION Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and undercorrection. Using a fixateur externe as an analog navigation method this three-dimensional control can be implemented intraoperatively for PAOs.
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Affiliation(s)
- Timo J Schwarz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Franziska Leiss
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Kappenschneider
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Knebl
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Follet L, Khanduja V, Thevendran G, Ayeni O, Shanmugasundaram S, Abd El-Radi M, Said H, Abdelazeem A, Slullitel P, Marin-Peña O, Audenaert E. How to start with hip arthroscopy in a safe and effective manner, using an evidence-based approach. SICOT J 2024; 10:35. [PMID: 39303141 DOI: 10.1051/sicotj/2024031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/02/2024] [Indexed: 09/22/2024] Open
Abstract
Hip arthroscopy is a rapidly evolving field in orthopedics, offering diagnostic and therapeutic benefits for a range of hip pathologies. This review outlines a comprehensive guide to initiating hip arthroscopy safely and effectively using evidence-based practices. Optimal surgical outcomes depend on correct indications for surgery, in particular in the presence of borderline dysplasia and degenerative joint diseases. Proper patient counseling and setting realistic expectations are crucial for satisfactory outcomes and recovery. Physical examination, radiographs, MRI, and CT scans are essential for accurate diagnosis. In case of diagnostic uncertainty, the use of intra-articular injections can help confirm the diagnosis before surgery. Techniques for hip arthroscopy include central compartment first, peripheral compartment first, and outside-in approaches. Each technique has advantages, and the optimal approach depends on the specific case. Finally, Proper operating room setup, meticulous patient positioning, and precise portal placement are critical for a successful procedure. A thorough understanding of the safe zone anatomy for portal placement is essential to minimize the risk of neurovascular complications. In conclusion, this manuscript provides a detailed, evidence-based framework for starting hip arthroscopy, emphasizing the importance of technical proficiency, patient selection, and a multidisciplinary approach to ensure patient safety and procedure efficacy.
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Affiliation(s)
- L Follet
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - V Khanduja
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - G Thevendran
- Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, Singapore 329563, Singapore
| | - O Ayeni
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 413 45, Sweden
| | - S Shanmugasundaram
- Department of Orthopedics, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry 605502, India
| | - M Abd El-Radi
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - H Said
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - A Abdelazeem
- Department of Orthopaedics and Traumatology, Kasr Alainy Hospital, Cairo Univerity, Cairo 11562, Egypt
| | - P Slullitel
- The Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - O Marin-Peña
- Orthopaedic Surgery and Traumatology Department, University Hospital Infanta Leonor, Madrid 28031, Spain
| | - E Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium - Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Wilson H, Harris J, Martin R, Ellis T, Kollmorgen R. Patients Undergoing Hip Arthroscopy with Concomitant Periacetabular Osteotomy Demonstrate Clinically Meaningful Improvement at 2 years using the PROMIS and iHOT-12. Arthroscopy 2024:S0749-8063(24)00669-8. [PMID: 39276946 DOI: 10.1016/j.arthro.2024.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/17/2024]
Abstract
PURPOSE To report the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) values using the Patient-Reported Outcome Measurement Information System (PROMIS) and International Hip Outcome Tool 12 (iHOT-12) in patients undergoing hip arthroscopy (HA) with concomitant periacetabular osteotomy (PAO), HA+PAO for acetabular dysplasia and intra-articular pathology with minimum 2-year follow up. METHODS Data from patients who underwent HA+PAO was prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients who had a diagnosis of hip dysplasia or hip instability and had minimum 2-year PROMs follow up. Data was collected electronically preoperatively and postoperatively at 6 months, 1year, and 2 years. Outcome measures analyzed were the iHOT -12 and PROMIS computer adaptive tests (CAT): Physical Function (PF), Pain Interference (PI), and Global Physical Health (GPH). MCID and SCB were calculated for these measures. RESULTS 106 patients were included in the study with an average age of 23.5 ± 6.6, an average body mass index (BMI) of 24.3, and the majority being female (94%). The values for MCID were calculated to be 40.9, 40.7, 60.2, and 43.5 and the percentage achieving MCID at 2 years was 82.6%, 82.9%, 79.6%, and 80.1% for the iHOT-12, PROMIS-PF, PROMIS-PI, and PROMIS-GPH respectively. The 1 year and 2-year SCB scores for ≥ 80% satisfaction and percent achieving were as follows respectively: iHOT-12 (71.8 (60.3%), 61.9 (65.1%)); PROMIS-PF (47.1 (64.2%), 47.2 (71.7%)); PROMIS-PI (50.6 (48.1%), 52.3 (49.1%)); PROMIS-GPH (49.3 (54.7%), 49.3 (55.7%)). The 1 year and 2 year SCB scores for 100% satisfaction and percent achieving were as follows respectively: iHOT-12 (80.2 (44.3%), 81.3 (47.2%)); PROMIS-PF (50.7 (46.2%), 50.3 (56.6%)); PROMIS-PI (52.4 (34.9%), 52.4 (49.1%)); PROMIS-GPH (52.5 (36.8%), 49.3 (55.7%)). CONCLUSION This study reports values for MCID and SCB for PROMIS and iHOT-12 at 2-year follow up in patients undergoing HA+PAO for hip dysplasia or instability. The percentage of patients achieving MCID ranged from 79.6%-82.9% at 2-year follow-up. In addition, the percentage of patients achieving SCB at 2-year follow up for ≥ 80% satisfaction ranged from 49.1%-71.2% and the percentage for 100% satisfaction ranged from 49.1%-56.6.
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Affiliation(s)
- Holly Wilson
- Rocky Vista University College of Osteopathic Medicine, Ivins, Utah, USA
| | - Joshua Harris
- Department of Orthopaedic Surgery, Houston Methodist, Houston, Texas, USA
| | - RobRoy Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | - Robert Kollmorgen
- Department of Orthopaedic Surgery, University of California San Francisco-Fresno, Fresno, California.
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Verhaegen JCF, Vorimore C, Galletta C, Rakhra K, Slullitel PA, Beaule PE, Grammatopoulos G. How to Best Identify Acetabular Retroversion on Radiographs: Thresholds to Guide Clinical Practice. Am J Sports Med 2024; 52:2728-2739. [PMID: 39166331 DOI: 10.1177/03635465241265087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
BACKGROUND Acetabular retroversion is associated with impingement and instability. An adequate interpretation of acetabular version and coverage on radiographs is essential to determine the optimal treatment strategy (periacetabular osteotomy vs hip arthroscopic surgery). The crossover sign (COS) has been associated with the presence of acetabular retroversion, and the anterior wall index (AWI) and posterior wall index (PWI) assess anteroposterior acetabular coverage. However, the radiographic appearance of the acetabulum is sensitive to anterior inferior iliac spine (AIIS) morphology and pelvic tilt (PT), which differs between the supine and standing positions. PURPOSE To (1) identify differences in the acetabular appearance between the supine and standing positions among patients presenting with hip pain; (2) determine factors (acetabular version, AIIS morphology, and spinopelvic characteristics) associated with the crossover ratio (COR), AWI, and PWI; and (3) define relevant clinical thresholds to guide management. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients who presented to a hip preservation surgical unit (n = 134) were included (mean age, 35 ± 8 years; 58% female; mean body mass index, 27 ± 6). All participants underwent supine and standing anteroposterior pelvic radiography to assess the COS, COR, AWI, and PWI as well as standing lateral radiography to determine standing PT. Computed tomography was used to measure supine PT, acetabular version, and AIIS morphology. Acetabular version was measured at 3 transverse levels, corresponding to the 1-, 2-, and 3-o'clock positions. The correlation between radiographic characteristics (COR, AWI, and PWI) and acetabular version, AIIS morphology, and PT was calculated using the Spearman correlation coefficient. Receiver operating characteristic curve analysis was performed to define thresholds for the COR, AWI, and PWI to identify retroversion (version thresholds: <10°, <5°, and <0°). RESULTS The COS was present in 55% of hips when supine and 30% when standing, with a mean difference in the COR of 12%. The supine COR (rho = -0.661) and AWI/PWI ratio (rho = -0.618) strongly correlated with acetabular version. The COS was more prevalent among patients with type 2 AIIS morphology (71%) than among those with type 1 AIIS morphology (43%) (P = .003). COR thresholds of 23% and 28% were able to identify acetabular version <5° (sensitivity = 81%; specificity = 80%) and <0° (sensitivity = 88%; specificity = 85%), respectively. An AWI/PWI ratio >0.6 was able to reliably identify acetabular version <0° (sensitivity = 83%; specificity = 84%). In the presence of a COR >30% and an AWI/PWI ratio >0.6, the specificity to detect retroversion was significantly increased (>90%). CONCLUSIONS The presence of the COS was very common among patients with hip pain. False-positive results (high COR/normal version) may occur because of AIIS morphology/low PT. Relevant thresholds of COR >30% and AWI/PWI ratio >0.6 can help with diagnostic accuracy. In cases in which either the COR or AWI/PWI ratio is high, axial cross-sectional imaging can further help to avoid false-positive results.
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Affiliation(s)
- Jeroen C F Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | - Camille Vorimore
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kawan Rakhra
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Pablo A Slullitel
- "Carlos E. Ottolenghi" Institute of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul E Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Verhaegen JCF, Kerhoulas Z, Burke M, Galletta C, Wilkin G, Smit K, Carsen S, Beaule PE, Grammatopoulos G. How Is Variability in Femoral and Acetabular Version Associated With Presentation Among Young Adults With Hip Pain? Clin Orthop Relat Res 2024; 482:1565-1579. [PMID: 39031040 PMCID: PMC11343531 DOI: 10.1097/corr.0000000000003076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Acetabular and femoral version contribute to hip pain in patients with femoroacetabular impingement (FAI) or dysplasia. However, definitions and measurement methods of femoral version have varied in different studies, resulting in different "normal" values being used by clinicians for what should be the same anatomic measurement. This could result in discrepant or even inappropriate treatment recommendations. QUESTIONS/PURPOSES In patients undergoing hip preservation surgery, (1) what is the range of acetabular and femoral version at presentation, and how much do two commonly used measurement techniques (those of Murphy and Reikerås) differ? (2) How are differences in acetabular and femoral version associated with clinical factors and outcomes scores at the time of presentation? METHODS This was a retrospective analysis of data gathered in a longitudinally maintained database of patients undergoing hip preservation at a tertiary care referral center. Between June 2020 and December 2021, 282 hips in 258 patients were treated for an isolated labral tear (9% [26 hips]), hip dysplasia (21% [59 hips]), FAI (52% [147 hips]), mixed FAI and dysplasia (17% [47 hips]), or pediatric deformity (slipped capital femoral head epiphysis or Perthes disease; 1% [3 hips]) with hip arthroscopy (71% [200 hips]), periacetabular osteotomy (26% [74 hips]), surgical hip dislocation (2.5% [7 hips]), or femoral derotation osteotomy (0.5% [1 hip]). We considered those with complete radiographic data (CT including the pelvis and distal femur) and patient-reported outcome scores as potentially eligible. Exclusion criteria were age younger than 18 or older than 55 years (5 hips, 3 patients), signs of hip osteoarthritis (Tönnis grade ≥ 2; 0), pediatric deformity (slipped capital femoral head epiphysis or Perthes disease; 3 hips, 3 patients), previous femoral or acetabular osteotomy (2 hips, 2 patients), avascular necrosis of the femoral head (0), history of neuromuscular disorder (Ehlers-Danlos syndrome; 3 hips, 3 patients) or rheumatoid disease (ankylosing spondylitis; 1 hip, 1 patient), and when CT did not include the knees (19 hips, 19 patients). Based on these criteria, 249 hips in 227 patients were included. Of patients with bilateral symptomatic hips, one side was randomly selected for inclusion, leaving 227 hips in 227 patients for further analysis. The patients' median age (range) was 34 years (19 to 55 years), the median BMI (range) was 27 kg/m 2 (16 to 55 kg/m 2 ), and 63% (144) were female; they were treated with hip arthroscopy (in 74% [168]) or periacetabular osteotomy (in 23% [52]). Patients underwent a CT scan to measure acetabular version and femoral version using the Murphy (low < 10°; normal: 10° to 25°; high > 25°) or Reikerås (low < 5°; normal: 5° to 20°; high > 20°) technique. The McKibbin index was calculated (low: < 20°; normal: 20° to 50°; high > 50°). Based on the central acetabular version and femoral version as measured by Murphy, hips were grouped according to their rotational profile into four groups: unstable rotational profile: high (high acetabular version with high femoral version) or moderate (high acetabular version with normal femoral version or normal acetabular version with high femoral version); normal rotational profile (normal acetabular version with femoral version); compensatory rotational profile (low acetabular version with high femoral version or high acetabular version with low femoral version); and impingement rotational profile (low acetabular version with low femoral version): high (low acetabular version with low femoral version) or moderate (low acetabular version with normal femoral version or normal acetabular version with low femoral version). Radiographic assessments were manually performed on digitized images by two orthopaedic residents, and 25% of randomly selected measurements were repeated by the senior author, a fellowship-trained hip preservation and arthroplasty surgeon. Interobserver and intraobserver reliabilities were calculated using the correlation coefficient with a two-way mixed model, showing excellent agreement for Murphy technique measurements (intraclass correlation coefficient 0.908 [95% confidence interval 0.80 to 0.97]) and Reikerås technique measurements (ICC 0.938 [95% CI 0.81 to 0.97]). Patient-reported measures were recorded using the International Hip Outcome Tool (iHOT-33) (0 to 100; worse to best). RESULTS The mean acetabular version was 18° ± 6°, and mean femoral version was 24° ± 12° using the Murphy technique and 12° ± 11° with the Reikerås method. Eighty percent (181 of 227) of hips had normal acetabular version, 42% (96 of 227) to 63% (142 to 227) had normal femoral version per Murphy and Reikerås, respectively, and 67% (152 to 227) had a normal McKibbin index. Patients with an impingement profile (low acetabular version or femoral version) were older (39 ± 9 years) than patients with an unstable (high acetabular version or femoral version; 33 ± 9 years; p = 0.004), normal (33 ± 9 years; p = 0.02), or compensatory (high acetabular version with low femoral version or vice versa; 33 ± 7 years; p = 0.08) rotational profile. Using the Murphy technique, femoral version was 12° greater than with the Reikerås method (R 2 0.85; p < 0.001). There were no differences in iHOT-33 score between different groups (impingement: 32 ± 17 versus normal 35 ± 21 versus compensated: 34 ± 20 versus unstable: 31 ± 17; p = 0.40). CONCLUSION Variability in femoral version is twice as large as acetabular version. Patients with an impingement rotational profile were older than patients with a normal, compensatory, or unstable profile, indicating there are other variables not yet fully accounted for that lead to earlier pain and presentation in these groups. Important differences exist between measurement methods. This study shows that different measurement methods for femoral anteversion result in different numbers; if other authors compare their results to those of other studies, they should use equations such as the one suggested in this study. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopaedic Centre Antwerp, AZ Monica, Antwerp, Belgium
| | - Zoe Kerhoulas
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Michaela Burke
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | | | - Geoffrey Wilkin
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Paul E. Beaule
- Division of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
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Vorimore C, Verhaegen JCF, Kashanian K, Horton I, Beaule P, Grammatopoulos G. How Does Radiographic Acetabular Morphology Change Between the Supine and Standing Positions in Asymptomatic Volunteers? Clin Orthop Relat Res 2024; 482:1550-1561. [PMID: 39031038 PMCID: PMC11343526 DOI: 10.1097/corr.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/11/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND The radiographic appearance of the acetabulum differs between the supine and standing positions in patients with hip conditions. The pelvis undergoes a change in tilt when transitioning between positions, resulting in variations in version and acetabular coverage. However, the extent of these variations in well-functioning volunteers without compensatory patterns caused by pain is unknown. QUESTIONS/PURPOSES We performed this study to (1) quantify differences in radiographic acetabular measurements when transitioning between supine and standing among asymptomatic, well-functioning volunteers; (2) assess differences in pelvic tilt between positions; and (3) test whether individual anatomic parameters are associated with the change in tilt. METHODS This was a prospective, single-center study performed at an academic referral center. One hundred volunteers (students, staff, and patients with upper limb injuries) with well-functioning hips (Oxford hip score ≥ 45) were invited to participate. A total of 45% (45) of them were female, their mean age was 37 ± 14 years, and their mean BMI was 25 ± 2 kg/m 2 . Supine and standing AP pelvic radiographs were analyzed to determine numerous acetabular parameters including the lateral center-edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI), crossover sign (COS), crossover ratio (COR), posterior wall sign (PWS), ischial spine sign (ISS), and femoroepiphyseal acetabular roof index (FEAR), as well as pelvic parameters including the sacrofemoral-pubic angle (SFP). Spinopelvic parameters were measured from lateral standing spinopelvic radiographs. Radiographic measurements were performed by one hip preservation research fellow and a fellowship-trained staff surgeon. Differences in parameters were determined, and correlations between postural differences and morphological parameters were tested. Clinically important differences were defined as a difference greater than 3° for acetabular angle measurements and 0.03 for acetabular ratio measurements, based on previous studies. RESULTS Lateral coverage angles did not show a clinically important difference between positions. AWI decreased when standing (0.47 ± 0.13 versus 0.41 ± 0.14; p < 0.001), whereas acetabular retroversion signs were more pronounced when supine (COS: 34% [34 of 100], PWS: 68% [68 of 100], and ISS: 34% [34 of 100] versus COS: 19% [19 of 100], PWS: 38% [38 of 100], and ISS: 14% [14 of 100]; all p values < 0.05). Pelvic tilt increased by a mean of 4° ± 4° when standing, but the range of change was from -15° to 7°. The change in AWI (ρ = 0.47; p < 0.001), PWI (ρ = -0.45; p < 0.001), and COR (ρ = 0.52; p < 0.001) between positions correlated with ΔSFP. Volunteers with spinal imbalance (pelvic incidence lumbar lordosis > 10°) demonstrated greater change in pelvic tilt (ΔSFP) (-7° ± 3° versus -4° ± 4°; p = 0.02) and a greater reduction in AWI (by 10%). These volunteers demonstrated reduced standing lumbar lordosis angles (45° ± 11° versus 61° ± 10°; p = 0.001). CONCLUSION Acetabular version increases from supine to standing because of an increase in pelvic tilt. The change in pelvic tilt between positions exhibited substantial variability. Individuals with reduced lumbar lordosis for a given pelvic incidence value demonstrated greater pelvic mobility. No features on supine radiographs were associated with the change in tilt. CLINICAL RELEVANCE Performing standing radiographs in addition to supine views can help identify aberrant physiologic patterns in patients with diagnostic dilemmas and might thus help with management. Normative data of pelvic tilt change can help clinicians identify patients who demonstrate excessive change in tilt that contributes to abnormal hip pathomechanics.
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Affiliation(s)
- Camille Vorimore
- Division of Orthopaedic Surgery, the Ottawa Hospital, Critical Care Wing, Ottawa, ON, Canada
| | - Jeroen C. F. Verhaegen
- Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
- Orthopaedic Centre Antwerp, AZ Monica, Antwerp, Belgium
| | - Koorosh Kashanian
- Division of Orthopaedic Surgery, the Ottawa Hospital, Critical Care Wing, Ottawa, ON, Canada
| | - Isabel Horton
- Division of Orthopaedic Surgery, the Ottawa Hospital, Critical Care Wing, Ottawa, ON, Canada
| | - Paul Beaule
- Division of Orthopaedic Surgery, the Ottawa Hospital, Critical Care Wing, Ottawa, ON, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, the Ottawa Hospital, Critical Care Wing, Ottawa, ON, Canada
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Wagner M, Schaller L, Endstrasser F, Vavron P, Braito M, Schmaranzer E, Schmaranzer F, Brunner A. Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2024; 106-B:775-782. [PMID: 39084659 DOI: 10.1302/0301-620x.106b8.bjj-2023-1478.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.
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Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Tyrol, Austria
| | | | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Petr Vavron
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Matthias Braito
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Ehrenfried Schmaranzer
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional, and Paediatric Radiology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann i.T., Tyrol, Austria
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Tanaka S, Fujii M, Kawano S, Ueno M, Nagamine S, Mawatari M. Factors associated with joint survival after transposition osteotomy of the acetabulum in patients with Tönnis grade 2 osteoarthritis secondary to hip dysplasia. Bone Joint J 2024; 106-B:783-791. [PMID: 39084631 DOI: 10.1302/0301-620x.106b8.bjj-2024-0196.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims The aim of this study was to determine the clinical outcomes and factors contributing to failure of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, for advanced osteoarthritis secondary to hip dysplasia. Methods We reviewed patients with Tönnis grade 2 osteoarthritis secondary to hip dysplasia who underwent TOA between November 1998 and December 2019. Patient demographic details, osteotomy-related complications, and the modified Harris Hip Score (mHHS) were obtained via medical notes review. Radiological indicators of hip dysplasia were assessed using preoperative and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method. A multivariate Cox proportional hazards model was used to identify predictors of failure. Results This study included 127 patients (137 hips). Median follow-up period was ten years (IQR 6 to 15). The median mHHS improved from 59 (IQR 52 to 70) preoperatively to 90 (IQR 73 to 96) at the latest follow-up (p < 0.001). The survival rate was 90% (95% CI 82 to 95) at ten years, decreasing to 21% (95% CI 7 to 48) at 20 years. Fair joint congruity on preoperative hip abduction radiographs and a decreased postoperative anterior wall index (AWI) were identified as independent risk factors for failure. The survival rate for the 42 hips with good preoperative joint congruity and a postoperative AWI ≥ 0.30 was 100% at ten years, and remained at 83% (95% CI 38 to 98) at 20 years. Conclusion Although the overall clinical outcomes of TOA in patients with advanced osteoarthritis are suboptimal, favourable results can be achieved in selected cases with good preoperative joint congruity and adequate postoperative anterior acetabular coverage.
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Affiliation(s)
- Shiori Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Syunsuke Kawano
- Research Center for Arthroplasty, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Satomi Nagamine
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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9
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Zhao L, Uchtman M, Aretakis A, Selberg C, McCarthy JJ, Whitlock PW. Maintenance of acetabular correction following PAO: a multicenter study comparing stainless-steel and titanium screws. J Hip Preserv Surg 2024; 11:140-143. [PMID: 39070209 PMCID: PMC11272636 DOI: 10.1093/jhps/hnae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 07/30/2024] Open
Abstract
Stainless-steel screws are commonly used for fragment fixation during periacetabular osteotomy (PAO) at our institutions. Titanium is reserved for patients with documented nickel allergies. Titanium screws possess a significantly lower Young's modulus than stainless steel and, therefore, potentially less resistance to physiologic loading. Thus, we hypothesized that the use of titanium screws might be associated with changes in acetabular correction prior to healing. The aim of this study was to compare the maintenance of acetabular correction following PAO using stainless-steel or titanium screws. A documented nickel allergy was confirmed with an allergy specialist. Patients' age at surgery, gender and BMI were collected. The lateral center-edge angle of Wiberg (LCEA), medial center-edge angle (MCEA), anterior wall index (AWI), posterior wall index (PWI) and Tönnis angle were measured. The delta value for radiographic parameters was calculated as the difference between values immediately post-operation and at 6 months post-operation. Only age at surgery (P < 0.001) and the pre-operative LCEA (P = 0.013) were significantly different between groups (Tables I and II). The remaining pre- and post-operative radiological measurements were similar (Table II). Comparison of delta values at 6 months follow-up indicated no significant differences between screw types (Table III). No patients in the titanium group had a trans-iliac retrograde screw included in their construct (P = 0.003). All patients healed from their osteotomies. The use of titanium screws in patients with an allergy to nickel was not associated with differences in acetabular correction or the rate of osseous union rates despite its lower inherent mechanical properties.
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Affiliation(s)
- Lei Zhao
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Molly Uchtman
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Alexander Aretakis
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - Courtney Selberg
- Orthopaedics Institute, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, Aurora 80045, USA
| | - James J McCarthy
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, 3230 Eden Avenue, Cincinnati, OH 45267, USA
- Department of Biomedical Engineering, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45219, USA
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10
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Fischer M, Nonnenmacher L, Zimmerer A, Reichert JC, Möller A, Hofer A, Matziolis G, Wassilew GI. The role of different acetabular morphologies on patient-reported outcomes following periacetabular osteotomy in borderline hip dysplasia. Arch Orthop Trauma Surg 2024; 144:3073-3081. [PMID: 38967778 PMCID: PMC11319516 DOI: 10.1007/s00402-024-05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction. MATERIALS AND METHODS A prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°-25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints. RESULTS Overall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips). CONCLUSIONS This study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Diakonieklinikum Stuttgart, Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany
| | - Johannes C Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Möller
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Eisenberg, Germany
| | - Georgi I Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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11
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Selley RS, Peck JB, Trotzky ZA, Robustelli SB, Sink EL. Retroverting Periacetabular Osteotomy for Symptomatic Acetabular Anteversion. J Arthroplasty 2024; 39:1235-1239. [PMID: 37972667 DOI: 10.1016/j.arth.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Acetabular dysplasia has traditionally been defined using the lateral center edge angle and treated with periacetabular osteotomy (PAO). However, the recently described Ottawa classification further quantifies dysplasia in 3-dimensional terms, categorizing Ottawa A as dysplasia due to isolated, excessive acetabular anteversion or anterior acetabular under-coverage. We sought to determine if patients who have Ottawa A dysplasia can expect similar outcomes when undergoing a PAO compared to a traditional dysplasia cohort. METHODS Patients who had undergone PAO with Ottawa A hip dysplasia were selected and compared to a control group of patients who had lateral acetabular undercoverage. The modified Harris Hip Score and International Hip Outcome Tool-33 were collected preoperatively and at various follow-up points for a final follow-up average of 2.3 years (range, 0.9 to 6.2). RESULTS The 17 patients (21 hips) who had Ottawa A dysplasia were compared to a control cohort of 69 patients (88 hips). Both groups saw significant improvements in modified Harris Hip Score and International Hip Outcome Tool-33 at final follow-up, P < .001. There were no differences between groups in any of the outcome measures or rates of achieving minimal clinically important difference (MCID) or substantial clinical benefit. Rates of MCID ranged from 82.4 to 100%, and rates of achieving substantial clinical benefit ranged from 47.1 to 52.9%. CONCLUSIONS In patients undergoing a PAO for Ottawa A hip dysplasia, a significant improvement in patient-reported outcomes can be expected with high rates of MCID achievement. This is not significantly different for patients undergoing PAO for more traditional dysplasia parameters.
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Affiliation(s)
- Ryan S Selley
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jeffrey B Peck
- Department of Orthopaedic Surgery, Children's National Hospital, Washington, District of Columbia
| | - Zachary A Trotzky
- Department of Hip Preservation, Hospital for Special Surgery, New York, New York
| | - Stacy B Robustelli
- Department of Hip Preservation, Hospital for Special Surgery, New York, New York
| | - Ernest L Sink
- Department of Hip Preservation, Hospital for Special Surgery, New York, New York
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12
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Haertlé M, Becker N, Windhagen H, Ahmad SS. Unveiling the learning curve of periacetabular osteotomy. Bone Joint J 2024; 106-B:336-343. [PMID: 38555935 DOI: 10.1302/0301-620x.106b4.bjj-2023-0830.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims Periacetabular osteotomy (PAO) is widely recognized as a demanding surgical procedure for acetabular reorientation. Reports about the learning curve have primarily focused on complication rates during the initial learning phase. Therefore, our aim was to assess the PAO learning curve from an analytical perspective by determining the number of PAOs required for the duration of surgery to plateau and the accuracy to improve. Methods The study included 118 consecutive PAOs in 106 patients. Of these, 28 were male (23.7%) and 90 were female (76.3%). The primary endpoint was surgical time. Secondary outcome measures included radiological parameters. Cumulative summation analysis was used to determine changes in surgical duration. A multivariate linear regression model was used to identify independent factors influencing surgical time. Results The learning curve in this series was 26 PAOs in a period of six months. After 26 PAO procedures, a significant drop in surgical time was observed and a plateau was also achieved. The mean duration of surgery during the learning curve was 103.8 minutes (SD 33.2), and 69.7 minutes (SD 18.6) thereafter (p < 0.001). Radiological correction of acetabular retroversion showed a significant improvement after having performed a total of 93 PAOs, including anteverting PAOs on 35 hips with a retroverted acetabular morphology (p = 0.005). Several factors were identified as independent variables influencing duration of surgery, including patient weight (β = 0.5 (95% confidence interval (CI) 0.2 to 0.7); p < 0.001), learning curve procedure phase of 26 procedures (β = 34.0 (95% CI 24.3 to 43.8); p < 0.001), and the degree of lateral correction expressed as the change in the lateral centre-edge angle (β = 0.7 (95% CI 0.001 to 1.3); p = 0.048). Conclusion The learning curve for PAO surgery requires extensive surgical training at a high-volume centre, with a minimum of 50 PAOs per surgeon per year. This study defined a cut-off value of 26 PAO procedures, after which a significant drop in surgical duration occurred. Furthermore, it was observed that a retroverted morphology of the acetabulum required a greater number of procedures to acquire proficiency in consistently eliminating the crossover sign. These findings are relevant for fellows and fellowship programme directors in establishing the extent of training required to impart competence in PAO.
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Affiliation(s)
- Marco Haertlé
- Department of Orthopaedic Surgery, Annastift Hospital, Hanover Medical School, Hanover, Germany
| | - Nils Becker
- Department of Orthopaedic Surgery, Annastift Hospital, Hanover Medical School, Hanover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Annastift Hospital, Hanover Medical School, Hanover, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery, Annastift Hospital, Hanover Medical School, Hanover, Germany
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13
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Verhaegen JCF, DeVries Z, Rakhra K, Speirs A, Beaule PE, Grammatopoulos G. Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study. Clin Orthop Relat Res 2024; 482:259-274. [PMID: 37498285 PMCID: PMC10776167 DOI: 10.1097/corr.0000000000002768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studies have used patients with unknown physical status to define morphological thresholds to guide management. QUESTIONS/PURPOSES (1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management. METHODS Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [ 28 ]), if they had a PROMIS less than 50 (1% [ 18 ]), or their Tönnis score was higher than 1 (0.4% [ 6 ]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls. RESULTS Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm 2 , covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface. CONCLUSION An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes.Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jeroen C. F. Verhaegen
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
- Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Zach DeVries
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Kawan Rakhra
- Department of Radiology, the Ottawa Hospital, Ottawa, ON, Canada
| | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, ON, Canada
| | - Paul E. Beaule
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
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14
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Verhaegen JCF, DeVries Z, Horton I, Slullitel PA, Rakhra K, Beaulé PE, Grammatopoulos G. Acetabular Sector Angles in Asymptomatic and Dysplastic Hips: Defining Dysplasia and Thresholds to Guide Management. J Bone Joint Surg Am 2023; 105:1709-1720. [PMID: 37486985 DOI: 10.2106/jbjs.23.00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Radiographic evaluation plays an important role in detecting and grading hip dysplasia. Acetabular sector angles (ASAs) measure the degree of femoral head coverage provided by the acetabulum on computed tomographic (CT) scans. In this study, we aimed to determine ASA values at different axial levels in a control cohort with asymptomatic, high-functioning hips without underlying hip pathology and a study group with symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO), thereby defining the ASA thresholds for hip dysplasia. METHODS This was a cross-sectional study evaluating a control group of 51 patients (102 hips) and a study group of 66 patients (72 hips). The control group was high-functioning and asymptomatic, with an Oxford Hip Score of >43, did not have osteoarthritis (Tönnis grade ≤1), underwent a pelvic CT scan, had a mean age (and standard deviation) of 52.1 ± 5.5 years, and was 52.9% female. The study group had symptomatic hip dysplasia treated with PAO, had a mean age of 29.5 ± 7.3 years, and 83.3% was female. Anterior ASA (AASA) and posterior ASA (PASA) were measured at 3 axial CT levels to determine equatorial, intermediate, and proximal ASA. The thresholds for dysplasia were determined using receiver operating characteristic (ROC) curve analysis, including the area under the curve (AUC). RESULTS Patients with dysplasia had significantly smaller ASAs compared with the control group; the differences were most pronounced for proximal AASAs and proximal and intermediate PASAs. The control group had a mean proximal PASA of 162° ± 17°, yielding a threshold for dysplasia of 137° (AUC, 0.908). The mean intermediate PASA for the control group was 117° ± 11°, yielding a threshold of 107° (AUC, 0.904). The threshold for anterior dysplasia was 133° for proximal AASA (AUC, 0.859) and 57° for equatorial AASA (AUC, 0.868). The threshold for posterior dysplasia was 102° for intermediate PASA (AUC, 0.933). CONCLUSIONS Measurement of ASA is a reliable tool to identify focal acetabular deficiency with high accuracy, aiding diagnosis and management. A proximal PASA of <137° or an intermediate PASA of <107° should alert clinicians to the presence of dysplasia. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Zach DeVries
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Pablo A Slullitel
- Instituto de Ortopedia 'Carlos E. Ottolenghi,' Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kawan Rakhra
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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15
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Dornacher D, Lutz B, Fuchs M, Zippelius T, Reichel H. Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection. Arch Orthop Trauma Surg 2023; 143:6139-6146. [PMID: 37272987 PMCID: PMC10491512 DOI: 10.1007/s00402-023-04920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION After pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthritis. There is evidence that acetabula in the borderline range, defined by a lateral center edge angle (LCEA) between 18° and 25°, are more delicate to be orientated physiologically. The aim of this study was to assess the quality of acetabular orientation by triple pelvic osteotomy (TPO), established by Tönnis and Kalchschmidt, especially with respect to acetabular overcorrection. MATERIALS AND METHODS A retrospective examination on 368 consecutive hips treated with TPOs was conducted. On the preoperative pelvic radiograph and the radiographic control 5 days after surgery, LCEA, acetabular index (AI), and anterior (AWI) and posterior wall index (PWI) were measured. According to the above-mentioned definition, the hips were divided into a borderline (n = 196) and a dysplastic (n = 172) group. Acetabular overcorrection was defined as when LCEA exceeded 35°, AI was below 0° and AWI exceeded 0.60, postoperatively. The postoperative occurrence of a relevant femoroacetabular impingement was correlated to these thresholds. Statistics comprised a priori power analysis, correlation analyses and receiver operating characteristics (ROC). RESULTS In the borderline group, in 64 hips (32.7%), LCEA and AI indicated lateral overcorrection. In the dysplastic group, in 14 hips (8.1%), solely AI indicated overcorrection. In none of the hips, relevant anterior overcorrection was detected since AWI never exceeded 0.60. Chi-square test demonstrated a significant correlation between the occurrence of a postoperative femoroacetabular impingement and LCEA exceeding 35°, as well as AI below 0° (p < 0.001, resp.). Bravais-Pearson's analysis showed a significant correlation between the pre- and postoperative values of all parameters in the borderline and the dysplasia group (p < 0.001). Thus, ROC analysis could be performed and provided preoperative cutoff values for LCEA (23°) and AI (12.5°), hinting at postoperative overcorrection. CONCLUSION The comparison of radiographic parameters after TPO showed a considerably greater percentage of laterally overcorrected acetabula in the borderline hips than in the dysplastic hips. According to the wall indices, anterior overcorrection was not observed. ROC analysis anticipated unfavorable lateral overcorrection when preoperative LCEA was above 23° and AI below 12.5°. These findings should sensitize the surgeon to the delicate acetabular correction in borderline dysplastic hips.
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Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Michael Fuchs
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Timo Zippelius
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Kitamura K, Fujii M, Motomura G, Hamai S, Kawahara S, Sato T, Yamaguchi R, Hara D, Utsunomiya T, Kokubu Y, Nakashima Y. The sourcil roundness index is a useful measure for quantifying acetabular concavity asphericity. Sci Rep 2023; 13:15851. [PMID: 37740003 PMCID: PMC10516987 DOI: 10.1038/s41598-023-42630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
This study aimed to clarify the clinical utility of the sourcil roundness index (SRI), a novel index for quantifying the asphericity of the acetabular concavity, by determining (1) the difference in the SRI between dysplastic and normal hips and (2) the correlation between the SRI and radiographic parameters of hip dysplasia. We reviewed standing anteroposterior pelvic radiographs of 109 dysplastic and 40 normal hips. The SRI was determined as the ratio of the distance from the medial edge of the sourcil to the most concave point of the acetabular sourcil (A) to the distance from the medial to the lateral edge of the sourcil (B). The formula for SRI is (A/B) × 100-50 (%), with an SRI of 0% indicating a perfectly spherical acetabulum, and higher SRI values indicating a more aspherical shape. The median SRI was greater in patients with hip dysplasia than in normal hips (5.9% vs. - 1.4%; p < 0.001). Furthermore, the median SRI was greater in the severe dysplasia subgroup (18.9%) than in the moderate (3.5%) and borderline-to-mild (- 1.3%) dysplasia subgroups (p < 0.05). Quantification of acetabular concavity asphericity by the SRI showed that dysplastic hips had a more lateral acetabular concave point than normal hips, and that the severity of hip dysplasia had an effect on the acetabular concavity asphericity.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Graesser EA, Schwabe MT, Clohisy JC, Nepple JJ. Defining the Borderline Dysplastic Hip: High Variability in Acetabular Coverage and Femoral Morphology on Low-Dose Computed Tomography. Am J Sports Med 2023; 51:2551-2558. [PMID: 37434506 DOI: 10.1177/03635465231184395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Borderline acetabular dysplasia is commonly radiographically defined as a lateral center-edge angle (LCEA) of 20° to 25°. While the variability of plain radiographic assessment of this population has been reported, an understanding of the variability of 3-dimensional (3D) hip morphology remains to be better defined. PURPOSE To investigate the variability of 3D hip morphology present on low-dose computed tomography (CT) in the setting of symptomatic borderline acetabular dysplasia and to determine if plain radiographic parameters correlate with 3D coverage. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A total of 70 consecutive hips with borderline acetabular dysplasia undergoing hip preservation surgery were included in the current study. Plain radiographic evaluation included LCEA, acetabular inclination, anterior center-edge angle (ACEA), anterior wall index (AWI), posterior wall index (PWI), and alpha angles on anteroposterior, 45° Dunn, and frog-leg views. All patients underwent low-dose pelvic CT for preoperative planning, which allowed detailed characterization of 3D morphology relative to normative data. Acetabular morphology was assessed with radial acetabular coverage (RAC) calculated according to standardized clockface positions from 8:00 (posterior) to 4:00 (anterior). Coverages at 10:00, 12:00, and 2:00 were classified as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative RAC values. Femoral morphology was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Correlation was assessed with the Pearson correlation coefficient (r). RESULTS Lateral coverage (12:00 RAC) was deficient in 74.1% of hips with borderline dysplasia. Anterior coverage (2:00 RAC) was highly variable, with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (10:00 RAC) was also highly variable, with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The 3 most common patterns of coverage were isolated lateral undercoverage (31.4%), normal coverage (18.6%), and combined lateral and posterior undercoverage (17.1%). The mean femoral version was 19.7°± 10.6° (range, -4° to 59°), with 47.1% of hips having increased femoral version (>20°). The mean maximum alpha angle was 57.2° (range, 43°-81°), with 48.6% of hips having an alpha angle ≥ 55°. The ACEA and AWI were poorly correlated with radial anterior coverage (r = 0.059 and 0.311, respectively), while the PWI was strongly correlated with radial posterior coverage (r = 0.774). CONCLUSION Patients with borderline acetabular dysplasia demonstrate highly variable 3D deformities, including anterior, lateral, and posterior acetabular coverage; femoral version; and alpha angle. Plain radiographic assessments of anterior coverage are poorly correlated with anterior 3D coverage on low-dose CT.
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Affiliation(s)
| | - Maria T Schwabe
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
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Slullitel PA, Holc F, Buljubasich M, Latorre M, Comba F, Zanotti G, Marquesini M, Grammatopoulos G, Buttaro MA. Anterior Center-Edge Angle Is Less Reliable Than Anterior Wall Index to Predict Anterior Coverage of the Femoral Head. Am J Sports Med 2023; 51:2151-2160. [PMID: 37227132 DOI: 10.1177/03635465231168902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND No consensus is available regarding which radiographic measurement most accurately correlates with anterior coverage of the femoral head. PURPOSE (1) To determine the correlation between 2 measurements of anterior wall coverage: total anterior coverage (TAC) calculated from radiographs and equatorial anterior acetabular sector angle (eAASA) calculated from computed tomography (CT) scans; (2) to define the correlation between anterior center-edge angle (ACEA) and anterior wall index (AWI) with TAC and eAASA; and (3) to investigate what other radiographic metrics may help predict anterior coverage. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS The authors retrospectively reviewed 77 hips (48 patients) for which radiographs and CT scans were obtained for reasons other than hip-related pain. Mean age of the population was 62 ± 22 years; 48 (62%) hips were from female patients. Two observers measured lateral center-edge angle (LCEA), AWI, Tönnis angle, ACEA, CT-based pelvic tilt, and CT-based acetabular version, with all Bland-Altman plots within 95% agreement. Correlation between intermethod measurements was estimated with a Pearson coefficient. Linear regression was used to test the ability of baseline radiographic measurements to predict both TAC and eAASA. RESULTS Pearson coefficients were r = 0.164 (ACEA vs TAC; P = .155), r = 0.170 (ACEA vs eAASA; P = .140), r = 0.58 (AWI vs TAC; P = .0001), and r = 0.693 (AWI vs eAASA; P < .0001). Multiple linear regression model 1 showed that AWI (β = 17.8; 95% CI, 5.7 to 29.9; P = .004), CT acetabular version (β = -0.45; 95% CI, -0.71 to -0.22; P = .001), and LCEA (β = 0.33; 95% CI, 0.19 to 0.47; P = .001) were useful to predict TAC. Multiple linear regression model 2 revealed that AWI (β = 25; 95% CI, 15.67 to 34.4; P = .001), CT acetabular version (β = -0.48; 95% CI, -0.67 to -0.29; P = .001), CT pelvic tilt (β = 0.26; 95% CI, 0.12 to 0.4; P = .001), and LCEA (β = 0.21; 95% CI, 0.1 to 0.3; P = .001) accurately predicted eAASA. Model-based estimates and 95% CIs using 2000 bootstrap samples from the original data were 6.16 to 28.6 for AWI in model 1 and 15.1 to 34.26 for AWI in model 2. CONCLUSION There was a moderate to strong correlation between AWI and both TAC and eAASA, whereas ACEA correlated weakly with the former measurements, thus not being useful to quantify anterior acetabular coverage. Other variables such as LCEA, acetabular version, and pelvic tilt may also help predict anterior coverage in asymptomatic hips.
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Affiliation(s)
| | - Fernando Holc
- Hospital Italiano Buenos Aires, Buenos Aires, Argentina
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Dornacher D, Sgroi M, Freitag T, Reichel H, Lutz B. Acetabular orientation in triple pelvic osteotomy: is intraoperative fluoroscopy reliable? Arch Orthop Trauma Surg 2023; 143:3715-3723. [PMID: 35947170 PMCID: PMC10293451 DOI: 10.1007/s00402-022-04568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE In pelvic osteotomies, unfavorable balancing of the anterior and posterior acetabular wall can affect the longevity of the natural joint. This raises the question, whether intraoperative fluoroscopy is sufficiently accurate. The objective was to assess the correlation between acetabular parameters [lateral center edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI)] acquired on intraoperative fluoroscopic images and postoperative pelvic radiographs and to analyze intra- and interobserver reliability of these parameters. METHODS A retrospective examination was conducted on 206 consecutive cases (176 patients) after triple pelvic osteotomy (TPO). Every patient received a pre- and postoperative pelvic radiograph in supine position in exactly the same technique. A highly standardized surgical sequence allowed consistent intraoperative fluoroscopic imaging. LCAE, AI, PWI and AWI were measured by an experienced orthopedic surgeon and an orthopedic surgeon in training. Statistics comprised a priori power analysis, Bland-Altman analysis and intraclass correlation coefficient (ICC). RESULTS A total of 165 cases were included. ICC between the parameters of the fluoroscopic images and postoperative radiographs was for LCEA: 0.935, AI: 0.936, AWI: 0.725 and PWI: 0.878. Intraobserver ICC for all parameters ranged from 0.953 to 0.989, interobserver ICC from 0.798 to 0.968, respectively. CONCLUSION In the surgical treatment of hip dysplasia by means of TPO, intraoperative fluoroscopic imaging has proven to be reliable and accurate. Intraobserver correlation was excellent for all parameters. The correlation between the intraoperative fluoroscopic images and postoperative radiographs ranged from good to excellent, with the lowest values for the acetabular wall indices (AWI and PWI).
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Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Tobias Freitag
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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20
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Fujii M, Kawano S, Ueno M, Sonohata M, Kitajima M, Tanaka S, Mawatari D, Mawatari M. Clinical results of periacetabular osteotomy with structural bone allograft for the treatment of severe hip dysplasia. Bone Joint J 2023; 105-B:743-750. [PMID: 37399069 DOI: 10.1302/0301-620x.105b7.bjj-2023-0056.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Aims To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. Methods We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure. Results A total of 64 patients (76 hips) were included in this study. The median follow-up period was ten years (interquartile range (IQR) five to 14). The median mHHS improved from 67 (IQR 56 to 80) preoperatively to 96 (IQR 85 to 97) at the latest follow-up (p < 0.001). The radiological parameters improved postoperatively (p < 0.001), with the resulting parameters falling within the normal range in 42% to 95% of hips. The survival rate was 95% at ten years and 80% at 15 years. Preoperative Tönnis grade 2 was an independent risk factor for TOA failure. Conclusion Our findings suggest that TOA with structural bone allografting is a viable surgical option for correcting severely dysplastic acetabulum in adolescents and young adults without advanced osteoarthritis, with favourable mid-term outcomes.
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Affiliation(s)
- Masanori Fujii
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shunsuke Kawano
- Research Center for Arthroplasty, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, JCHO Saga Central Hospital, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopedic Surgery, Shiroishi Kyoritsu Hospital, Saga, Japan
| | - Shiori Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Daisuke Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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21
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Dornacher D, Lutz B, Fuchs M, Zippelius T, Reichel H. Acetabular deficiency in borderline hip dysplasia is underestimated by lateral center edge angle alone. Arch Orthop Trauma Surg 2023; 143:3937-3944. [PMID: 36271941 PMCID: PMC10293430 DOI: 10.1007/s00402-022-04652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION In hip preservation surgery, the term "borderline hip dysplasia" was used when the lateral center edge angle (LCEA), historically described by Wiberg, measured 18-25°. In recent years, several radiographic parameters have been described to assess the antero posterior coverage of the femoral head, for example, the anterior and posterior wall index (AWI and PWI). This allowed an increasingly comprehensive understanding of acetabular morphology and a questioning of the borderline definition. MATERIAL AND METHODS A retrospective review of 397 consecutive hips was performed, all treated with triple pelvic osteotomy (TPO) due to symptomatic hip dysplasia. On all preoperative pelvic radiographs with a LCEA of 18-25°, acetabular index (AI), AWI and PWI were measured. With these values, the hips were categorized into laterally, antero-laterally and postero-laterally dysplastic and stratified by gender. Intra- and interobserver correlation of the parameters was analyzed by intraclass correlation coefficient (ICC). RESULTS According to LCEA, 192 hips were identified as "borderline dysplastic". Based on AWI and PWI, the categorization resulted in 116 laterally dysplastic (60.4%), 33 antero-laterally (17.2%) and 43 postero-laterally dysplastic hips (22.4%). Gender stratification revealed that male acetabula seemed to be slightly more postero-laterally deficient than female (mean PWI 0.80 vs 0.89; p = 0.017). ICC confirmed highly accurate and reproducible readings of all parameters. CONCLUSION The rather high proportion of symptomatic hips labelled borderline dysplastic suggested, that there might be substantial acetabular deficiency not recognizable by LCEA. Comprehensive deformity analysis using LCEA, AI, AWI and PWI showed, that 40% of these hips were deficient either antero-laterally or postero-laterally. Male acetabula were more deficient postero-laterally than female.
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Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Michael Fuchs
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Timo Zippelius
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
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Cheng H, Zhang Z, Sun W, Ren N, Luo D, Li Y, Zhang J, Zhang H. Can we determine anterior hip coverage from pelvic anteroposterior radiographs? A study of patients with hip dysplasia. BMC Musculoskelet Disord 2023; 24:522. [PMID: 37355606 DOI: 10.1186/s12891-023-06624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE Insufficient coverage causes hip joint instability and results in hip pain. Anterior hip coverage can be determined on both pelvic anteroposterior (AP) radiographs and false profile (FP) radiographs. Four parameters are commonly used to determine the anterior coverage on pelvic AP radiographs: the crossover index, crossover sign, anterior wall index (AWI), and rule of thirds. This study aims to clarify the relationship between these 4 parameters on AP radiographs and the anterior center edge angle (ACEA) on FP radiographs. METHODS In this study, 53 patients who underwent periacetabular osteotomy for hip dysplasia at our center between July 2020 and October 2020 were retrospectively reviewed. Four parameters on AP radiographs and the ACEA on FP radiographs before surgery and 6 months after surgery were measured and compared for each hip. RESULTS Upon examining the 53 hips in this study, there was no correlation between either the crossover index and the ACEA (P = 0.66) or the crossover sign before surgery. The postoperative correlation between the crossover index and the ACEA was weak (r = 0.36, P = 0.007), and that between the crossover sign and the ACEA was moderate (r = 0.41, P = 0.003). There was a weak correlation between the AWI and ACEA both before (r = 0.288, P = 0.036) and after (r = 0.349, P = 0.011) the operation. Evaluation of the anterior coverage by the rule of thirds was also not consistent when determining the anterior coverage with the ACEA. CONCLUSION Anterior coverage on AP radiographs is largely inconsistent with ACEA on FP radiographs, especially before the surgery. It is recommended to take FP radiographs routinely for determining anterior hip coverage.
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Affiliation(s)
- Hui Cheng
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Zhendong Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Wei Sun
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Ningtao Ren
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Dianzhong Luo
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China.
| | - Yong Li
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Jianli Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Hong Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
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Becker L, Hipfl C, Schömig F, Perka C, Hardt S, Pumberger M, Leopold VJ. The influence of lumbo-sacral transitional vertebrae in developmental dysplasia of the hip: a matched pair analysis. Sci Rep 2023; 13:10027. [PMID: 37340098 PMCID: PMC10281988 DOI: 10.1038/s41598-023-37208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/18/2023] [Indexed: 06/22/2023] Open
Abstract
Lumbo-sacral transitional vertebrae (LSTV) are the most common congenital alteration of the lumbo-sacral junction and known to significantly influence pelvic anatomy. However, the influence of LSTV on dysplasia of the hip (DDH) and the surgical treatment by periacetabular osteotomy (PAO) remains unknown. We retrospectively examined standardized standing anterior-posterior pelvic radiographs of 170 patients in 185 PAO procedures. Radiographs were examined for LSTV, lateral-central-edge-angle (LCEA), Tönnis-angle (TA), femoral-head-extrusion index (FHEI), and anterior-wall-index (AWI) and posterior-wall-index (PWI). Patients with LSTV were compared to an age- and sex-matched control group. Patient-reported outcome measurements (PROMs) were evaluated pre- and in the mean 63.0 months (range 47-81 months) postoperatively. 43 patients (25.3%) had LSTV. Patients with LSTV had significantly greater PWI (p = 0.025) compared to the matched control group. No significant differences were seen in AWI (p = 0.374), LCEA (p = 0.664), TA (p = 0.667), and FHEI (p = 0.886). Between the two groups, no significant differences were detected in pre- or postoperative PROMs. Due to the increased dorsal femoral head coverage in patients with LSTV and DDH compared to patients with sole DDH, a more pronounced ventral tilting might be performed in those patients with prominent posterior wall sign to avoid anterior undercoverage, which is a significant predictor for premature conversion to hip arthroplasty after PAO. However, anterior overcoverage or acetabular retroversion must be avoided due to the risk of femoroacetabular impingement. Patients with LSTV reported similar functional outcomes and activity after PAO as the control group. Therefore, even for patients with concomitant LSTV, which are frequent with one-fourth in our cohort, PAO is an efficient treatment option to improve clinical symptoms caused by DDH.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Vincent Justus Leopold
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
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24
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Huang YY, Chen IJ, Wu CT, Chan YS, Chen DWC, Tang HC. The posterior capsule is distended in dysplastic hips, but the anterior capsule is not. Knee Surg Sports Traumatol Arthrosc 2023; 31:79-85. [PMID: 36315266 DOI: 10.1007/s00167-022-07207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE In the setting of acetabular dysplasia, the increased translational motion of the femur may damage the labrum and cartilage, as well as stretch the capsule. The purpose of the study was to investigate the relationship between the acetabular coverage and the capsular stiffness by assessing the distension of anterior and posterior joint recesses on the hip computed tomography arthrography. METHODS One hundred thirty-three patients (138 hips) with a median age of 36 years (range 18-50 years) who received the computed tomography arthrography for evaluation of nonarthritic hip pain in our institute between 2015 and 2017 were retrospectively reviewed. The maximal distance between the anterior/posterior capsule and the anterior femoral head-neck junction/posterior femoral head on the axial imaging of computed tomography arthrography was defined as the width of anterior/posterior joint recess. The width of anterior/posterior joint recess was adjusted with the diameter of the femoral head and was then compared between acetabular dysplasia (lateral center-edge angle < 25°), normal acetabulum (lateral center-edge angle between 25 and 39°), and deep acetabulum (lateral center-edge angle > 39°). In addition, the standard univariate linear regression analysis was used to investigate the relationship between the adjusted width of anterior/posterior joint recess and anterior/posterior coverage of the hip, determined by the anterior/posterior wall index. RESULTS The adjusted width of posterior joint recess was significantly greater in the acetabular dysplasia group than the normal acetabulum and deep acetabulum groups (p < 0.01 and p = 0.02, respectively). There was no significant difference of the adjusted width of anterior joint recess between the groups (n.s.). The adjusted width of posterior joint recess had a significant but weak negative correlation with the anterior wall index (r = - 0.25, p < 0.001), and no correlation with the posterior wall index (r = - 0.0004, n.s.). There was no significant correlation between the adjusted width of anterior joint recess and the anterior/posterior wall index (r = 0.05, n.s./r = 0.07, n.s.). CONCLUSIONS The distension of posterior capsule on the computed tomography arthrography was significantly greater in acetabular dysplasia. In addition, there was a significant but weak negative correlation between the distension of posterior capsule and the anterior coverage of the hip. It indicated a looser posterior capsule was observed in a dysplastic hip. The relevance of posterior capsular laxity to clinical outcomes warrants further investigation. Given the fact that the distension of anterior capsule was not significantly higher in acetabular dysplasia, the need of anterior capsular plication in a dysplastic hip should be carefully evaluated. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan
| | - I-Jung Chen
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Chen-Te Wu
- College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan.,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No.222, Maijin Rd., Anle Dist, Keelung, 204, Taiwan. .,College of Medicine, Chang Gung University, No.259, Wunhua 1st Rd., Guishan Dist, Taoyuan, 333,, Taiwan.
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25
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Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine 2023; 90:105465. [PMID: 36150666 DOI: 10.1016/j.jbspin.2022.105465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023]
Abstract
Hip labral tears are found in 22-55% of individuals with hip pain, but labral tears without cysts are usually not responsible for hip pain, which originates mostly from other structures than the torn labrum, like osteochondral, but also tendinous injuries (rectus femoris, gluteus minimus, iliopsoas) or capsulo-ligamentous tears (iliofemoral ligaments, ligament teres). Those lesions are mainly the consequences of underlying unrecognized functional acetabular dysplasia, and/or femoroacetabular impingements. Although the early repair of labral tears in young sportsmen induces a marked and lasting relief, and might delay the onset of osteoarthritis, the microinstability fostered by labral damages seems less important than underlying dysplasias/impingements. This narrative review details recent findings on: (i) the various mechanisms of pain associated with labral tears; (ii) few evidence for hip microinstability induced by isolated labral tears; (iii) how to best detect labral tears, both clinically (including through IROP test) and on imaging (MRI, MRA, computed tomography arthrography, ultrasound). Some authors suggested to use pull-out tests during surgery, but pulling of hips do not seem to increase much diagnostic performances of ultrasounds. Ultrasound-guided intra-articular and peri-articular injections may tell how often hip pain is exclusively induced by peri-capsular injuries secondary to the acetabular dysplasia/femoro-acetabular impingements already responsible for labral tears. Further works could tell whether labral repair, tendinous debridement, plication of capsule, and/or focal denervation, may induce lasting reliefs of pain induced by the chronic contraction of surrounding muscles (rectus femoris, gluteus minimus, psoas), whose deep aponeuroses mix with the superficial fibres of the thick hip capsule.
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Affiliation(s)
- Jean-Marie Berthelot
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France.
| | - Kevin Brulefert
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Paul Arnolfo
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
| | - Benoît Le Goff
- Rheumatology Department, Nantes University Hospital, Hôtel-Dieu, Place Alexis-Ricordeau, 44093 Nantes Cedex 01, France
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26
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Intraoperative Fluoroscopy Allows the Reliable Assessment of Deformity Correction during Periacetabular Osteotomy. J Clin Med 2022; 11:jcm11164817. [PMID: 36013054 PMCID: PMC9410010 DOI: 10.3390/jcm11164817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to determine the accuracy and reliability of measures characterizing anterior, lateral, and posterior acetabular coverage on intraoperative fluoroscopic images compared to postoperative radiographs when performing periacetabular osteotomies (PAOs). A study involving 100 PAOs was initiated applying a standardized intraoperative imaging protocol. Coverage was determined by the lateral center edge angle (LCEA), the Tönnis angle (TA), and the anterior and posterior wall index (AWI, PWI). An intraclass correlation coefficient (ICC) model was used to assess interrater (ICC (3,2)) and intrarater (ICC (2,1)) reliability. The ICC (2,2) between analyses obtained from intraoperative fluoroscopy and postoperative radiographs and the corresponding 95% confidence interval (CI) were determined and complemented by Bland–Altman analysis, the mean difference, and 95% limits of agreement (LOA). The ICCs were 0.849 for the LCEA (95% CI 0.783–0.896), 0.897 for the TA (95% CI 0.851–0.930), 0.864 for the AWI (95% CI 0.804–0.907), and 0.804 for the PWI (0.722–0.864). The assessed interrater reliability was excellent except for the AWI, which was graded good (ICC = 0.857, 95% CI 0.794–0.902). Interrater agreement was generally good and fair for the AWI (ICC = 0.715, 95% CI 0.603–0.780). For each postoperative radiograph, interrater reliability was good with ICCs ranging from 0.813 (TA) to 0.881 (PWI). Intrarater reliability was good for all measurements and excellent for the preoperative TA (ICC = 0.993, 95% CI 0.984–0.997) and PWI (ICC = 0.954, 95% CI 0.919–0.97). In summary, we confirm the validity and reliability of intraoperative fluoroscopy as an alternative imaging modality to radiography to evaluate acetabular fragment orientation during PAO. We affirm the LCEA and TA as precise measures for lateral head coverage, and show the suitability of the AWI and PWI to steadily assess acetabular version.
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Sano K, Homma Y, Shirogane Y, Ishii S, Ito T, Baba T, Kaneko K, Ishijima M. Acetabular morphological variation in Asian patients with femoral neck fracture: A three-dimensional CT-based study. Injury 2022; 53:2823-2831. [PMID: 35768326 DOI: 10.1016/j.injury.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/26/2022] [Accepted: 06/19/2022] [Indexed: 02/02/2023]
Abstract
AIMS The acetabular morphology varies greatly among individuals, and hypoplasia is more common in Asia than in Europe. Dislocation after bipolar hip arthroplasty (BHA) for femoral neck fracture occurs at a constant rate, and is affected by the acetabular morphology. This study aimed to clarify individual differences in the acetabula of Asian patients with displaced femoral neck fractures. PATIENTS AND METHODS Fifty patients with displaced femoral neck fractures were assessed (50 fractured hips, 50 non-fractured hips). On CT corrected by the anterior pelvic plane, the 100 hips were assessed regarding acetabular coverage (six parameters), acetabular depth (two parameters), and acetabular opening angle (four parameters). Additional parameters related to the fracture and sex were examined. The percentile of each parameter was shown for all hips. RESULTS There was no patient with hip dysplasia defined as superior acetabular sector angle (SASA) less than 110° Compared with men, women had a significantly smaller anterior acetabular sector angle (AASA) (p = 0.016), and significantly larger acetabular inclination angle (p = 0.006) and acetabular index angle (p = 0.034). In the group with a normal SASA, seven hips (7.3%) had an anterior wall defect (AASA<50°) and five hips (5.2%) had a posterior wall defect (posterior acetabular sector angle<90°). CONCLUSION Older adults with femoral neck fractures can have anterior wall and posterior wall defects, even if their SASA is normal. Hidden acetabular dysplasia may be related to post-BHA dislocation. So, our results suggest that is important to accurately evaluate the acetabulum of patients with femoral neck fracture before surgery.
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Affiliation(s)
- Kei Sano
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomoyuki Ito
- Division of Orthopedic Surgery, Tominaga Kusano Hospital, Niigata, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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28
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Laboudie P, Fischman D, Speirs AD, Salih S, Holc F, Beaule PE, Witt JD, Grammatopoulos G. Comparison of Acetabular Measurements Between 2 Validated Software Programs Used in Hip Preservation Surgery. Am J Sports Med 2022; 50:2637-2646. [PMID: 35867779 DOI: 10.1177/03635465221109240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Validated software tools (Clinical Graphics [CG] and Hip2Norm) permit measurement of the percentage of femoral head coverage (%FHC), which aids in morphological classification and prediction of outcome after hip preservation surgery. PURPOSE (1) To assess whether acetabular parameter measurements determined from 2 commonly used software systems are comparable. (2) To determine which parameters influence the correlation or differences between software outputs and measurements. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The study included 69 patients (90 hips) who underwent periacetabular osteotomy and had comprehensive preoperative imaging available. Lateral center-edge angle (LCEA), acetabular index (AI), and %FHC were determined using 3-dimensional computed tomography (CT) measurements by CG and Hip2Norm software. Images of 18 pelvises were segmented to determine spinopelvic parameters and subtended acetabular angles. Between-group measurements were compared using correlation coefficients and Bland-Altman analyses. The difference in the outputs of the 2 programs was defined as delta (Δ). Radiographic parameters were tested to assess whether they were responsible for differences in %FHC between software programs. RESULTS Strong correlations between LCEA (ρ = 0.862) and AI (ρ = 0.825) measurements were seen between the Hip2Norm and CG programs. However, weak correlation was seen in the estimate of %FHC (ρ = 0.358), with the presence of a systematic error. Hip2Norm consistently produced lower anterior, posterior, and total %FHC values than CG. The %FHC determined by CG, but not Hip2Norm, correlated with acetabular subtended angles (P < .05). Pelvic tilt measured on CT did not correlate with pelvic tilt estimated by Hip2Norm (P = .56), and ΔPelvicTilt strongly correlated with the difference in %FHC by the 2 software programs (ρ = 0.63; P = .005), pelvic incidence (ρ = 0.73; P < .001), and pelvic tilt (ρ = -0.91; P < .001) as per CT. CONCLUSION The correlation of %FHC between Hip2Norm and CG was weak (ρ = 0.358). The difference in measurements of %FHC correlated with ΔPelvicTilt. The %FHC determined by CG strongly correlated with the segmented acetabular subtended angles and thus more likely reflected true values. Hip preservation surgeons should be aware of these measurement differences because %FHC is important in the diagnosis and prognosis of acetabular dysplasia.
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Affiliation(s)
- Pierre Laboudie
- Orthopaedic Surgery Department, Cochin Hospital, Paris, France.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel Fischman
- Division of Orthopaedic Surgery, Hospital Militar Santiago, Chile
| | - Andrew D Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Saif Salih
- Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, UK
| | - Fernando Holc
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul E Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Johan D Witt
- Reconstruction Service, University College London Hospitals, London, UK
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Atzmon R, Safran MR. Arthroscopic Treatment of Mild/Borderline Hip Dysplasia with Concomitant Femoroacetabular Impingement-Literature Review. Curr Rev Musculoskelet Med 2022; 15:300-310. [PMID: 35708882 PMCID: PMC9276885 DOI: 10.1007/s12178-022-09765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. Recent Findings With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite early studies that condemned its use. Recent outcome data have demonstrated that hip arthroscopy is a viable option in BDH, with and without FAI, and has been gaining wider acceptance. Hip arthroscopy can address the concomitant soft tissue and bony intra-articular pathologies and obviate the necessity for other surgeries. Moreover, hip arthroscopy may be used as an adjuvant treatment to other procedures such as a periacetabular osteotomy (PAO). Summary Hip arthroscopy for BDH is an evolving procedure with promising short- and mid-term outcomes. The combination of BDH and FAI is becoming recognized as a problem in its own right, requiring dedicated treatment.
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Affiliation(s)
- Ran Atzmon
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
| | - Marc R Safran
- Department of Orthopaedics Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063 USA
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30
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Foissey C, Abid H, Martinot P, Cazor A, Thaunat M. Predictive radiological parameters of failure following surgical management of femoroacetabular impingement associated with borderline acetabular dysplasia. Orthop Traumatol Surg Res 2022; 109:103349. [PMID: 35688380 DOI: 10.1016/j.otsr.2022.103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18-25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure. HYPOTHESIS A larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment. METHODS This was a retrospective study done with data collected prospectively after a minimum of 2 years' follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori. RESULTS The study analyzed 39 patients. The mean mHHS was 76±15 [40-92]. The "success" group consisted of 21 patients (56%, 21/39), the "moderate improvement" group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the "failure" group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the "moderate improvement" group were significantly older (37 years±8 [18-45]<p= 0.04) with a significantly higher offset (2mm±3 [-5-5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%. CONCLUSION A FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients. LEVEL OF EVIDENCE IV, retrospective series.
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Affiliation(s)
- Constant Foissey
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Pierre Martinot
- Service d'orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Antoine Cazor
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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31
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Ng KCG, Bankes MJK, El Daou H, Beaulé PE, Cobb JP, Jeffers JRT. Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia. J Bone Joint Surg Am 2022; 104:1015-1023. [PMID: 35133990 DOI: 10.2106/jbjs.21.00405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips. METHODS Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested. RESULTS The PAO reduced internal rotation in flexion of 90° (∆IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (∆ER = +7°; p = 0.001) and flexion of 90° (∆ER = +11°; p = 0.001). The PAO also reduced abduction in extension (∆ABD = -10°; p = 0.002), neutral 0° (∆ABD = -7°; p = 0.001), and flexion of 30° (∆ABD = -8°; p = 0.001), but increased adduction in neutral 0° (∆ADD = +9°; p = 0.001), flexion of 30° (∆ADD = +11°; p = 0.002), and flexion of 60° (∆ADD = +11°; p = 0.003). CONCLUSIONS PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
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Affiliation(s)
- K C Geoffrey Ng
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Medical Imaging, Western University, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Marcus J K Bankes
- Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Fortius Clinic, London, United Kingdom
| | - Hadi El Daou
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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32
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Wong SE, Newhouse AC, Wichman DM, Bessa F, Williams J, Nho SJ. Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery. Arthroscopy 2022; 38:1509-1515. [PMID: 34710573 DOI: 10.1016/j.arthro.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index and in patients without radiographic evidence of hip instability. METHODS Data from consecutive patients with borderline hip dysplasia (lateral center edge angle between 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of FAIS were analyzed. Baseline demographic data, radiographic parameters, preoperative, and 2-year postoperative patient-reported outcome measures were collected. The FEAR index was measured by 3 different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinically important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and <2°. RESULTS A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7 ± 13.2 (P < .325) years and 25.1 ± 5.6 kg/m2 (P < .862). There were no statistically significant demographic differences between the groups. Nineteen (13.0%) patients were found to have a FEAR index of over 2˚. The FEAR index <2° and FEAR index ≥2° groups had a mean preoperative FEAR index (standard deviation, range) of -7.0 (5.2, -26.8 to 1.9) and 4.8 (2.5, 2.0-11.8), respectively. The interrater intraclass correlation coefficient was 0.96. Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement were not statistically different between the radiographically stable and unstable groups. (p>0.05 for all). CONCLUSION Patients with borderline hip dysplasia and radiographic evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips after arthroscopic treatment of FAIS. CLINICAL RELEVANCE Retrospective Level III cohort study.
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Affiliation(s)
- Stephanie E Wong
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Daniel M Wichman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Felipe Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joel Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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33
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Gebhardt S, Lerch S, Sobau C, Miehlke W, Wassilew GI, Zimmerer A. Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip. J Hip Preserv Surg 2022; 9:78-83. [PMID: 35854807 PMCID: PMC9291363 DOI: 10.1093/jhps/hnac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/26/2022] [Accepted: 03/27/2022] [Indexed: 11/12/2022] Open
Abstract
Recently, there was a debate about whether borderline dysplastic hips should be treated surgically with hip arthroscopy or periacetabular osteotomy (PAO). Current studies recommend a classification into stable and unstable hips. Therefore, radiological scores have been described in recent years. Likewise, a new clinical stability test with the Prone Apprehension Relocation Test (PART) has been described. However, there has been no correlation between the modern radiological scores and the PART. We prospectively studied a consecutive group of patients who presented to our clinic. The PART and radiological scores were assessed in these patients. We divided the patients into a PART-positive and a PART-negative group and analyzed the associated clinical and radiological findings. Out of 126 patients (126 hips) included, 36 hips (29%) were evaluated as PART positive. There were significantly more females in the PART positive group (P = 0.005). Comparing the PART groups, significant differences (P < 0.0001) were found for the lateral center edge angle (LCEA), Femoro-Epiphyseal Acetabular Roof (FEAR) index, Gothic arch angle (GAA), anterior wall index (AWI), the occurrence of the upsloping lateral sourcil (ULS) and signs of acetabular retroversion. The correlation analysis showed an association between LCEA, FEAR index, GAA, AWI, ULS and the PART. A chi-square automatic interaction detection algorithm revealed that the strongest predictor of positive PART was the GAA. In conclusion, a high correlation between the PART and known radiological instability parameters was found. Consequently, a combination of clinical instability testing and radiological instability parameters should be applied to detect unstable hips.
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Affiliation(s)
- Sebastian Gebhardt
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany
| | - Solveig Lerch
- Department of Orthopaedic Surgery, Klinikum Agnes Karll Laatzen, Laatzen, Germany
| | | | | | - Georgi I Wassilew
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany
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Risk Factors for Composite Failure of Hip Dysplasia Treated With Periacetabular Osteotomy: A Minimum 10-Year Follow-up. J Am Acad Orthop Surg 2022; 30:e690-e702. [PMID: 35171882 DOI: 10.5435/jaaos-d-21-00535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/05/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Periacetabular osteotomy (PAO) is a common surgical treatment of prearthritic hip dysplasia in young adults, but there are few long-term studies of clinical outcomes. The purpose of this investigation was to report a minimum 10-year clinical follow-up of hip dysplasia treated with PAO and identify risk factors for composite failure. METHODS We identified 151 patients (198 hips) who underwent PAO to treat hip dysplasia at a single institution. Enrolled subjects completed a series of six patient-reported outcome instruments and provided information about subsequent surgeries. We defined composite failure as conversion to total hip arthroplasty or modified Harris Hip Score ≤70. Logistic regression with generalized estimating equations was used to evaluate the relationships between odds of failure and potential predictor variables in univariate and multivariate analyses. RESULTS A total of 124 subjects (167 hips) with a minimum 10-year follow-up were enrolled. The median time from PAO to the final follow-up was 13 years (range 10-18 years). There were 71 hips that met criteria for failure: 32 with total hip arthroplasty and 39 with modified Harris Hip Score ≤70. Univariate logistic regression analyses revealed multiple preoperative factors that predicted composite failure: increased age and body mass index, osteoarthritis (OA), and more severe acetabular dysplasia. Postoperative factors that predicted failure included lateral undercoverage and formation of heterotopic ossification (HO). The final multivariate model identified body mass index ≥30 kg/m2 (odds ratio [OR], 3.84 [95% confidence interval (CI), 1.68-8.78], P = 0.001), higher preoperative Tönnis grade OA (OR, 2.65 [95% CI, 1.50-4.66], P < 0.001), and HO formation (OR, 16.52 [95% CI, 2.08-135.96], P = 0.009) as independent predictors of failure. CONCLUSIONS This study corroborates current hip dysplasia literature, identifying increasing age and presence of preoperative OA as risk factors for composite failure in univariate analyses. In addition, we found that obesity and HO formation were independent predictors of persistent hip dysfunction. LEVEL OF EVIDENCE Therapeutic Level IV.
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Amer MH, Dunlop DG. Recurrent Post-traumatic Posterior Hip Dislocation Treated Using a Bone Block Technique: Case Report and a Review of the Literature. JBJS Case Connect 2022; 12:01709767-202206000-00044. [PMID: 37440473 DOI: 10.2106/jbjs.cc.22.00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
CASE A 26-year-old man presented with recurrent native hip dislocation after an initially traumatic posterior right hip dislocation. The combined soft-tissue and bony deficiency was addressed using an autologous bone block technique, as previously popularized for shoulder instability. Thirteen years postoperatively, no subsequent dislocations occurred, and the patient has an excellent functional outcome. CONCLUSION The bone block technique for hip stabilization can be used to address focal acetabular deficiencies with promising long-term follow-up.
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Affiliation(s)
- Mohammad H Amer
- University Hospital of Southampton NHS Trust, Southampton, United Kingdom
- Department of Trauma and Orthopaedics, Cairo University, Cairo, Egypt
| | - Douglas G Dunlop
- University Hospital of Southampton NHS Trust, Southampton, United Kingdom
- Department of Orthopaedics, Southampton University, Southampton, United Kingdom
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Chen S, Zhang L, Mei Y, Zhang H, Hu Y, Chen D. Role of the Anterior Center-Edge Angle on Acetabular Stress Distribution in Borderline Development Dysplastic of Hip Determined by Finite Element Analysis. Front Bioeng Biotechnol 2022; 10:823557. [PMID: 35299631 PMCID: PMC8921530 DOI: 10.3389/fbioe.2022.823557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background: The joint with hip dysplasia is more likely to develop osteoarthritis because of the higher contact pressure, especially in the socket. The lateral center-edge angle (LCEA) is the major indicator for hip dysplasia via radiography. However, the pathological conditions of LCEA angles in the range of 18°–25° are still controversial, which challenges precise diagnosis and treatment decision-making. Objective: The purpose of this study is to investigate the influence of anterior center-edge angle (ACEA) on the mechanical stress distribution of the hip joint, via finite element analysis, to provide insights into the severity of the borderline development dysplasia. Methods: From 2017 to 2019, there were 116 patients with borderline developmental dysplasia of the hip (BDDH) enrolled in this research. Based on the inclusion criteria, nine patients were involved and categorized into three LCEA groups with the maximal ACEA differences. Patient-specific hip joint models were reconstructed from computed tomography scans, and the cartilages, including the labrum, were established via a modified numerical method. The finite element analysis was conducted to compare the stress distributions due to the different ACEA. Results: As ACEA decreased, the maximum stress of the acetabulum increased, and the high stress area developed toward the edge. Quantitative analysis showed that in the cases with lower ACEA, the area ratio of high stress increased, and the contact facies lunata area significantly affected the stress distribution. Conclusion: For patients with BDDH, both the ACEA and the area of facies lunata played essential roles in determining the severity of hip dysplasia and the mechanical mechanism preceding osteoarthritis.
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Affiliation(s)
- Songhao Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Liqiang Zhang
- Tianjin Medical University, Tianjin, China
- Department of Orthopaedics, Shanxi Children’s Hospital, Taiyuan, China
| | - Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
- School of Medical Imaging, North Sichuan Medical College, Sichuan, China
| | - Hong Zhang
- Department of Orthopaedics, The Fourth Medical Centre of PLA General Hospital, Beijing, China
| | - Yongcheng Hu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
- *Correspondence: Yongcheng Hu, ; Duanduan Chen,
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- *Correspondence: Yongcheng Hu, ; Duanduan Chen,
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Marland JD, Horton BS, West HS, Wylie JD. Association of Radiographic Markers of Hip Instability and Worse Outcomes 2 to 4 Years After Hip Arthroscopy for Femoroacetabular Impingement in Female Patients. Am J Sports Med 2022; 50:1020-1027. [PMID: 35188827 DOI: 10.1177/03635465211073341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reported outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with underlying borderline acetabular dysplasia are mixed. This may in part be the result of mixed-sex reporting. PURPOSE To determine the effect of radiographic measures of acetabular dysplasia and hip instability on outcomes of female patients undergoing hip arthroscopy for FAI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This was a retrospective study of female patients undergoing arthroscopic surgery for FAI. All patients had preoperative radiographs including a standing anteroposterior pelvic view on which lateral center-edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and femoroepiphyseal acetabular roof (FEAR) index were measured. Patient outcomes were quantified by preoperative and postoperative 12-Item International Hip Outcome Tool (iHOT-12) scores. All patients had follow-up at 2 to 4 years postoperatively. Published values for minimal clinically important difference (MCID), substantial clinical benefit (SCB), Patient Acceptable Symptom State (PASS), and a normal (iHOT-12 > 86 points) or abnormal (iHOT-12 < 56 points) hip were used to determine outcome, as well as the final iHOT-12 score and iHOT-12 preoperative to postoperative difference. RESULTS The cohort consisted of 249 female patients (83% follow-up) with iHOT-12 scores at 2 to 4 years after surgery (mean, 34.6 months). Female patients with combined LCEA ≤25° and AWI <0.35 had lower final iHOT-12 score and iHOT-12 difference and were less likely to meet MCID, SCB, and PASS and have a normal hip and were more likely to have an abnormal hip as determined by iHOT-12 cutoffs when compared with those patients who had an LCEA >25° and an AWI ≥0.35 (all P < .05). There was no effect of PWI on outcomes. Similarly, female patients with combined LCEA ≤25° and a laterally oriented (positive) FEAR index were less likely to meet MCID, SCB, and PASS and have a normal hip and were more likely to have an abnormal hip compared with those patients who had an LCEA >25° and a negative (medial) FEAR index (all P < .05). In multivariate regression, an LCEA between 18° and 25° was an independent predictor of worse outcomes. CONCLUSION An LCEA of 18° to 25°, in combination with an AWI of <0.35 or a laterally opening FEAR index, was predictive of worse outcomes in female patients undergoing hip arthroscopy for FAI.
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Affiliation(s)
- Jennifer D Marland
- The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, Utah, USA
| | - Brandy S Horton
- The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, Utah, USA
| | - Hugh S West
- The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, Utah, USA
| | - James D Wylie
- The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, Utah, USA
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Zimmerer A. Editorial Commentary: Hip Dysplasia-Arthroscopic Femoroacetabular Impingement Versus Periacetabular Osteotomy: Do Not FEAR the Size of the Next Step. Arthroscopy 2022; 38:382-384. [PMID: 35123716 DOI: 10.1016/j.arthro.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
Hip dysplasia is characterized by inadequate acetabular coverage of the femoral head. There is a consensus that hip dysplasia with a lateral center edge angle (LCEA) less than18° should be treated with realignment of acetabular coverage by acetabular osteotomy, but there is controversy whether milder, borderline dysplasia with an LCEA between 18° and 25° should be treated with arthroscopy or acetabular reorientation. Identifying whether the problem is related to dysplasia or femoroacetabular impingement syndrome is essential, and a crucial factor is whether the hip is unstable. A femoroepiphyseal acetabular roof (FEAR) index with a cutoff value of 2 predicts hip stability with 90% probability, even with a normative LCEA. In addition, according to the anterior-wall index (AWI), the anterior acetabular border should cross onto the middle third of the medial femoral head radius on a line that runs parallel to the femoral neck axis through the center of the femoral head. A reduced AWI suggests a deficient anterior rim. Next, lateral labrum length correlates with the FEAR index and anterior labrum length with AWI, i.e., anterior dysplasia. Consequently, the lateral labrum increases in size with progressive instability, and the anterior labrum increases in size with decreased anterior coverage. Threshold values for labrum size should be defined to guide clinical decision making. Ultimately, we require an algorithm to guide arthroscopy versus bony correction.
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Kuroda Y, Hashimoto S, Saito M, Matsumoto T, Nakano N, Kuroda R, Hayashi S. Femoro-Epiphyseal Acetabular Roof (FEAR) Index and Anterior Acetabular Coverage Correlate With Labral Length in Developmental Dysplasia of the Hip. Arthroscopy 2022; 38:374-381. [PMID: 33964382 DOI: 10.1016/j.arthro.2021.04.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the association between labral length and radiographic parameters of lateral and anterior acetabular coverage and the femoro-epiphyseal acetabular roof (FEAR) index in patients with developmental dysplasia of the hip (DDH). METHODS We retrospectively analyzed data from patients with DDH who visited our hip joint clinic for the first time due to hip symptoms. DDH presence was defined as a lateral center-edge angle (LCEA) of ≤25°. The labral lengths on the anterior and lateral sides were measured on central axial and central coronal slices of T1-weighted magnetic resonance imaging, respectively. The Pearson correlation coefficients (r) and simple linear regression analyses were performed to determine the association of the lateral and anterior labral lengths with the radiographic parameters, including the LCEA, acetabular roof obliquity, FEAR index, anterior wall index, and vertical center anterior angle. RESULTS This study included 88 patients, with a mean age of 39.6 ± 11.8 years. There were 65 women and 23 men. The lateral and anterior labral lengths correlated with all parameters of dysplasia. Specifically, the lateral labral length had a strong positive correlation with the FEAR index (R = 0.65, P < .001). The anterior labral length had a strong negative correlation with the anterior wall index (R = -0.66, P < .001). CONCLUSIONS The lateral labral length had a strong positive correlation with the FEAR index. Furthermore, the anterior labral length had a correlation with the anterior dysplasia. LEVEL OF EVIDENCE Level III, retrospective cross-sectional study.
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Affiliation(s)
- Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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Kitamura K, Fujii M, Iwamoto M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Effect of coronal plane acetabular correction on joint contact pressure in Periacetabular osteotomy: a finite-element analysis. BMC Musculoskelet Disord 2022; 23:48. [PMID: 35031030 PMCID: PMC8760799 DOI: 10.1186/s12891-022-05005-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background The ideal acetabular position for optimizing hip joint biomechanics in periacetabular osteotomy (PAO) remains unclear. We aimed to determine the relationship between acetabular correction in the coronal plane and joint contact pressure (CP) and identify morphological factors associated with residual abnormal CP after correction. Methods Using CT images from 44 patients with hip dysplasia, we performed three patterns of virtual PAOs on patient-specific 3D hip models; the acetabulum was rotated laterally to the lateral center-edge angles (LCEA) of 30°, 35°, and 40°. Finite-element analysis was used to calculate the CP of the acetabular cartilage during a single-leg stance. Results Coronal correction to the LCEA of 30° decreased the median maximum CP 0.5-fold compared to preoperatively (p < 0.001). Additional correction to the LCEA of 40° further decreased CP in 15 hips (34%) but conversely increased CP in 29 hips (66%). The increase in CP was associated with greater preoperative extrusion index (p = 0.030) and roundness index (p = 0.038). Overall, virtual PAO failed to normalize CP in 11 hips (25%), and a small anterior wall index (p = 0.049) and a large roundness index (p = 0.003) were associated with residual abnormal CP. Conclusions The degree of acetabular correction in the coronal plane where CP is minimized varied among patients. Coronal plane correction alone failed to normalize CP in 25% of patients in this study. In patients with an anterior acetabular deficiency (anterior wall index < 0.21) and an aspherical femoral head (roundness index > 53.2%), coronal plane correction alone may not normalize CP. Further studies are needed to clarify the effectiveness of multiplanar correction, including in the sagittal and axial planes, in optimizing the hip joint’s contact mechanics.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Chen L, Wu Y, Chen Z, Zhou C, Fan Y, Li Z, Chen M, Zhang J, Liang Y, Wei Z. What happens to the gluteus medius in young and middle-aged patients with hip dysplasia? INTERNATIONAL ORTHOPAEDICS 2022; 46:761-768. [PMID: 34988620 DOI: 10.1007/s00264-021-05271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Much research has focused on quantifying the bony characteristics of patients with developmental dysplasia of the hip (DDH). Far less attention, however, has been paid to muscle abnormalities around the hip such as those in the gluteus medius (GM). METHODS We retrospectively examined clinical and imaging data, such as the age of onset and computed tomography (CT) findings, in 108 consecutive hips. Subjects for the control group were selected from our radiology database. Two readers independently evaluated the length (LGM), cross-sectional area (CSA), width (WGM), and thickness (TGM) of the GM and arm of GM (AGM) and angle of the GM activation (AOA) and bony parameters including the acetabulum-head index (AHI), lateral central edge angle (LCEA), acetabular index (AI), femoral offset (FO), and height of the rotation centre of femoral head (HCFH) among all cases using the imaging data. RESULTS The patient group included 108 hips. The AGM, LGM, CSA, and TGM were lower in the DDH patients, while AOA was higher. However, there was no significant difference in the WGM between the two groups. Multiple linear regression analysis showed that AGM and AOA were independent factors affecting LCEA. The following regression equation was used: Y(LCEA) = 5.377 * X1 (AGM) - 0.310 * X2 (AOA) - 11.331. The mechanical characteristics of the GM and many bony parameters were significantly correlated (the AGM and AHI, LCEA, AI, FO, but not HCFH; AOA and AHI, LCEA, AI, but not FO or HCFH). The CSA was positively correlated with only HCFH. The rest were not statistical significance linear correlation. The multivariate regression results showed that the age of onset was positively correlated with AGM (r = 0.467). The regression equation used was Y = 9.0 * X (age of onset) - 11.4. CONCLUSION We found difference in the morphological and mechanical characteristics of the GM between hips with DDH and hips of normal morphology. Of note, the mechanical characteristics of the GM were influenced by bony parameters in patients with DDH.
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Affiliation(s)
- Lixin Chen
- Guangdong Province, Huizhou Herbalist Doctor Hospital, Guangzhou University of Chinese Medicine, Huizhou, 516000, China
| | - Yunlong Wu
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Zhenqiu Chen
- The Department of Orthopedics, Guangdong Province, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Chi Zhou
- The Department of Orthopedics, Guangdong Province, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yinuo Fan
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Zhongfeng Li
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Minghai Chen
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Jiahao Zhang
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Yupeng Liang
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
| | - Zhiming Wei
- The First Clinical Medical College, Guangdong Province, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, China
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Salih S, Grammatopoulos G, Burns S, Hall-Craggs M, Witt J. Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage? Bone Jt Open 2022; 3:12-19. [PMID: 34985308 PMCID: PMC9047077 DOI: 10.1302/2633-1462.31.bjo-2021-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC). Methods This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017. Overall, 97 hips in 75 patients had 3D analysis by Clinical Graphics, giving measurements for LCEA, acetabular index (AI), and FHC. Roentgenographical LCEA, AI, posterior wall index (PWI), and anterior wall index (AWI) were measured from supine AP pelvis radiographs. The correlation between CT and roentgenographical measurements was calculated. Sequential multiple linear regression was performed to determine the relationship between roentgenographical measurements and CT FHC. Results CT-measured LCEA and AI correlated strongly with roentgenographical LCEA (r = 0.92; p < 0.001) and AI (r = 0.83; p < 0.001). Radiological LCEA correlated very strongly with CT FHC (r = 0.92; p < 0.001). The sum of AWI and PWI also correlated strongly with CTFHC (r = 0.73; p < 0.001). CT measurements of LCEA and AI were 3.4° less and 2.3° greater than radiological LCEA and AI measures. There was a linear relation between radiological LCEA and CT FHC. The linear regression model statistically significantly predicted FHC from LCEA, F(1,96) = 545.1 (p < 0.001), adjusted R2 = 85.0%, with the prediction equation: CT FHC(%) = 42.1 + 0.77(XRLCEA) Conclusion CT and roentgenographical measurement of acetabular parameters are comparable. Currently, a radiological LCEA greater than 25° is considered normal. This study demonstrates that those with hip pain and normal radiological acetabular parameters may still have deficiencies in FHC. More sophisticated imaging techniques such as 3D CT should be considered for those with hip pain to identify deficiencies in FHC. Cite this article: Bone Jt Open 2022;3(1):12–19.
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Affiliation(s)
- Saif Salih
- Department of Trauma and Orthopaedics, Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | | | - Johan Witt
- University College London Hospital, London, UK
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Tassinari E, Mariotti F, Castagnini F, Lucchini S, Perdisa F, Bracci G, Cosentino M, Bordini B, Traina F. Isolated arthroscopic treatment of intra-articular pathologies in mild hip dysplasia: a short-term case control study. J Exp Orthop 2021; 8:112. [PMID: 34860310 PMCID: PMC8642519 DOI: 10.1186/s40634-021-00428-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim is to compare the results of isolated hip arthroscopy in patients with borderline dysplasia with Lateral center edge angle (LCEA) between 18° and 25° with a control group of patients with normal LCEA (> 25°). METHODS Fifty hip arthroscopies performed in 45 patients were retrospectively evaluated. Exclusion criteria were: age > 40, hip arthritis > grade 2 according to Tonnis classification, femoral head avascular necrosis, pediatric's orthopaedics conditions and true dysplasia with LCEA < 18°.Two groups were identified: group A with 15 hips with LCEA between 25° and 18° and Group control B made of 35 hips with LCEA > 25°. RESULTS The groups were homogeneous for demography and pre-operative WOMAC and HOOS. Osteoplasty for CAM were performed in 100% of patients in both groups, only in 12 hips (34.4%) in group B we had both femoral and acetabular osteoplasty. Labral repair was performed in 86% of patients in group A, in 60% of patients in group B, capsular plication in 93% of group A, in 5% of case of group B. WOMAC and HOOS statically significant improved in both groups at final follow-up (24 months). No cases in both groups required conversion to total hip arthroplasty. Clinical outcomes of study group were comparable to the control group. CONCLUSION Even if the present small series is not conclusive, we suggest isolated arthroscopic management of patients with FAI and LCEA between 18° and 25°, but capsular plication and careful labral management are strongly recommended. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federica Mariotti
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Perdisa
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Bracci
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IrCCs Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IrCCs Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti di Anca e di Ginocchio, IrCCs Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Dittmer Flemig AJ, Essilfie A, Schneider B, Robustelli S, Sink EL. The use of image analysis software increases the accuracy of the periacetabular osteotomy fragment placement. J Hip Preserv Surg 2021; 8:325-330. [PMID: 35505798 PMCID: PMC9052410 DOI: 10.1093/jhps/hnab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to report on the use of image analysis technology to enhance accuracy of intra-operative imaging and evaluation of periacetabular osteotomy (PAO) correction. This was a retrospective study reporting on the first 25 cases of PAO performed with the use of an image analysis tool. This technology was used intra-operatively to assess the position of the supine coronal image in comparison to pre-operative standing images using a ratio of pelvic tilt (PT). Intra-operative PT, Tönnis angle, lateral center–edge angle (LCEA) and anterior wall index were compared to post-operative images. Post-operative radiographic parameters in the study group were compared with a control group of PAO cases performed prior to the implementation of the new software. The image analysis software was able to obtain intra-operative supine imaging that was equivalent to pre-operative standing imaging. When comparing the PAOs performed with the use of the software versus those without, the study group trended toward being more likely within the surgeon’s defined target range of radiographic values, which was statistically significant for LCEA. This tool can be used to assure the surgeon that the intra-operative image being used for surgical decision-making is representative of the functional radiograph. PAOs performed with the use of this technology showed enhanced accuracy of surgical correction for the parameters within our defined target ranges. This may increase the ability of the surgeon to place the acetabular fragment more precisely within his or her goal parameters for acetabular reorientation correction.
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Affiliation(s)
- Alison J Dittmer Flemig
- Department of Orthopedic Surgery, Gillette Children’s Specialty Healthcare, 200 University Avenue East, St. Paul, MN 55101, USA
| | - Anthony Essilfie
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Brandon Schneider
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Stacy Robustelli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Ernest L Sink
- Department of Hip Preservation, Hospital for Special Surgery, 535 East 70th Street, NY, NY 10021, USA
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Watchmaker LE, Hetzel SJ, Sink EL, Spiker AM. Interrater Reliability of the Prone Apprehension Relocation Test. Orthop J Sports Med 2021; 9:23259671211032229. [PMID: 34568506 PMCID: PMC8461127 DOI: 10.1177/23259671211032229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The Prone Apprehension Relocation Test (PART) augments existing radiographic measures and clinical provocative maneuvers in diagnosing hip instability. One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. Purpose: To determine the interrater reliability of the PART among health care providers. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by a single physician as well as 1 of 12 physician extenders (a licensed athletic trainer or a physical therapist). The providers were blinded to the findings of the other examining professional. Interrater reliability was assessed using the Cohen κ (≥0.75 was considered excellent; between 0.75 and 0.40, moderate; and ≤0.40, poor). Results: A total of 96 patients (190 hips) were included in this study (61 women and 35 men, average age 32 ± 12.1 years). A total of 23 hips had a positive PART from both examiners. Interrater reliability was excellent between health care professionals for the PART when evaluating the right hip (κ = 0.80), left hip (κ = 0.82), and when combining the results for left and right (κ = 0.81). A subanalysis of patients with a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center-edge angle >25°. Conclusion: Our study demonstrated excellent interrater reliability of the PART, supporting its use in the physical evaluation of painful hips.
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Affiliation(s)
- Lauren E Watchmaker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Nazaroff J, Mark B, Learned J, Wang D. Measurement of acetabular wall indices: comparison between CT and plain radiography. J Hip Preserv Surg 2021; 8:51-57. [PMID: 34567600 PMCID: PMC8460168 DOI: 10.1093/jhps/hnab008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 01/13/2020] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to compare measurements of anterior wall index (AWI) and posterior wall index (PWI) on computed tomography (CT) to those on radiographs (XR). A consecutive cohort of 33 patients (45 hips total) being evaluated for hip pain with both XR and CT was examined. Preoperative measurements of AWI and PWI were performed utilizing supine anteroposterior pelvic XR and coronal and swiss axial CT scans by two independent raters. Mean differences between XR and CT measurements were compared, and agreement between measurements was assessed using the concordance correlation coefficient (rc) and Bland–Altman analysis. A total of 39 hips in 28 patients were analyzed. The mean patient age was 31.1 ± 9.0 years, and 50% were female. Mean AWI and PWI on XR was 0.50 ± 0.14 and 0.91 ± 0.12, respectively. Measured values of AWI were consistently larger (0.08 ± 0.10, P < 0.01) on XR compared with both coronal and swiss axial CT, with moderate agreement between XR and CT measurements (rc = 0.68–0.70). Measured values of PWI were consistently smaller (0.15 ± 0.12, P < 0.05) on XR compared with both coronal and swiss axial CT, with poor agreement between XR and CT measurements (rc = 0.37–0.45). Measured values of acetabular wall indices on XR were consistently larger for AWI and smaller for PWI relative to CT. Agreement between XR and CT measures of the indices were moderate to poor. This highlights the need for standardization of XR- and CT-based measurements to improve assessment of acetabular coverage and subsequent clinical decision-making.
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Affiliation(s)
- Jaron Nazaroff
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA
| | - Bryan Mark
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
| | - James Learned
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
| | - Dean Wang
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
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Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Shibanuma N, Ishida K, Niikura T, Nishida K, Kuroda R. Postoperative excessive anterior acetabular coverage is associated with decrease in range of motion after periacetabular osteotomy. Hip Int 2021; 31:669-675. [PMID: 32126854 DOI: 10.1177/1120700020910370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between acetabular 3-dimensional (3D) alignment reorientation and clinical range of motion (ROM) after periacetabular osteotomy (PAO). METHODS 50 patients (58 hips) with hip dysplasia participated in the study and underwent curved PAO. The pre- and postoperative 3D centre-edge (CE) angles and femoral anteversion were measured and compared with clinical outcomes, including postoperative ROM. RESULTS The correlation between pre- and postoperative acetabular coverage and postoperative ROM was evaluated. Postoperative abduction and internal rotation ROM were significantly associated with postoperative lateral CE angles (abduction; p < 0.001, internal rotation; p = 0.028); flexion and internal rotation ROM was significantly associated with postoperative anterior CE angles (flexion; p < 0.001, internal rotation; p = 0.028). Femoral anteversion was negatively correlated with postoperative abduction (p = 0.017) and external rotation (p = 0.047) ROM. CONCLUSION Postoperative anterior acetabular coverage may affect internal rotation ROM more than the lateral coverage. Therefore, the direction of acetabular reorientation should be carefully determined according to 3D alignment during PAO.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease. Sci Rep 2021; 11:16506. [PMID: 34389771 PMCID: PMC8363621 DOI: 10.1038/s41598-021-95806-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/22/2021] [Indexed: 11/08/2022] Open
Abstract
The acetabular retroversion has a moderate incidence of 31-60% in all patients of the Perthes disease. It might be caused by posterior wall dysplasia based on recent animal researches. However, some studies support that hemipelvic retroversion is the main factor for the acetabular retroversion. The primary pathological factor of increasing retroversion angle is still controversial anatomically. This study aimed to identify whether there is acetabular retroversion in children with Perthes disease,and to find a method to distinguish version types. Forty children with unilateral Perthes disease who were admitted to our hospital from January 1, 2012 to December 31, 2018 were enrolled, and 40 controls were matched based on sex and age. The acetabular anteversion angle (AAA), internal wall anteversion angle (IWAA), anterior wall height of the acetabulum (A), acetabular posterior wall height (P), and acetabular width (W) were assessed on computed tomography (CT) at the level of the femoral head center. The acetabular wall difference index (AWDI; AWDI = P-A)/W*100) was calculated. The mean AAA was significantly lower in Perthes disease hips (10.59 (8.05-12.46)) than in contralateral hips (12.04 (9.02-13.33)) (p = 0.002) but did not differ from control hips (9.68 ± 3.76) (p = 0.465). The mean IWAA was significantly lower in Perthes hips (9.16 ± 3.89) than in contralateral hips (11.31 ± 4.04) (p = 0.000) but did not differ from control hips (9.43 ± 3.82) (p = 0.753). The mean AWDI did not differ between Perthes hips (0.41 ± 4.94) and contralateral hips (- 1.12 (- 4.50, 2.17)) (p = 0.06) or control hips (- 0.49 ± 5.46) (p = 0.437). The mean W was significantly higher in Perthes hips (44.61 ± 5.06) than in contralateral hips (43.36 ± 4.38) (p = 0.000) but did not differ from control hips (45.02 ± 5.01) (p = 0.719). The mean A and P did not differ between Perthes hips and contralateral hips or control hips. Correlation analysis of all hip joints revealed a significant correlation between AAAs and IWAAs (r = 0.772; r = 0.643; r = 0.608; and r = 0.540). Linear regression analysis revealed that AAAs increased with IWAAs. Multiple linear regression showed that IWAAs and AWDIs have good predictive value for AAAs in both Perthes and control hips (R2 = 0.842, R2 = 0.869). In patients with unilateral Perthes disease, the affected acetabulum is more retroverted than that on the contralateral side, which may be caused by hemipelvic retroversion. The measurements in this study could distinguish the form of acetabular retroversion. IWAAs and AWDIs can be used as new observations in future studies of acetabular version.
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Murata Y, Fukase N, Dornan G, Martin M, Soares R, Pierpoint L, Philippon MJ. Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211015973. [PMID: 34395680 PMCID: PMC8358532 DOI: 10.1177/23259671211015973] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.
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Affiliation(s)
- Yoichi Murata
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Naomasa Fukase
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Grant Dornan
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Maitland Martin
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Rui Soares
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Lauren Pierpoint
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
| | - Marc J Philippon
- The Steadman Philippon Research Institute and the Steadman Clinic, Vail, Colorado, USA
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50
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Kitamura K, Fujii M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Does Patient-specific Functional Pelvic Tilt Affect Joint Contact Pressure in Hip Dysplasia? A Finite-element Analysis Study. Clin Orthop Relat Res 2021; 479:1712-1724. [PMID: 33787527 PMCID: PMC8277263 DOI: 10.1097/corr.0000000000001737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although individual and postural variations in the physiologic pelvic tilt affect the acetabular orientation and coverage in patients with hip dysplasia, their effect on the mechanical environment in the hip has not been fully understood. Individual-specific, finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the contact mechanics of dysplastic hips, which can lead to further understanding of the pathogenesis and improved treatment of this patient population. QUESTION/PURPOSE We used finite-element analysis to ask whether there are differences between patients with hip dysplasia and patients without dysplasia in terms of (1) physiologic pelvic tilt, (2) the pelvic position and joint contact pressure, and (3) the morphologic factors associated with joint contact pressure. METHODS Between 2016 and 2019, 82 patients underwent pelvic osteotomy to treat hip dysplasia. Seventy patients with hip dysplasia (lateral center-edge angle ≥ 0° and < 20° on supine AP pelvic radiographs) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or supine surgery, or poor-quality imaging were excluded. Thirty-two patients (32 hips) were eligible to this finite-element analysis study. For control groups, we reviewed 33 female volunteers without a history of hip disease. Individuals with frank or borderline hip dysplasia (lateral center-edge angle < 25°) or poor-quality imaging were excluded. Sixteen individuals (16 hips) were eligible as controls. Two board-certified orthopaedic surgeons measured sagittal pelvic tilt (the angle between the anterior pelvic plane and vertical axis: anterior pelvic plane [APP] angle) and acetabular version and coverage using pelvic radiographs and CT images. Intra- and interobserver reliabilities, evaluated using the kappa value and intraclass correlation coefficient, were good or excellent. We developed individual-specific, finite-element models using pelvic CT images, and performed nonlinear contact analysis to calculate the joint contact pressure on the acetabular cartilage during the single-leg stance with respect to three pelvic positions: standardized (anterior pelvic plane), supine, and standing. We compared physiologic pelvic tilt between patients with and without dysplasia using a t-test or the Wilcoxon rank sum test. A paired t-test or the Wilcoxon signed rank test with a Bonferroni correction was used to compare joint contact pressure between the three pelvic positions. We correlated joint contact pressure with morphologic parameters and pelvic tilt using the Pearson or the Spearman correlation coefficients. RESULTS The APP angle in the supine and standing positions varied widely among individuals. It was greater in patients with hip dysplasia than in patients in the control group when in the standing position (3° ± 6° versus -2° ± 8°; mean difference 5° [95% CI 1° to 9°]; p = 0.02) but did not differ between the two groups when supine (8° ± 5° versus 5° ± 7°; mean difference 3° [95% CI 0° to 7°]; p = 0.06). The mean pelvic tilt was 6° ± 5° posteriorly when shifting from the supine to the standing position in patients with hip dysplasia. The median (range) maximum contact pressure was higher in dysplastic hips than in control individuals (in standing position; 7.3 megapascals [MPa] [4.1 to 14] versus 3.5 MPa [2.2 to 4.4]; difference of medians 3.8 MPa; p < 0.001). The median maximum contact pressure in the standing pelvic position was greater than that in the supine position in patients with hip dysplasia (7.3 MPa [4.1to 14] versus 5.8 MPa [3.5 to 12]; difference of medians 1.5 MPa; p < 0.001). Although the median maximum joint contact pressure in the standardized pelvic position did not differ from that in the standing position (7.4 MPa [4.3 to 15] versus 7.3 MPa [4.1 to 14]; difference of medians -0.1 MPa; p > 0.99), the difference in the maximum contact pressure varied from -3.3 MPa to 2.9 MPa, reflecting the wide range of APP angles (mean 3° ± 6° [-11° to 14°]) when standing. The maximum joint contact pressure in the standing position was negatively correlated with the standing APP angle (r = -0.46; p = 0.008) in patients with hip dysplasia. CONCLUSION Based on our findings that individual and postural variations in the physiologic pelvic tilt affect joint contact pressure in the hip, future studies on the pathogenesis of hip dysplasia and joint preservation surgery should not only include the supine or standard pelvic position, but also they need to incorporate the effect of the patient-specific pelvic tilt in the standing position on the biomechanical environment of the hip. CLINICAL RELEVANCE We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning preservation hip surgery because assessment in a supine or standard pelvic position may overlook alterations in the hip's contact mechanics in the weightbearing positions. Further studies are needed to elucidate the effect of patient-specific functional pelvic tilt on the degeneration process of dysplastic hips, the acetabular reorientation maneuver, and the clinical result of joint preservation surgery.
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Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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