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Yasunaga Y, Oshima S, Shoji T, Adachi N, Ochi M. A 30-year follow-up study of rotational acetabular osteotomy for pre- and early-stage osteoarthritis secondary to dysplasia of the hip. Bone Joint J 2024; 106-B:25-31. [PMID: 38688491 DOI: 10.1302/0301-620x.106b5.bjj-2023-0818.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: 05/02/2024]
Abstract
Aims The objective of this study was to present the outcomes of rotational acetabular osteotomy (RAO) over a 30-year period for osteoarthritis (OA) secondary to dysplasia of the hip in pre- or early-stage OA. Methods Between September 1987 and December 1994, we provided treatment to 47 patients (55 hips) with RAO for the management of pre- or early-stage OA due to developmental hip dysplasia. Of those, eight patients (11 hips) with pre-OA (follow-up rate 79%) and 27 patients (32 hips) with early-stage OA (follow-up rate 78%), totalling 35 patients (43 hips) (follow-up rate 78%), were available at a minimum of 28 years after surgery. Results In the pre-OA group, the mean Merle d'Aubigné score improved significantly from 14.5 points (SD 0.7) preoperatively to 17.4 points at final follow-up (SD 1.2; p = 0.004) and in the early-stage group, the mean score did not improve significantly from 14.0 (SD 0.3) to 14.6 (SD 2.4; p = 0.280). Radiologically, the centre-edge angle, acetabular roof angle, and head lateralization index were significantly improved postoperatively in both groups. Radiological progression of OA was observed in two patients (two hips) in the pre-OA group and 17 patients (18 hips) in the early-stage group. Kaplan-Meier survival analysis, with radiological progression of OA as the primary outcome, projected a 30-year survival rate of 81.8% (95% confidence interval (CI) 0.59 to 1.00) for the pre-OA group and 42.2% (95% CI 0.244 to 0.600) for the early-stage group. In all cases, the overall survival rate stood at 51.5% (95% CI 0.365 to 0.674) over a 30-year period, and when the endpoint was conversion to total hip arthroplasty, the survival rate was 74.0% (95% CI 0.608 to 0.873). Conclusion For younger patients with pre-OA, joint preservation of over 30 years can be expected after RAO.
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Affiliation(s)
- Yuji Yasunaga
- Hiroshima Prefectural Rehabilitation Center, Hiroshima, Japan
| | | | - Takeshi Shoji
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Nobou Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Tang Y, Wang D, Wang L, Xiong W, Fang Q, Lin W, Wang G. A minimally invasive periacetabular osteotomy improves the radiographic parameters and functional outcomes in the treatment of developmental dysplasia of the hip in adolescents and adults: surgical technique and early results. INTERNATIONAL ORTHOPAEDICS 2022; 46:2807-2814. [PMID: 35963963 DOI: 10.1007/s00264-022-05545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To introduce West China Hospital periacetabular osteotomy (WCH PAO) for acetabular dysplasia in adolescent and young adult patients and evaluate the early clinical results of WCH PAO. METHODS A retrospective analysis of 34 patients with developmental dysplasia of the hip was performed from October 2019 to April 2021. Baseline data with surgical time and perioperative blood-loss volume were retrieved from medical record systems. The lateral center-to-edge angle (LCEA), acetabular inclination (AI), hip disability and osteoarthritis outcome score (HOOS), University of California Los Angeles (UCLA), and modified Harris hip score (mHHS) were compared preoperatively and postoperatively. RESULTS All patients had significant postoperative radiology improvements, including LCEA and AI. The LCEA was improved from 12.9 to 33.2°, and the AI was decreased from 27.2 to 8.5°. In addition, hip functional outcomes, including HOOS, UCLA and mHHS, were improved. The UCLA was improved from 3.9 to 6.3, and the HOOS was decreased from 71.0 to 10.5. The Harris hip score improved from 50.8 before surgery to 87.4 after surgery. The mean operative time was 155 min (range 120 to 190 min), and the mean intra-operative blood loss was 580.2 ± 285.5 ml. Furthermore, no major complications, including nerve injury or bone nonunion, occurred in the cohort study. CONCLUSION WCH PAO is a minimally invasive surgical method for acetabular dysplasia in adolescent and young adult patients who that simplifies the surgical procedure and decreases the incidence of complications related to osteotomy.
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Affiliation(s)
- Yunfeng Tang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Dong Wang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Limin Wang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wei Xiong
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Qian Fang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wei Lin
- West China Women's and Children's Hospital, No. 17 People's South Road, Chengdu, Sichuan, China.
| | - Guanglin Wang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Treatment of Severe Hip Dysplasia with Leg Length Discrepancy Using Spherical Periacetabular Osteotomy. Case Rep Orthop 2022; 2022:3930806. [PMID: 36106153 PMCID: PMC9467771 DOI: 10.1155/2022/3930806] [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: 03/09/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022] Open
Abstract
Case. A 20-year-old woman with severe subluxation of the hip displayed a leg length discrepancy of approximately 20 mm. The proposed treatment was a spherical periacetabular osteotomy (SPO) for joint preservation and postoperative leg length maintenance. SPO is a novel periacetabular osteotomy procedure. At her 3-year follow-up, the patient had functional, pain-free motion and high satisfaction. In this case, the SPO technique was able to achieve satisfactory clinical results without further exacerbating the leg length discrepancy after surgery.
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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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Kaneuji A, Hara T, Takahashi E, Fukui K, Ichiseki T, Kawahara N. A Novel Minimally Invasive Spherical Periacetabular Osteotomy: Pelvic Ring Preservation and Patient-Specific Osteotomy by Preoperative 3-Dimensional Templating. J Bone Joint Surg Am 2021; 103:1724-1733. [PMID: 33988546 DOI: 10.2106/jbjs.20.00940] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spherical periacetabular osteotomy (SPO) is a novel osteotomy involving splitting the teardrop, using patient-specific preoperative planning, and requiring only a 7-cm skin incision. We report preoperative planning methods and short-term results of SPO. METHODS In preoperative planning, computed tomography (CT) images were imported into 3-dimensional templating software. The radius of the curved chisel was mapped to pass through the teardrop, the infracotyloid groove of the ischium, and the area between the anterior superior iliac spine and the anterior inferior iliac spine. The osteotomy height and the predicted depth of osteotome insertion were measured, and those values were reproduced during surgery. We performed a retrospective analysis of data on 52 consecutive patients (55 hips) with hip dysplasia who underwent SPO and were followed for at least 2 years: 27 hips had Tönnis grade 0, 21 had grade 1, and 7 had grade 2. The mean age at surgery was 38 years (range, 17 to 56 years). The rotated bone fragment and iliac crest were fixed with absorbable screws. Statistical analysis was performed with the paired t test. RESULTS The mean (range) of the lateral center-edge and sourcil angles were 6.0° (-20° to 18°) and 26.0 (13° to 38°), respectively, before surgery and 30.0° (15° to 43°) and 3.8° (-4° to 27°), respectively, after surgery (p < 0.001). However, 11 hips (20%) showed a loss of correction of bone rotation (<3 mm) or the sourcil angle (<3°). Radiographs showed bone union in all hips within 3 months after the surgery. Early second surgery related to absorbable screws was performed in 2 hips. No patient had required conversion to total hip arthroplasty at the time of writing. Clinical scores were significantly improved at the 2-year follow-up (p < 0.001). Paresthesia of the lateral femoral cutaneous nerve area was very common but had resolved in 92% of the patients at the 2-year follow-up. CONCLUSIONS SPO is a novel minimally invasive periacetabular osteotomy that has the potential disadvantage of early loss of correction (observed in 20% of the hips in the present study) but may provide the benefit of decreasing the risk of nonunion at the pubis osteotomy site. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka City, Fukuoka, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Kiyokazu Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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Stetzelberger VM, Leibold CS, Steppacher SD, Schwab JM, Siebenrock KA, Tannast M. The Acetabular Wall Index Is Associated with Long-term Conversion to THA after PAO. Clin Orthop Relat Res 2021; 479:1052-1065. [PMID: 33605631 PMCID: PMC8052033 DOI: 10.1097/corr.0000000000001641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/17/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) has been shown to be a valuable option for delaying the onset of osteoarthritis in patients with hip dysplasia. Published studies at 30 years of follow-up found that postoperative anterior overcoverage and posterior undercoverage were associated with early conversion to THA. The anterior and posterior wall indices are practical tools for assessing AP coverage on standard AP radiographs of the pelvis pre-, intra-, and postoperatively. However, no study that we know of has evaluated the relationship between the postoperative anterior and posterior wall indices and survivorship free from arthroplasty. QUESTIONS/PURPOSES In a study including patients after PAO for developmental dysplasia of the hip (DDH), we evaluated whether the acetabular wall index is associated with conversion to THA in the long-term after PAO. We asked: (1) Is an abnormal postoperative anterior wall index associated with conversion to THA after PAO? (2) Is an abnormal postoperative posterior wall index associated with conversion to THA after PAO? (3) Are there other factors associated with joint replacement after PAO? METHODS This retrospective study involved pooling data of PAO for DDH from two previously published sources. The first series (1984-1987) comprised the very first 75 PAOs for symptomatic DDH performed at the inventor's institution. The second (1997-2000) comprised a series of PAOs for symptomatic DDH completed at the same institution 10 years later. No patient was lost to follow-up. Fifty hips (44 patients) were excluded for predefined reasons (previous surgery, substantial femoral pathomorphologies, poor-quality radiographs), leaving 115 hips (102 patients, mean age 29 ± 11 years, 28% male) for analysis with a mean follow-up of 22 ± 6 years. One observer not involved in patient treatment digitally measured the anterior and posterior wall indices on postoperative AP pelvic radiographs of all patients. All patients were contacted by mail or telephone to confirm any conversion to THA and the timing of that procedure relative to the index procedure. We performed univariate and multivariate Cox regression analyses using conversion to THA as our endpoint to determine whether the anterior and posterior wall indices are associated with prosthetic replacement in the long-term after PAO. Thirty-one percent (36 of 115) of hips were converted to THA within a mean of 15 ± 7 years until failure. The mean follow-up duration of the remaining patients was 22 ± 6 years. RESULTS A deficient anterior wall index was associated with conversion THA in the long-term after PAO (adjusted hazard ratio 10 [95% CI 3.6 to 27.9]; p < 0.001). Although observed in the univariate analysis, we could not find a multivariate association between the posterior wall index and a higher conversion rate to THA. Grade 0 Tönnis osteoarthritis was associated with joint preservation (adjusted HR 0.2 [95% CI 0.07 to 0.47]; p = 0.005). Tönnis osteoarthritis Grades 2 and 3 were associated with conversion to THA (adjusted HR 2.3 [95% CI 0.9 to 5.7]; p = 0.08). CONCLUSION A deficient anterior wall index is associated with a decreased survivorship of the native hip in the long-term after PAO. Intraoperatively, in addition to following established radiographical guidelines, the acetabular wall indices should be measured systematically to ascertain optimal acetabular fragment version to increase the likelihood of reconstructive survival after PAO for DDH. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Vera M Stetzelberger
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christiane S Leibold
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Simon D Steppacher
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph M Schwab
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Klaus A Siebenrock
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Moritz Tannast
- V. M. Stetzelberger, M. Tannast. Department of Orthopaedic Surgery and Traumatology, Hôpital Fribourgeois HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
- C. S. Leibold, S. D. Steppacher, K. A. Siebenrock, Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
- J. M. Schwab, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Hwang DS, Kang C, Lee JK, Park JY, Zheng L, Hwang JM. The utility of hip arthroscopy for patients with painful borderline hip dysplasia. J Orthop Surg (Hong Kong) 2021; 28:2309499020923162. [PMID: 32410527 DOI: 10.1177/2309499020923162] [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: 11/15/2022] Open
Abstract
PURPOSE We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy. METHODS A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score-activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted. RESULTS The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively (p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 (p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved (p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%). CONCLUSIONS The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.
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Affiliation(s)
- Deuk-Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeong-Kil Lee
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jae-Young Park
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Long Zheng
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea.,Department of Orthopedic Surgery, Yanbian University Hospital, Yanji, China
| | - Jung-Mo Hwang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
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Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Kamenaga T, Niikura T, Kuroda R. Overcorrection of the acetabular roof angle or anterior center-edge angle may cause decrease of range of motion after curved periacetabular osteotomy. J Hip Preserv Surg 2020; 7:583-590. [PMID: 33948214 PMCID: PMC8081436 DOI: 10.1093/jhps/hnaa065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 11/17/2020] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to evaluate the relationship between the correction of radiographic parameters and clinical range of motion (ROM) after periacetabular osteotomy (PAO). Sixty-nine patients with hip dysplasia were enrolled and underwent curved PAO. The pre- and post-operative 3D center-edge (CE) angles, total anteversion (acetabular and femoral anteversion), and radiographic acetabular roof angle were measured and compared with the post-operative ROM. The aim of surgery was to rotate the central acetabular fragment laterally without anterior or posterior rotation. Multiple linear regression analysis demonstrated that post-operative internal rotation at 90° flexion was significantly associated with the post-operative Tönnis sourcil angle (rr = 0.31, P = 0.02) and that the post-operative ROM of flexion and internal rotation at 90° flexion were significantly associated with the anterior CE (flex; rr = -0.44, P = 0.001, internal rotation at 90° flexion; rr = -0.44, P < 0.001). However, we found no association between the lateral CE, femoral anteversion, or total anteversion and the post-operative ROM. We demonstrated that the overcorrection of the acetabular roof angle or anterior CE angle may cause a decrease in the range of motion after curved PAO. Therefore, surgeons need to be careful during surgery to prevent the overcorrection of the weight-bearing area and anterior acetabular coverage of the acetabular fragment to avoid femoroacetabular impingement after PAO.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Lara J, Garín A, Herrera C, Abara S, Besomi J, Villegas D, Neumann H, Tobar C. Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg 2020; 7:256-261. [PMID: 33163210 PMCID: PMC7605770 DOI: 10.1093/jhps/hnaa014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19–31), 96% females. Mean follow-up 7 years (range: 3–16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.
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Affiliation(s)
- Joaquín Lara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Alan Garín
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Cristhián Herrera
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Selim Abara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Javier Besomi
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Diego Villegas
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Hassan Neumann
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Carlos Tobar
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
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Lall AC, Walsh JP, Maldonado DR, Pinto LE, Ashberg LJ, Lodhia P, Radha S, Correia APR, Domb BG, Perez-Carro L, Marín-Peña O, Griffin DR. Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting. J Hip Preserv Surg 2020; 7:2-21. [PMID: 33072394 PMCID: PMC7546541 DOI: 10.1093/jhps/hnaa037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy-the International Hip Preservation Society-in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the most up-to-date and expert views on a wide variety of subjects, including: diagnostic problems in groin pain, buttock pain and low back pain; surgical techniques in acetabular dysplasia, hip instability, femoroacetabular impingement syndrome, labral repair and reconstruction, cartilage defects, adolescent hips and gluteus medius and hamstring tears; and new ideas about femoral torsion, hip-spine syndrome, hip capsule surgery, impact of particular sports on hip injuries, registries, robotics and training for hip preservation specialists. Surgeons, sports physicians, radiologists and physiotherapists looking after young people with hip problems have an increasingly sophisticated armoury of ideas and techniques with which to help their patients. The concept of hip preservation has developed incredibly fast over the last decade; now it is clear that the best results can only be achieved by a multidisciplinary team working together. The 2020s will be the decade of 'Teamwork in Hip Preservation'.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - John P Walsh
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,Des Moines University, Desert Orthopaedic Center, 2800 E, Desert Inn Rd, Las Vegas, NV 89121, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Leonardo E Pinto
- Centro Medico Decente La Trinidad (Trinity Medical Center), Av. Principal de El Hatillo, Caracas 1080, Metropolitan District of Caracas, Venezuela
| | - Lyall J Ashberg
- Atlantis Orthopaedics, 4560 Lantana Rd Suite 100, Lake Worth, Atlantis, FL 33463, USA
| | - Parth Lodhia
- Footbridge Centre for Integrated Orthopaedic Care, 181 Keefer Pl #221, Vancouver, BC V6B 6C1, Canada
| | - Sarkhell Radha
- Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, London, UK
| | | | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA.,American Hip Institute, 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA
| | - Luis Perez-Carro
- Hospital Clinica Mompia, Av. de los Condes, s/n, 39108 Mompía, Cantabria, Spain
| | - Oliver Marín-Peña
- University Hospital Infanta Leonor, Av. Gran Vía del Este, 80, 28031 Madrid, Spain and
| | - Damian R Griffin
- Warwick Medical School, University of Warwick and University Hospitals of Coventry and Warwickshire, Coventry CV4 7AL, UK
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11
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Tang HC, Dienst M. Surgical Outcomes in the Treatment of Concomitant Mild Acetabular Dysplasia and Femoroacetabular Impingement: A Systematic Review. Arthroscopy 2020; 36:1176-1184. [PMID: 31809799 DOI: 10.1016/j.arthro.2019.11.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the current approaches and clinical outcomes in the surgical management of concomitant mild acetabular dysplasia and femoroacetabular impingement (FAI). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method, the PubMed and Medline databases were searched in March 2019 for studies that reported on surgical outcomes in hips with concomitant mid acetabular dysplasia and FAI. Studies published in English that focused on the surgical outcomes after hip arthroscopy, open surgery, or periacetabular osteotomy of concomitant acetabular dysplasia and FAI, in which the lateral center-edge angle of all subjects was between 15° and 25°, were included. Articles that included subjects with lateral center-edge angle <15°, with a minimum follow-up duration <1 year, had <5 subjects, or were not original articles were excluded. RESULTS The initial search yielded 748 studies, and 5 studies met the inclusion criteria. All these 5 studies focused on hip arthroscopic treatment for patients with concomitant mild acetabular dysplasia and FAI. Three studies had level III evidence, whereas 2 studies had level IV evidence. The mean patient age range across the studies was 29.8 to 49.6 years, and the female-to-male ratio was 1.14. Improved patient-reported outcomes (Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport, modified Harris Hip Score, Short Form-12 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index) at a minimum 2-year follow-up were obtained in 4 of the 5 studies. Two of these 4 studies had a comparative cohort of patients with FAI with normal acetabular coverage, and there was no significant difference in the postoperative outcomes and secondary procedure rate between patients with mild acetabular dysplasia and those with normal acetabular coverage. CONCLUSIONS This systematic review indicates that improved patient-reported outcomes can be obtained with hip arthroscopy in the treatment of concomitant mild acetabular dysplasia and FAI at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level IV, systematic review of Level III and Level IV studies.
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Affiliation(s)
- Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
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12
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Mei-Dan O, Welton KL, Kraeutler MJ, Young DA, Raju S, Garabekyan T. The CU PAO: A Minimally Invasive, 2-Incision, Interlocking Periacetabular Osteotomy: Technique and Early Results. J Bone Joint Surg Am 2019; 101:1495-1504. [PMID: 31436658 DOI: 10.2106/jbjs.19.00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this study were to describe a novel minimally invasive, interlocking periacetabular osteotomy (PAO) for the treatment of hip dysplasia that was developed at our institution and to report on its safety, complications, and early clinical outcomes. METHODS This was a prospective longitudinal study of the first 200 consecutive hips that underwent the CU (University of Colorado) PAO, an interlocking osteotomy combining the benefits of the Birmingham interlocking pelvic osteotomy (BIPO) and the Ganz PAO. The technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight-bearing postoperatively. Demographic characteristics, intraoperative and perioperative parameters, and functional outcomes were documented. All patients underwent hip arthroscopy 3 to 10 days prior to the PAO to address concomitant intra-articular pathology. Mechanical deep venous thrombosis (DVT) prophylaxis was used for 2 weeks postoperatively. Results were stratified to compare the first 100 and the second 100 cases. RESULTS A total of 161 patients (200 hips) underwent primary PAO; mean follow-up was 20 months (range, 3 to 33 months). The mean patient age at the time of surgery was 29.4 years (range, 13 to 55 years). Females accounted for 89% of the patients included in this study. The average length of stay was 4 days. A concomitant proximal femoral derotational osteotomy was performed in 19 hips. The lateral center-edge angle (LCEA) improved from a mean of 18.8° preoperatively to 31.5° postoperatively (p < 0.001). The mean Non-Arthritic Hip Score (NAHS) improved from 56.0 preoperatively to 89.4 at the 24-month follow-up (p < 0.0001). Paresthesias in the distribution of the lateral femoral cutaneous nerve were common (65% at 2 weeks postoperatively) but resolved in 85% of the patients within the first 6 months. There were no sciatic nerve-related complications, deep infections, or DVTs. CONCLUSIONS The CU PAO enables corrective realignment of symptomatic acetabular dysplasia with direct visualization of the sciatic nerve, early weight-bearing, cosmetic incisions, and good short-term outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - K Linnea Welton
- Hip Preservation and Sports Surgery, MultiCare Health System, Auburn, Washington
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
| | - David A Young
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | - Sivashanmugam Raju
- Department of Pediatric Orthopedic Surgery, St. Louis University School of Medicine, St. Louis, Missouri
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13
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CORR Insights®: Are Complications After the Bernese Periacetabular Osteotomy Associated With Subsequent Outcomes Scores? Clin Orthop Relat Res 2019; 477:1164-1167. [PMID: 30958393 PMCID: PMC6494301 DOI: 10.1097/corr.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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14
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Yasunaga Y, Tanaka R, Mifuji K, Shoji T, Yamasaki T, Adachi N, Ochi M. Rotational acetabular osteotomy for symptomatic hip dysplasia in patients younger than 21 years of age: seven- to 30-year survival outcomes. Bone Joint J 2019; 101-B:390-395. [PMID: 30929485 DOI: 10.1302/0301-620x.101b4.bjj-2018-1200.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to report the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients aged younger than 21 years at the time of surgery. PATIENTS AND METHODS We evaluated 31 patients (37 hips) aged younger than 21 years at the time of surgery retrospectively. There were 29 female and two male patients. Their mean age at the time of surgery was 17.4 years (12 to 21). The mean follow-up was 17.9 years (7 to 30). The RAO was combined with a varus or valgus femoral osteotomy or a greater trochanteric displacement in eight hips, as instability or congruence of the hip could not be corrected adequately using RAO alone. RESULTS The mean Merle d'Aubigné clinical score improved significantly from 15.4 to 17.2 (p < 0.0001). The mean centre-edge (CE) angle improved from -2.6° to 26°, the mean acetabular roof angle improved from 3.0° to 5.2°, and the mean head lateralization index improved from 0.68 to 0.62. Progression of radiological osteoarthritis (OA) was seen in seven hips, but no patient underwent total hip arthroplasty. CONCLUSION RAO is an effective form of correction for a severely dysplastic hip in adolescent and young adult patients. Cite this article: Bone Joint J 2019;101-B:390-395.
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Affiliation(s)
- Y Yasunaga
- Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Japan
| | - R Tanaka
- Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, Japan
| | - K Mifuji
- Department of Orthopaedic Surgery, Hiroshima University, Higashi-Hiroshima, Japan
| | - T Shoji
- Department of Orthopaedic Surgery, Hiroshima University, Higashi-Hiroshima, Japan
| | - T Yamasaki
- Department of Orthopaedic Surgery, Hiroshima University, Higashi-Hiroshima, Japan
| | - N Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Higashi-Hiroshima, Japan
| | - M Ochi
- Hiroshima University, Higashi-Hiroshima, Japan
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15
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Witt JD, Haddad FS. Acetabular dysplasia: multiple pathologies and myriad solutions. Bone Joint J 2018; 99-B:705-707. [PMID: 28566387 DOI: 10.1302/0301-620x.99b6.bjj-2017-0491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- J D Witt
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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16
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Kraeutler MJ, Raju S, Garabekyan T, Mei-Dan O. Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis. J Hip Preserv Surg 2018; 5:119-124. [PMID: 29876127 PMCID: PMC5961113 DOI: 10.1093/jhps/hny008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/29/2017] [Accepted: 02/11/2018] [Indexed: 02/02/2023] Open
Abstract
There are currently no established guidelines for appropriate antithrombotic prophylaxis following periacetabular osteotomy (PAO) or derotational femoral osteotomy (DFO). The purpose of this study was to determine the incidence of clinical deep venous thrombosis (DVT) following PAO and/or DFO wherein a portable, mechanical device and low-dose aspirin were used postoperatively for DVT prophylaxis. Patients who had undergone staged hip arthroscopy and primary PAO and/or DFO were prospectively reviewed. Following PAO/DFO, patients were prophylactically treated for thromboembolic disease with a portable, mechanical compression device for 3 weeks and low-dose aspirin for 4 weeks. Patients were followed in clinic until 24 months postoperatively. During the study period, 145 hips (124 patients) underwent surgery (PAO: 109, DFO: 24, PAO + DFO: 12). Overall, the incidence of clinically apparent DVT was 0% in the study cohort. Average estimated blood loss during surgery was 601 mL and five cases required blood transfusions of 1 or 2 units. Ten patients were seen in the emergency room 10–20 days after surgery presenting with calf tenderness and DVT was ruled out in all cases with ultrasound. There were no postoperative bleeding or wound complications. A portable, mechanical compression device and low-dose aspirin effectively lessens the risk of DVT following staged hip arthroscopy and PAO/DFO without an increased risk of bleeding complications.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, 400 S Orange Ave, South Orange, NJ 07079, USA
| | - Sivashanmugam Raju
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B202, Room L15-4505, Aurora, CO 80045, USA
| | - Tigran Garabekyan
- Southern California Hip Institute, 10640 Riverside Dr, North Hollywood, CA 91602, USA
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B202, Room L15-4505, Aurora, CO 80045, USA
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17
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Malviya A. What the papers say. J Hip Preserv Surg 2018; 4:341-344. [PMID: 29302332 PMCID: PMC5739042 DOI: 10.1093/jhps/hnx044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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