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Clohisy JC, Nepple JJ, Beaulé PE, Zaltz I, Millis M, Sierra RJ, Kim YJ, Sucato D, Sink E. Development and implementation of a roadmap for improving quality of care in prearthritic hip disease: A journey over 20 years. J Orthop Res 2024; 42:2362-2372. [PMID: 39180284 DOI: 10.1002/jor.25953] [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: 06/11/2024] [Accepted: 07/24/2024] [Indexed: 08/26/2024]
Abstract
The understanding and treatment of prearthritic hip disease has evolved remarkably over the past 20 years. The principal investigator and the multicenter Academic Network of Conservational Hip Outcomes Research (ANCHOR) group have had a key role in improving the quality of care for these patients suffering from the three most common prearthritic conditions: femoroacetabular impingement, developmental dysplasia of the hip, and residual Legg-Calve-Perthes Disease. We aim to demonstrate that based on the six quality of care dimensions as defined by Donabedian, our 20-year academic journey has markedly improved the quality of care for young patients with prearthritic hip disease.
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Affiliation(s)
- John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul E Beaulé
- University of Ottawa, Ottawa Research Institute, Ontario, Ottawa, Canada
| | - Ira Zaltz
- University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Millis
- Boston's Children Hospital-Harvard, Boston, Massachusetts, USA
| | | | - Young-Jo Kim
- Boston's Children Hospital-Harvard, Boston, Massachusetts, USA
| | | | - Ernest Sink
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Wilson ES, Wagner KR, Spiker AM. Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy? Curr Rev Musculoskelet Med 2024:10.1007/s12178-024-09928-5. [PMID: 39340721 DOI: 10.1007/s12178-024-09928-5] [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] [Accepted: 09/09/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE OF REVIEW As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. RECENT FINDINGS Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.
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Affiliation(s)
- Erin S Wilson
- Department of Orthopedic Surgery, University of Wisconsin - Madison, UW Health at East Madison Hospital, 4602 Eastpark Blvd, Madison, WI, 53718, USA
| | - Kyle R Wagner
- Department of Orthopedic Surgery, University of Wisconsin - Madison, UW Health at East Madison Hospital, 4602 Eastpark Blvd, Madison, WI, 53718, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin - Madison, UW Health at East Madison Hospital, 4602 Eastpark Blvd, Madison, WI, 53718, USA.
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Aitken HD, Goetz JE, Glass NA, Miller A, Rivas DJL, Westermann RW, McKinley TO, Willey MC. Persistently elevated joint contact stress after periacetabular osteotomy is associated with joint failure at minimum 10-year follow-up. J Orthop Res 2024. [PMID: 39030968 DOI: 10.1002/jor.25935] [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: 03/26/2024] [Revised: 06/21/2024] [Accepted: 06/27/2024] [Indexed: 07/22/2024]
Abstract
Periacetabular osteotomy (PAO) is a common treatment for prearthritic hip dysplasia. The goal of this investigation was to determine if computationally assessed hip contact mechanics are associated with joint failure at minimum 10-year follow-up. One hundred patients with hip dysplasia (125 hips) completed patient-reported outcomes an average of 13.8 years (range 10.0-18.0 years) after PAO. 63/125 hips were classified as having failed: 26 converted to total hip arthroplasty (THA) and 37 with significant disability indicated by modified Harris Hip Score (mHHS) ≤ 70. Differences in discrete element analysis-computed contact mechanics were compared between (1) preserved and failed hips, (2) preserved hips and hips that failed by THA, and (3) preserved hips and hips that failed by mHHS ≤ 70. Failed hips had significantly higher preoperative contact stress and exposure metrics (p < 0.001-0.009) than preserved hips. Failed hips also had significantly higher postoperative peak contact stress (p = 0.018), higher mean contact stress (p < 0.001), and smaller contact area (p = 0.044). When assessed based on type of failure, hips that failed by THA had significantly higher postoperative contact stress and exposure metrics than preserved hips (p < 0.001-0.020). In hips that failed by mHHS ≤ 70, mean postoperative contact stress exposure was significantly higher compared to preserved hips (p = 0.043). Despite improved radiographic measures of dysplasia after PAO, pathologic joint contact mechanics can persist and predict treatment failure at minimum 10 years after surgery. Operative and nonoperative techniques specifically intended to reduce harmful contact mechanics in dysplastic hips may have the potential to further improve clinical outcomes after PAO.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Jessica E Goetz
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Aspen Miller
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dominic J L Rivas
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Robert W Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Todd O McKinley
- Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Kamenaga T, Hayashi S, Kuroda Y, Tsubosaka M, Nakano N, Kuroda R, Matsumoto T. Combined assessment of acetabular coverage and femoral head-neck shapes predicts osteoarthritis progression after periacetabular osteotomy. Arch Orthop Trauma Surg 2024; 144:3083-3090. [PMID: 38967782 DOI: 10.1007/s00402-024-05439-7] [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: 12/11/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Postoperative osteoarthritis (OA) progression is a major determinant of failure after curved periacetabular osteotomy (CPO). A large postoperative combination angle, i.e., the combination of computed tomography-based anterior center edge and alpha angles, is associated with femoroacetabular impingement after CPO, but its association with postoperative OA progression is unclear. We aimed to identify the anatomical parameters that can lead to OA progression after CPO and the impact of the combination angle on the same. MATERIALS AND METHODS We included 90 hips that were subjected to CPO at our center between March 2013 and March 2018. Seventeen hips showed OA progression with an increase in the Tönnis classification after surgery; 73 hips showed no progression. Radiographic anatomical parameters, including the lateral and anterior center edge angles, femoral and acetabular anteversion, and combination angle, and clinical outcomes, including modified Harris Hip Scores (mHHSs), postoperative anterior impingement, and range of motion, were compared between the two groups. Statistical significance was set at P < 0.05. RESULTS Postoperative OA progression was significantly affected by preoperative OA evidence (P = 0.017), acetabular anteversion < 5.0° (P = 0.003), and a combination angle > 107.0° (P = 0.025). Patients with radiographic OA progression were associated with poor mHHSs (P = 0.017) and high frequencies of anterior impingement with a limited hip flexion and internal rotation angle. CONCLUSIONS OA progression after CPO may be associated with preoperative evidence of OA and postoperative acetabular retroversion as well as a large combination angle. Surgeons should focus on the potential effects of preoperative OA grades, postoperative reduction in acetabular anteversion, and postoperative combination angle.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, 650-0017, Japan
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Kazi O, Gilat R, Alvero AB, Danilkowicz R, Williams JC, Nho SJ. Staged Hip Arthroscopy with Labral Repair, Femoroplasty, and Capsular Plication Followed by Periacetabular Osteotomy for Hip Dysplasia Results in Improved Outcomes and 100% Survivorship at Minimum 2-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00411-0. [PMID: 38876446 DOI: 10.1016/j.arthro.2024.05.029] [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: 01/29/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and survivorship following staged hip arthroscopy with labral repair, femoroplasty, and capsular plication followed by periacetabular osteotomy (PAO) for the management of femoroacetabular impingement syndrome (FAIS) and hip dysplasia (lateral center edge angle ≤25°). METHODS A prospectively maintained database was queried to retrospectively identify patients who underwent staged primary hip arthroscopy and PAO between 1/2018-10/2021 and had a minimum 2-year follow-up. PROs collected included, Hip Outcome Score Activities of Daily Living/Sports Subscale (HOS-ADL/SS), international Hip Outcome Tool-12 item questionnaire (iHOT-12), and Visual Analog Scale for Pain (VAS Pain). CSO achievement for minimal clinical important difference (MCID) and patient acceptable symptom state (PASS) were determined through cohort specific thresholds. Rates of reoperation, including, revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated to determine short-term survivorship. RESULTS Thirty-nine hips met criteria for inclusion, of which 35 hips had minimum 2-year follow up (89.7% compliance). Mean age was 25±9.1 years and 91.7% of patients were female. Respective pre- and postoperative radiographic outcomes were: Alpha angle 59.8±5.9 to 39.7±2.6°, Tönnis angle 14.6±5.6° to -1.0±2.9°, lateral center-edge angle 16.6±5.5° to 36.6±4.6°, and anterior center-edge angle 15.6±9.1° to 36.1±3.8°, with statistically significant differences pre- to postoperatively for all (P<0.001). Patients demonstrated significant improvement in all PROs pre- to postoperatively (P ≤0.004). MCID and PASS achievement rates for any PRO were 93.9% and 78.8%, respectively. There were no revision hip surgeries or conversion to THA at a mean 2.7±1.0-year follow-up. Four patients (11.1%) underwent hardware removal. One patient (2.8%) experienced a postoperative infection treated with incision and drainage. CONCLUSIONS Staged hip arthroscopy and PAO for the management of hip dysplasia demonstrated improvement in PROs, high CSO achievement rates, and 100% survivorship at minimum 2-year follow-up.
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Affiliation(s)
- Omair Kazi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA.
| | - Ron Gilat
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA
| | - Alexander B Alvero
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA
| | - Richard Danilkowicz
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA
| | - Joel C Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center; Chicago, IL, USA
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Sunil Kumar KH, Bhargava K, Stamp G, Malviya A. Functional and radiological outcomes of periacetabular osteotomy for hip dysplasia in patients under fifty years using a minimally invasive approach-a single surgeon series with a minimum follow up of two years. INTERNATIONAL ORTHOPAEDICS 2024; 48:1225-1231. [PMID: 38407597 PMCID: PMC11001707 DOI: 10.1007/s00264-024-06094-8] [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: 12/28/2022] [Accepted: 01/15/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE We conducted a retrospective analysis of prospectively collected data to evaluate (1) the extent of surgical correction following minimally invasive periacetabular osteotomy, (2) improvements in functional outcomes and any potential predictors for favourable outcome, and (3) complications after minimally invasive periacetabular osteotomy. METHODS A total of 352 minimally invasive periacetabular osteotomy procedures were performed on 312 hip dysplasia patients between 2013 and 2020. Radiological parameters such as lateral centre edge angle, acetabular index, and Tönnis grade of arthritis were calculated. Patients also completed a range of patient reported outcome measures. Wilcoxon signed-rank tests were performed to assess for differences between patient reported outcome measures and radiological outcomes across the follow-up periods. Univariate linear regression and logistic regression were used to assess for predictors of change in functional outcome. RESULTS Patients had a significant correction in mean lateral centre edge angle from 17.2° to 35.3° (p < 0.001) and mean acetabular index from 13.2° to - 0.82°. At one year follow-up all patient reported outcome measures were significantly greater than their baseline measurements and this improvement was maintained at two years. Changes in patient reported outcome measures were independent of radiological parameters such as change in the lateral centre edge angle and acetabular index, pre-operative Tönnis grade, and patient factors such as age and sex. A total of 5.11% of patients developed post-operative complications, with four requiring posterior column fixation. Four patients (1.12%) needed a total hip replacement. CONCLUSION Minimally invasive periacetabular osteotomy is a safe procedure that provides significant functional outcome improvements following surgery at six months which is maintained at two years. More than three-fourths of patients achieved improvement of iHOT-12 score beyond the minimal clinically important difference and more than half of the patients achieved substantial clinical benefit for iHOT-12 score.
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Affiliation(s)
| | | | - Gregory Stamp
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK.
- Newcastle University, Newcastle Upon Tyne, UK.
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Aitken HD, Miller A, Rivas DJ, Tatum M, Westermann RW, Willey MC, Goetz JE. Providing a computationally derived, mechanically optimised target correction during preoperative planning can improve joint contact mechanics of hip dysplasia treated with periacetabular osteotomy. Hip Int 2024; 34:378-389. [PMID: 38073284 PMCID: PMC11073912 DOI: 10.1177/11207000231212403] [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] [Indexed: 12/21/2023]
Abstract
AIM Preoperative identification of acetabular corrections that optimally improve joint stability and reduce elevated contact stresses could further reduce osteoarthritis progression in patients with hip dysplasia who are treated with periacetabular osteotomy (PAO). The purpose of this study was to investigate how providing patient-specific, mechanically optimal acetabular reorientations to the surgeon during preoperative planning affected the surgically achieved correction. METHODS Preoperative CT scans were used to create patient-specific hip models for 6 patients scheduled for PAO. A simulated acetabular fragment was extracted from the preoperative pelvis model and computationally rotated to simulate candidate acetabular reorientations. For each candidate, discrete element analysis was used to compute contact stresses during walking, which were summed over the gait cycle and scaled by patient age to obtain chronic contact stress-time exposure. The ideal patient-specific reorientation was identified using a cost function that balances minimising chronic stress exposures and achieving surgically acceptable acetabular coverage angles. The optimal reorientation angles and associated contact mechanics were provided to the surgeon preoperatively. After PAO was performed, a model of the surgically achieved correction was created from a postoperative CT scan. Radiographic coverage and contact mechanics were compared between preoperative, optimal, and surgically achieved orientations. RESULTS While surgically achieved reorientations were not significantly different from optimal reorientations in radiographically measured lateral (p = 0.094) or anterior (p = 0.063) coverage, surgically achieved reorientations had significantly (p = 0.031) reduced total contact area compared to optimal reorientations. The difference in lateral coverage and peak chronic exposure between surgically achieved and optimal reorientations decreased with increasing surgeon experience using the models (R² = 0.758, R2 = 0.630, respectively). CONCLUSIONS Providing hip surgeons with a patient-specific, computationally optimal reorientation during preoperative planning may improve contact mechanics after PAO, which may help reduce osteoarthritis progression in patients with hip dysplasia.
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Affiliation(s)
- Holly D. Aitken
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Aspen Miller
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Dominic J.L. Rivas
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Marcus Tatum
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Robert W. Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael C. Willey
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Jessica E. Goetz
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
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Leopold VJ, Hipfl C, Perka C, Hardt S, Becker L. Periacetabular osteotomy for symptomatic hip dysplasia in middle aged patients: does age alone matter? Arch Orthop Trauma Surg 2024; 144:1065-1070. [PMID: 38133805 PMCID: PMC10896936 DOI: 10.1007/s00402-023-05160-x] [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: 06/14/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Conflicting evidence exists regarding outcomes in middle-aged patients undergoing periacetabular osteotomy (PAO) for symptomatic developmental dysplasia of the hip (DDH). AIMS To compare patient reported outcomes (PROMs) of middle-aged PAO patients with younger patient groups. METHODS Retrospective analysis of prospectively collected data of PAO patients between 01/2015 and 06/2017 at a single orthopedic university center with a primary diagnosis of symptomatic DDH. The cohort was divided into four age groups and compared: < 20, 20-30, 30-40 and > 40 years. Joint function was assessed using iHOT-12, mHHS and SHV. Activity level was assessed using UCLA Activity score. Patient satisfaction and pain were assessed on the numerical rating scale 0-10. Conversion rates to THA were assessed. RESULTS Out of 202 PAOs, 120 cases with complete data were included. Mean follow-up was 63 months (range 47-81 months). Eighteen patients were < 20 years old, 54 were 20-30 years, 37 were 30-40 years, 11 patients were older than 40. No significant differences were observed for preoperative or postoperative iHOT-12 (p = 0.898; p = 0.087), mHHS (p = 0.878; p = 0.103), SHV (p = 0.602; p = 0.352) or UCLA (p = 0.539; p = 0.978) between groups. Improvement deltas were also not significantly different for all PROMs. Postoperative patient satisfaction was similar between groups (p = 0.783). CONCLUSION Patients with symptomatic DDH may benefit from PAO even at middle age with similar outcomes and pre- to postoperative improvements as younger age groups. Indication should be based on biological age and preoperative joint condition rather than age.
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Affiliation(s)
- Vincent J Leopold
- Center for Musculoskeletal Surgery, University Hospital Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, University Hospital Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, University Hospital Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, University Hospital Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, University Hospital Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Gaddis JM, Laboret B, Bialaszewski R, Bergman E, LaCross J, Mulligan E, Wells J. Periacetabular osteotomy: an analysis of social media to determine the most common questions asked by the periacetabular osteotomy population. BMC Musculoskelet Disord 2024; 25:150. [PMID: 38368343 PMCID: PMC10874080 DOI: 10.1186/s12891-024-07249-9] [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: 08/11/2023] [Accepted: 02/01/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The Bernese Periacetabular Osteotomy (PAO) has become a popular surgery for fixing development dysplasia of the hip, yet the most common concerns of the PAO population remains ambiguous. The aim of this study was to investigate Facebook, Instagram and Twitter to further understand what the most common preoperative and postoperative questions patients undergoing PAO are asking. We hypothesized most questions would be asked by patients in the preoperative timeframe with regards to education surrounding PAO surgery. METHODS Facebook, Instagram and Twitter were queried consecutively from February 1, 2023 to November 23, 2011. Facebook was searched for the two most populated interest groups; "Periacetabular Osteotomy (PAO)" and "Periacetabular Osteotomy Australia". Instagram and Twitter were queried for the most popular hashtags: "#PAOwarrior", "#PAOsurgery", "#periacetabularosteotomy", "#periacetabularosteotomyrecovery", and "#paorecovery". Patient questions were categorized according to preoperative and postoperative questions. Questions were further placed into specific themes in their respective preoperative or postoperative question types. RESULTS Two thousand five hundred and fifty-nine posts were collected, with 849 (33%) posts containing 966 questions. Of the 966 questions, 443 (45.9%) and 523 (54.1%) were preoperative and postoperative questions, respectively. The majority of questions were postoperative complication related (23%) and symptom management (21%). Other postoperative questions included recovery/rehabilitation (21%), and general postoperative questions (18%). The most common preoperative questions were related to PAO education (23%). Rehabilitation (19%), hip dysplasia education (17%), and surgeon selection (12%) were other preoperative questions topics included. Most questions came from Facebook posts. Of 1,054 Facebook posts, 76% were either preoperative or postoperative questions and from the perspective of the patient (87%). CONCLUSION The majority of patients in the PAO population sought advice on postoperative complications and symptom management. Some patients asked about education surrounding PAO surgery. Understanding the most common concerns and questions patients have can help providers educate patients and focus on more patient-relevant perioperative conversations.
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Affiliation(s)
- John M Gaddis
- University of Texas Rio Grande Valley School of Medicine, 1201 West University Drive, Edinburg, TX, 78501, USA.
| | - Bretton Laboret
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ryan Bialaszewski
- University of Texas Rio Grande Valley School of Medicine, 1201 West University Drive, Edinburg, TX, 78501, USA
| | | | | | - Edward Mulligan
- Tufts University Doctor of Physical Therapy Program - Phoenix, Phoenix, AZ, USA
| | - Joel Wells
- Baylor Scott and White Hip Preservation Center, Department of Orthopedic Surgery, McKinney, TX, USA
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Laboret B, Bialaszewski R, Gaddis J, Middleton E, Kendall B, Lynch K, Stewart A, Wells J. A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study. BMC Surg 2024; 24:36. [PMID: 38267893 PMCID: PMC10809620 DOI: 10.1186/s12893-024-02318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Social media is a popular resource for patients seeking medical information and sharing experiences. Periacetabular osteotomy (PAO) is an accepted treatment for symptomatic acetabular dysplasia with a low published complication profile in specialty centers. Little is known regarding patient reporting of complications on social media following PAO. The purpose of this study was to describe the patient-perceived complications of PAO posted on social media and analyze how additional factors (postoperative timeframe, concomitant surgery) correlate with these complication posts. METHODS Facebook and Instagram were queried from 02/01/18-02/01/23; Twitter was searched over an extended range back to 02/01/11. Facebook posts (1054) were collected from the two most populated interest groups; "Periacetabular Osteotomy" and "PAO Australia." Instagram posts (1003) and Tweets (502) were found using the same five most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data, perspective, timing (early postoperative or late postoperative), additional surgeries, type of complication, and post engagement. RESULTS Facebook posts (1054), Instagram posts (1003), and Tweets (502) were assessed; 13.6% of posts included a complication. The majority of complications were reported > 6 months postoperatively with excessive pain being the most common complication (57.2%), including chronic pain (41.8%), acute pain (6.7%), and nerve pain (8.8%). Bony complications (6.7%), neurologic/psychiatric complications (3.8%), swelling (1.7%), infection (1.4%), other specified complications (16.2%), and unspecified complications (10.2%) were reported. Complication posts were found to be correlated with postoperative timeframe and concomitant surgery. Post engagement decreased in complication-related posts. CONCLUSIONS Few patients posted a perceived complication associated with PAO surgery. Of those who did, the majority reported unmanageable pain during the late postoperative period. Posts including a perceived complication were found to be positively correlated with postoperative timeframe and negatively correlated with concomitant surgery. This study found a higher pain complication rate, but a lower overall complication rate compared to prior studies. Considering the social media reported complications of PAO patients in addition to traditional outcome measures reveals which aspects of postoperative recovery are most important to patients themselves.
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Affiliation(s)
- Bretton Laboret
- University of Texas Southwestern Medical School, Dallas, TX, USA.
| | | | - John Gaddis
- University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Emily Middleton
- Department of Physical Therapy - School of Health Professions, University of Texas Southwestern, 6011 Harry Hines Blvd., Dallas, TX, 75390-8876, USA
| | - Brittany Kendall
- Baylor Scott & White Outpatient Rehabilitation - Frisco, 3800 Gaylord Pkwy Ste 130, Frisco, TX, 75034, USA
| | - Katie Lynch
- Baylor Scott & White Outpatient Rehabilitation - Frisco, 3800 Gaylord Pkwy Ste 130, Frisco, TX, 75034, USA
| | - Adina Stewart
- Department of Orthopedic Surgery, Baylor Scott and White Hip Preservation Center, 5220 W University Dr Ste 220, McKinney, TX, 75071, USA
| | - Joel Wells
- Department of Orthopedic Surgery, Baylor Scott and White Hip Preservation Center, 5220 W University Dr Ste 220, McKinney, TX, 75071, USA
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11
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Bialaszewski R, Gaddis J, Laboret B, Bergman E, Mulligan EP, LaCross J, Stewart A, Wells J. Perceived outcomes of periacetabular osteotomy. Bone Jt Open 2024; 5:53-59. [PMID: 38240364 PMCID: PMC10797643 DOI: 10.1302/2633-1462.51.bjo-2023-0093.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter). Methods Facebook, Instagram, and X posts were retrospectively collected from 1 February 2023. Facebook posts were collected from the two most populated interest groups: "periacetabular osteotomy" and "PAO Australia." Instagram and X posts were queried using the most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomyrecovery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data (sex, race, location), perspective (patient, physician, professional organization, industry), timing (preoperative vs postoperative), and perceived outcome (positive, negative, neutral). Results A total of 1,054 Facebook posts, 1,003 Instagram posts, and 502 X posts were consecutively assessed from 887 unique authors. The majority (63.3%) of these posts were from patients in the postoperative period, with a median of 84 days postoperatively (interquartile range 20 to 275). The longest follow-up timeframe postoperatively was 20 years. Regarding perceived outcomes, 52.8% expressed satisfaction, 39.7% held neutral opinions, and 7.5% were dissatisfied. Most dissatisfied patients (50.9%) reported pain (chronic or uncontrolled acute) as an attributing factor. Conclusion Most PAO-perceived surgical outcomes on social media had a positive tone. Findings also indicate that a small percentage of patients reported negative perceived outcomes. However, dissatisfaction with PAO primarily stemmed from postoperative pain. Social media posts from other sources (physicians, hospitals, professional organizations, etc.) trend towards neutrality. Healthcare providers must consider the social media narratives of patients following PAO, as they may reveal additional outcome expectations and help improve patient-centred care, create informed decision-making, and optimize treatment outcomes.
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Affiliation(s)
- Ryan Bialaszewski
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - John Gaddis
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Bretton Laboret
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Adina Stewart
- Baylor Scott & White Hip Preservation Center and Comprehensive Hip Center, McKinney, Texas, USA
| | - Joel Wells
- Baylor Scott & White Hip Preservation Center and Comprehensive Hip Center, McKinney, Texas, USA
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Blackwell RD, Parlamas S, Dunbar NJ, Ismaily SK, Rodriguez-Quintana D, Mansour AA, Han S. Pelvic tilt affects superolateral coverage, but not superomedial coverage of the femoral head following periacetabular osteotomy. Clin Biomech (Bristol, Avon) 2024; 111:106160. [PMID: 38096680 DOI: 10.1016/j.clinbiomech.2023.106160] [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: 07/29/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Pelvic tilt is an important sagittal parameter that varies greatly among individuals. The objective of this study was to quantify the effect of pelvic tilt on femoral head coverage and range of motion in a dysplastic population following periacetabular osteotomy. METHODS Twenty-three dysplastic hips from 19 patients (17 female, 2 male) were included in this study. Three-dimensional models were reconstructed using pre-operative CT images, and patient-specific neutral pelvic tilt was obtained on an anteroposterior X-ray. Following a simulated periacetabular osteotomy, the pelvic tilt was changed from -15° to +15°, and the effects on femoral head coverage and hip range of motion was quantified using a customized MATLAB program. FINDINGS Pelvic tilt did not significantly affect total femoral head coverage (P > 0.2). However, a 15° anterior tilt from neutral resulted in a 17.72 ± 9.45% increase in anterolateral coverage and a 23.96 ± 7.48% decrease in posterolateral coverage (P < 0.0001), as well as an 18.2 ± 8.4° loss of internal rotation at 90° of hip flexion. Contrarily, posterior pelvic tilt led to a 26.79 ± 9.04% reduction in anterolateral coverage (P < 0.0001) and an 18.02 ± 9.57% increase in posterolateral coverage (P < 0.0001), and the maximum internal rotation increased 11.8 ± 3.7°. INTERPRETATION While pelvic tilt did not affect total femoral head coverage, it had a significant impact on the distribution of coverage within the superolateral region of the femoral head. Anterior pelvic tilt led to increased anterolateral coverage, but also had a negative impact on hip range of motion. An optimal surgical plan should achieve adequate coverage while not significantly limiting the patient's mobility.
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Affiliation(s)
- Ryan D Blackwell
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1317, USA; Graduate Medical Education, Southeast Health, 1108 Ross Clark Circle, Dothan, AL 36301, USA
| | - Stephen Parlamas
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Nicholas J Dunbar
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Alfred A Mansour
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth Houston, 6431 Fannin, Houston, TX 77030, USA.
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O’Brien MJM, Semciw AI, Mechlenburg I, Tønning LCU, Stewart CJW, Kemp JL. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis. Hip Int 2024; 34:96-114. [PMID: 37306161 PMCID: PMC10787396 DOI: 10.1177/11207000231179610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. PURPOSE In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. METHODS A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. RESULTS From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. CONCLUSIONS Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. REGISTRATION PROSPERO (CRD42020144748).
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Affiliation(s)
- Michael JM O’Brien
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- MOG Sports Medicine, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa CU Tønning
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris JW Stewart
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Everett BP, Lin J, Gudmundsson P, Owhonda R, Nakonezny PA, Middleton E, Chhabra A, Wells JE. The Relationship Between Postoperative Patient-Reported Psychological Outcomes and Preoperative Pain Characteristics in Patients Who Underwent Periacetabular Osteotomy. Orthopedics 2024; 47:28-33. [PMID: 37126840 DOI: 10.3928/01477447-20230426-07] [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: 05/03/2023]
Abstract
This study sought to investigate the relationship between multiple preoperative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were reviewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no significant difference between these two locations on any of the postoperative psychological outcomes (HADS, P=.53; DASS21, P=.85; PCS, P=.97). Additionally, there was not a significant relationship between pain in any location other than the groin and any postoperative psychological outcomes (P≥.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postoperative psychological outcomes (maximum severity: HADS, P=.28; DASS21, P=.49; PCS, P=.57; number of pain locations: HADS, P=.47; DASS21, P=.60; PCS, P=.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [Orthopedics. 2024;47(1):28-33.].
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Thummala A, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The Relationship Between Pelvic Tilt and Clinical Outcomes After Hip Preservation Surgery in Femoroacetabular Impingement Syndrome and Hip Dysplasia. Orthopedics 2023; 46:e341-e346. [PMID: 37052593 DOI: 10.3928/01477447-20230407-04] [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: 04/14/2023]
Abstract
Pelvic tilt is thought to be a compensatory mechanism in hip pathology, specifically in patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. This study investigated the relationship between preoperative pelvic tilt and postoperative outcomes in patients undergoing hip preservation surgery for FAIS or hip dysplasia. We reviewed a prospective hip preservation database for demographic, radiographic, and outcome data for 89 patients who underwent hip preservation surgery with a primary diagnosis of FAIS or dysplasia from 2016 to 2020. Pelvic tilt was assessed on the standing anteroposterior radiograph with the pubic symphysis to sacroiliac joint (PS-SI) distance measurement. The International Hip Outcome Tool 12 (iHOT-12), Hip Outcome Score, Harris Hip Score, UCLA activity score, and European Quality of Life-Visual Analog Scale were used to assess hip function and pain preoperatively and postoperatively. The mean pelvic tilt (PS-SI distance) was 86.4±18.3 mm for the FAIS group and 96.2±15.1 mm for the dysplasia group. The statistical analysis demonstrated a positive relationship between pelvic tilt and change in iHOT-12 score (rs=0.262, P=.019) for all 89 patients with hip pathology and, separately, a trend toward significance for the 42 patients with FAIS (rs=0.330, P=.056). No other significant relationships were observed. The improvement in iHOT-12 score was greater for patients with more anterior tilt and less for patients with posterior pelvic tilt, regardless of underlying hip etiology. These results provide intriguing insights into an initial investigation on pelvic tilt in patients undergoing hip preservation surgery. Further investigation is necessary to assess pelvic tilt preoperatively and postoperatively, spinal parameters, and longer-term outcomes. [Orthopedics. 2023;46(6):e341-e346.].
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Atadja LA, Chhabra A, Kohli A, Lin J, Gudmundsson P, Owhonda R, Middleton E, Wells JE. Duration of Symptoms Does Not Significantly Influence Short-term Outcomes for Patients Undergoing Periacetabular Osteotomy. Orthopedics 2023; 46:365-372. [PMID: 37018619 DOI: 10.3928/01477447-20230329-04] [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] [Indexed: 04/07/2023]
Abstract
Factors influencing the clinical outcomes after periacetabular osteotomy (PAO) have not been well explored. This study evaluated the influence of symptom duration in developmental dysplasia of the hip on short-term patient-reported outcomes after PAO. A retrospective review of prospectively collected data identified PAOs performed on 139 patients. Sixty-five patients were then stratified into two groups based on preoperative symptom duration: 2 years or less (n=22) vs more than 2 years (n=43). We compared the results of hip-specific patient-reported outcome surveys collected preoperatively and postoperatively. When comparing the two groups, we found no significant differences in clinical outcome scores except for the UCLA Activity Scale. The shorter duration group achieved improvement 6 months postoperatively on the visual analog scale average pain score (from 4.5 to 2.167; P=.0017), International Hip Outcome Tool-12 (from 42.95 to 59.19; P=.0176), and Harris Hip Score (from 53.88 to 69.88; P=.049). The longer duration group also achieved postoperative improvement across multiple surveys. Nevertheless, a multivariate analysis controlling for age, sex, and body mass index and found that symptom duration did not independently affect the change in clinical outcomes. Although PAO leads to improvements in functional status and pain, preoperative symptom duration does not significantly affect these clinical outcomes. [Orthopedics. 2023;46(6):365-372.].
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Kuhn AW, Clohisy JC, Troyer SC, Cheng AL, Hillen TJ, Pascual-Garrido C, Tatman J, Bloom N, Schoenecker PL, Nepple JJ. Team Approach: Hip Preservation Surgery. JBJS Rev 2023; 11:01874474-202310000-00001. [PMID: 37793005 PMCID: PMC11421827 DOI: 10.2106/jbjs.rvw.23.00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The evaluation and treatment of adolescents and young adults with hip pain has seen tremendous growth over the past 20 years. Labral tears are well established as a common cause of hip pain but often occur because of underlying bony abnormalities. Femoroacetabular impingement (FAI) and acetabular dysplasia are now well-established causes of hip osteoarthritis and are increasingly treated in the prearthritic stage in hopes of improving symptoms and prolonging the longevity of the native hip. Beyond FAI and acetabular dysplasia, this patient population can present with a complex and variable group of underlying conditions that need to be taken into account. Expertise in the conservative management of this population, including physical therapy, is valuable to maximize the success. Preoperative, surgical, and postoperative decision-making and care in this population is complex and evolving. A comprehensive, multidisciplinary approach to the care of this patient population has been used for over 20 years by our institution with great success. The purpose of this article is to review the "team-based approach" necessary for successful management of the spectrum of adolescent and young adult hip disorders.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO USA
| | | | - Abby L. Cheng
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO USA
| | - Travis J. Hillen
- Department of Radiological Science, Washington University in St. Louis, St. Louis, MO USA
| | | | - Justin Tatman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO USA
| | - Nancy Bloom
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO USA
| | | | - Jeffrey J. Nepple
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO USA
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Hoch A, Grossenbacher G, Jungwirth-Weinberger A, Götschi T, Fürnstahl P, Zingg PO. The periacetabular osteotomy: angulation of the supraacetabular osteotomy for quantification of correction. Hip Int 2023; 33:934-940. [PMID: 35672882 DOI: 10.1177/11207000221103079] [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: 02/04/2023]
Abstract
BACKGROUND Malcorrection of the acetabular fragment in periacetabular osteotomy (PAO) is associated with inferior outcomes. 2-dimensional radiographic parameters are being used for intraoperative verification of a satisfactory result. After reorientation of the fragment, the acetabular version must be verified with an intraoperative radiograph. In the case of an unsatisfactory correction, a reorientation would be required. A slim and radiation-free intraoperative navigation method to directly quantify the correction is highly desirable. AIM To find out whether the measurable angulation of the supraacetabular osteotomy can be used for this purpose. METHODS To determine the angulation, 13 consecutive patients who underwent a PAO were investigated. The preoperative and postoperative standard radiographs as well as CT scans were available. The surgically produced alteration of radiographic parameters was correlated to tilting and spreading of the supraacetabular osteotomy planes. RESULTS Tilting of the supraacetabular osteotomy planes correlates strongly to alteration of the lateral centre-edge angle (LCEA) and the acetabular index (ACI), whereas spreading of the same planes showed also a strong correlation, but to the LCEA only. 1° of tilting resulted in a 0.2° alteration of the LCEA and a 0.5° alteration of the ACI, whereas 1° of spreading resulted in a 0.5° alteration of the LCEA. CONCLUSIONS This study shows that the measurable angulation of the supraacetabular osteotomy planes can be used to monitor the three-dimensional reorientation of the acetabular fragment in PAO. As long as sophisticated modalities are lacking, this technique offers an easy way to intraoperatively navigate the correction in PAO.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | | | | | - Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Nunley B, Mulligan EP, Chhabra A, Fey NP, Wells J. Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip. BMC Musculoskelet Disord 2023; 24:635. [PMID: 37550652 PMCID: PMC10405504 DOI: 10.1186/s12891-023-06768-1] [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: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. METHODS This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman's rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1-0.3), moderate (r = ± 0.3-0.5) and strong (r > ± 0.5). RESULTS Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. CONCLUSION Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.
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Affiliation(s)
- Brandon Nunley
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | | | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas P Fey
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Joel Wells
- Department of Orthopedic Surgery, Baylor Scott & White Medical Center, 301 N. Washington Ave, Dallas, TX, 75246, USA.
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20
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Novais EN, Ferraro SL, Miller P, Kim YJ, Millis MB, Clohisy JC. Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia in Patients ≥40 Years Old: Intermediate and Long-Term Outcomes and Predictors of Failure. J Bone Joint Surg Am 2023; 105:1175-1181. [PMID: 37235681 DOI: 10.2106/jbjs.23.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The Bernese periacetabular osteotomy (PAO) is controversial as a treatment for symptomatic acetabular dysplasia in patients ≥40 years of age. We conducted a retrospective study to evaluate the outcomes, measure the survival rate, and identify factors associated with PAO failure in patients ≥40 years of age. METHODS We performed a retrospective study of patients ≥40 years of age undergoing PAO. Study eligibility criteria were met by 166 patients (149 women; mean age, 44 ± 3 years), and 145 (87%) were followed for ≥4 years after PAO. We used a Kaplan-Meier curve with right-censoring to calculate survivorship, with "failure" defined as either conversion to or recommendation for total hip arthroplasty or a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score of ≥10 at the most recent follow-up. We used simple logistic regression models to determine whether any preoperative characteristics were significantly associated with PAO failure. RESULTS The median follow-up time was 9.6 years (range, 4.2 to 22.5 years). Sixty-one of 145 hips (42%, 95% confidence interval [CI] = 34% to 51%) experienced PAO failure during follow-up. The median survival time was 15.5 years (95% CI = 13.4 to 22.1 years). The median survival time was longer for hips with no or mild preoperative osteoarthritis: 17.0 years for Tönnis grade 0, 14.6 years for grade 1, and 12.9 years for grade 2. Higher preoperative Tönnis arthritis grades (p = 0.03) and worse WOMAC function scores (p < 0.001) were associated with an increased likelihood of failure. CONCLUSIONS PAO is usually effective at improving function and is effective at preserving the hip in patients ≥40 years of age provided that they have good preoperative function and no or mild preoperative osteoarthritis (Tönnis grade 0 or 1). Patients who are ≥40 years old with advanced preoperative osteoarthritis (Tönnis grade 2) and those with poor preoperative dysfunction have a high risk of therapeutic failure after PAO. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eduardo N Novais
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children's Hospital, Boston, Massachusetts
| | - Samantha L Ferraro
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children's Hospital, Boston, Massachusetts
| | - Patricia Miller
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children's Hospital, Boston, Massachusetts
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children's Hospital, Boston, Massachusetts
| | - Michael B Millis
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program, Boston Children's Hospital, Boston, Massachusetts
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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21
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Wei T, Xiao F, He X, Peng P, He W, He M, Wei Q. A bibliometric analysis and visualization of research trends on periacetabular osteotomy. J Hip Preserv Surg 2023; 10:181-191. [PMID: 38162277 PMCID: PMC10757413 DOI: 10.1093/jhps/hnad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/07/2023] [Accepted: 10/07/2023] [Indexed: 01/03/2024] Open
Abstract
Bernese periacetabular osteotomy (PAO) is a practical and safe acetabular reorientation technique used to correct structural hip deformities, and much relevant literature has been published over the past decades. This bibliometric study aims to determine the status of PAO research between 1994 and 2022. Information about PAO research publications from 1994 to 2022 was obtained from the Web of Science Core Collection. This bibliometric study is implemented and analyzed through three bibliometric tools with respect to publication counts, countries, institutions, authors, journals, funding agencies, references and keywords. In total, 634 publications concerning PAO were identified. The United States and Washington University in St. Louis have published the most literature in terms of country and institution. Additionally, Switzerland and the University of Bern are the country and the institution with the highest average number of citations in the PAO field. The most published and co-cited journal is Clinical Orthopaedics and Related Research. Burst keyword detection has discovered that 'patient-reported outcome', 'instability', 'risk', 'survivorship' and 'outcome' are regarded as the current research frontier. In summary, our findings provide insight into the bibliometric overview of research status in the PAO field, which may offer later investigators' references in exploring further research directions.
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Affiliation(s)
| | - Fangjun Xiao
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Peng Peng
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Mincong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
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22
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Tanaka S, Fujii M, Kawano S, Ueno M, Sonohata M, Kitajima M, Mawatari D, Mawatari M. Joint awareness following periacetabular osteotomy in patients with hip dysplasia. Bone Joint J 2023; 105-B:760-767. [PMID: 37399111 DOI: 10.1302/0301-620x.105b7.bjj-2022-1441.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Aims The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS). Methods Data from 686 patients (882 hips) with hip dysplasia who underwent transposition osteotomy of the acetabulum, a type of PAO, between 1998 and 2019 were reviewed. After screening the study included 442 patients (582 hips; response rate, 78%). Patients who completed a study questionnaire consisting of the visual analogue scale (VAS) for pain and satisfaction, FJS-12, and Hip disability and Osteoarthritis Outcome Score (HOOS) were included. The ceiling effects, internal consistency, convergent validity, and PASS thresholds of FJS-12 were investigated. Results The median follow-up was 12 years (interquartile range 7 to 16). The ceiling effect of FJS-12 was 7.2%, the lowest of all the measures examined. FJS-12 correlated with all HOOS subscales (ρ = 0.72 to 0.77, p < 0.001) and pain and satisfaction-VAS (ρ = -0.63 and 0.56, p < 0.001), suggesting good convergent validity. Cronbach's α was 0.95 for the FJS-12, which indicated excellent internal consistency. The median FJS-12 score for preoperative Tönnis grade 0 hips (60 points) was higher than that for grade 1 (51 points) or 2 (46 points). When PASS was defined as pain-VAS < 21 and satisfaction-VAS ≥ 77, the FJS-12 threshold that maximized the sensitivity and specificity for detecting PASS was 50 points (area under the curve (AUC) = 0.85). Conclusion Our results suggest that FJS-12 is a valid and reliable assessment tool for patients undergoing PAO, and the threshold of 50 points may be useful to determine patient satisfaction following PAO in clinical settings. Further investigation of the factors influencing postoperative joint awareness may enable improved prediction of treatment efficacy and informed decision-making regarding the indication of PAO.
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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
| | - Shunsuke 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
| | - Motoki Sonohata
- Department of Orthopedic Surgery, JCHO Saga Central Hospital, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopedic Surgery, Shiroishi Kyouritsu Hospital, Saga, Japan
| | - Daisuke Mawatari
- 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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23
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Sivamurugan G, Westermann RW, Glass N, Davison JC, Miller A, Henrichsen J, McKinley TO, Willey MC. Incidence and risk factors for non-union of the superior ramus osteotomy when hip dysplasia is treated with periacetabular osteotomy. J Hip Preserv Surg 2023; 10:80-86. [PMID: 37900885 PMCID: PMC10604061 DOI: 10.1093/jhps/hnad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 03/03/2023] [Indexed: 10/31/2023] Open
Abstract
Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia. Few studies report risk factors for the development of superior ramus osteotomy non-union. The purpose of this investigation was to document the incidence and risk factors for this complication. We identified 316 consecutive hips that underwent PAO for symptomatic acetabular dysplasia with a minimum 1-year radiographic follow-up. We developed and validated a technique to measure the superior ramus osteotomy location on anterior-posterior (AP) pelvis radiographs and computed tomography. Logistic regression with generalized estimating equations was used to evaluate the relationships between odds of non-union and potential demographic and radiographic predictor variables in univariate and multivariate analyses. Twenty-nine (9.2%) hips developed superior ramus non-union. Age {median [interquartile range (IQR)] 23 years (18-35) healed versus 35 years (26-40) non-united, P = 0.001}, pre-operative lateral center-edge angle (LCEA) [16° (11-20) healed versus 10° (6-13) non-united, P < 0.001] and the distance from the superior ramus osteotomy to the ilioishial line [15.8 mm (13.2-18.7) healed versus 18.1 mm (16.2-20.5) non-united, P < 0.001] varied significantly between groups. Using multivariate analysis, moderate-to-severe dysplasia [LCEA < 15°, odds ratio (OR) 5.95, standard error (SE) 3.32, 95% confidence interval (CI) 1.99-17.79, P = 0.001], increased age (5-year increase, OR 1.29, SE 3.32, 95% CI 1.105-1.60, P-value = 0.018) and distance from the ilioishial line (3-mm increase, OR 1.67, SE 0.22, 95% CI 1.29-2.18, P < 0.001) were at increased risk of developing non-union. Superior ramus osteotomy non-union is common after PAO. Older age, moderate-to-severe dysplasia, and more medial osteotomy location were independent risk factors for non-union. Consideration should be made in high-risk patients for a more lateral superior ramus osteotomy and adjuvant medical and surgical interventions.
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Affiliation(s)
- Ganesh Sivamurugan
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Robert W Westermann
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Natalie Glass
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - John C Davison
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Aspen Miller
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jacob Henrichsen
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Todd O McKinley
- Indiana University Health, Methodist Hospital, 1801 N Senate Boulevard, Suite 535, Indianapolis, IN 46202, USA
| | - Michael C Willey
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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24
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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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25
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Aitken HD, Miller A, Rivas DJL, Tatum M, Westermann RW, Willey MC, Goetz JE. Radiographically successful periacetabular osteotomy does not achieve optimal contact mechanics in dysplastic hips. Clin Biomech (Bristol, Avon) 2023; 104:105928. [PMID: 36906984 PMCID: PMC10122705 DOI: 10.1016/j.clinbiomech.2023.105928] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Optimal correction of hip dysplasia via periacetabular osteotomy may reduce osteoarthritis development by reducing damaging contact stress. The objective of this study was to computationally determine if patient-specific acetabular corrections that optimize contact mechanics can improve upon contact mechanics resulting from clinically successful, surgically achieved corrections. METHODS Preoperative and postoperative hip models were retrospectively created from CT scans of 20 dysplasia patients treated with periacetabular osteotomy. A digitally extracted acetabular fragment was computationally rotated in 2-degree increments around anteroposterior and oblique axes to simulate candidate acetabular reorientations. From discrete element analysis of each patient's set of candidate reorientation models, a mechanically optimal reorientation that minimized chronic contact stress exposure and a clinically optimal reorientation that balanced improving mechanics with surgically acceptable acetabular coverage angles was selected. Radiographic coverage, contact area, peak/mean contact stress, and peak/mean chronic exposure were compared between mechanically optimal, clinically optimal, and surgically achieved orientations. FINDINGS Compared to actual surgical corrections, computationally derived mechanically/clinically optimal reorientations had a median[IQR] 13[4-16]/8[3-12] degrees and 16[6-26]/10[3-16] degrees more lateral and anterior coverage, respectively. Mechanically/clinically optimal reorientations had 212[143-353]/217[111-280] mm2 more contact area and 8.2[5.8-11.1]/6.4[4.5-9.3] MPa lower peak contact stresses than surgical corrections. Chronic metrics demonstrated similar findings (p ≤ 0.003 for all comparisons). INTERPRETATION Computationally selected orientations achieved a greater mechanical improvement than surgically achieved corrections; however, many predicted corrections would be considered acetabular over-coverage. Identifying patient-specific corrections that balance optimizing mechanics with clinical constraints will be necessary to reduce the risk of osteoarthritis progression after periacetabular osteotomy.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Aspen Miller
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Dominic J L Rivas
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Marcus Tatum
- Department of Industrial & Systems Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA.
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26
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Ahmad SS, Giebel GM, Perka C, Meller S, Pumberger M, Hardt S, Stöckle U, Konrads C. Survival of the dysplastic hip after periacetabular osteotomy: a meta-analysis. Hip Int 2023; 33:306-312. [PMID: 34569355 PMCID: PMC9978864 DOI: 10.1177/11207000211048425] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) has become a popular procedure for re-orientation of the acetabulum in patients with a developmental pathomorphology. Since its first description by Reinhold Ganz in 1988, many institutions worldwide have adopted the procedure for the treatment of developmental hip dysplasia (DDH) and have subsequently reported their results. The aim of this study was to provide a meta-analysis of the likelihood of long-term survival of a dysplastic hip after PAO. METHODS A systematic literature review was conducted using Medline, Cochrane and "Web of Science" databases to identify articles reporting survival estimates for PAO in patients with DDH. To be included in the analysis, studies had to include patient cohorts aged <40 years, with Osteoarthritis grade < Tönnis III and no form of neuromuscular dysplasia. Adjustment for cohort overlap was performed. Quality assessment included level of evidence (LOE) according to the oxford center for LOE criteria and the "Methodological index for non-randomized studies (MINORS)". After data extraction, a random-effects meta-analytical model was applied to provide weighted mean estimates of survival at 5 years, 10 years, 15 years and 20 years. RESULTS Nine relevant articles included 2268 dysplastic hips that underwent PAO in 9 institutions. Of the included studies, 5 presented level III evidence and 4 presented level IV evidence. The MINORS score was 11 for 3 studies, 12 for 4 studies and 13 for 2 studies. The 5-year survival after PAO was 96.1% (95% CI, 94.9-97.3), the 10-year survival was 91.3% (95% CI, 87.7-94.8), 15-year survival 85.0% (95% CI, 78.9-91.1), 20-year survival 67.6% (95% CI, 53.9-81.3). CONCLUSIONS The results provide a representative survival estimate of a dysplastic hip after PAO based on global evidence. This should provide clinicians and patients with an adequate reflection of prognostic expectations after this kind of surgery.
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Affiliation(s)
- Sufian S Ahmad
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany,Sufian S Ahmad, Centre for Musculoskeletal
Surgery, Charité-University Medical Centre Berlin, Augustenburger Platz 1,
Berlin, 10117, Germany.
| | - Gregor M Giebel
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Sebastian Meller
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Matthias Pumberger
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Sebastian Hardt
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Ulrich Stöckle
- Centre for Musculoskeletal Surgery,
Charité-University Medical Centre Berlin, Berlin, Germany
| | - Christian Konrads
- Department for Trauma and
Reconstructive Surgery, BG Klinik, University of Tübingen, Germany
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27
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Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation. Arch Orthop Trauma Surg 2023; 143:691-697. [PMID: 34406508 PMCID: PMC9925476 DOI: 10.1007/s00402-021-04112-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
AIMS The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. PATIENTS AND METHODS We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16-48) in the K-wire group and 27.3 (15-45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up. RESULTS Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53-202) compared to the screw group with 119.7 min (50-261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters. CONCLUSION K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal. LEVEL OF EVIDENCE III, retrospective trial.
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28
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Alter T, Fitch A, Bailey Terhune E, Williams JC. The economics of patients undergoing periacetabular osteotomy for hip dysplasia: the financial relationship between physicians and hospitals. J Hip Preserv Surg 2022; 9:225-231. [PMID: 36908555 PMCID: PMC9993450 DOI: 10.1093/jhps/hnac041] [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: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 03/14/2023] Open
Abstract
Periacetabular osteotomy (PAO) is the gold standard for treating hip dysplasia in patients with preserved articular cartilage. The aim of this study is to evaluate the financial relationship between facility and professional revenue for patients undergoing PAO for hip dysplasia and acetabular version abnormalities. All patients who underwent PAO for hip dysplasia by a single surgeon at a tertiary academic medical center between December 2016 and November 2020 were identified. Financial records for facility and professional services were reviewed and analyzed. The orthopedic charge multiplier, the dollars of facility charge created by a single dollar of orthopedic professional charge, and orthopedic net revenue multiplier, the dollars collected by the hospital for facility services generated for each dollar collected by the orthopedic surgeon, were calculated. A total of 36 patients were included in the study. The mean total charge for all patients was $144 939.35 ± $23 726.48 (range $109 002.71 to $227 290.20), and the average total revenue for all patients was $44 218.79 ± $12 352.97 (range $29 397.39 to $90,830.62). The mean orthopedic charge multiplier was 2.47 ± 1.32 (range 0.78-6.53), and the net revenue collection multiplier was 8.62 ± 10.69 (range, 1.20-57.80). The majority of charges and revenue related to care of patients undergoing PAO return to the hospital. The significant mean orthopedic charge multiplier for this procedure increases the value of the service and the surgeon to hospital profitability. This information can help shape the relationship between the hospital and the surgeon and create a firm platform to advocate for program advancement.
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Affiliation(s)
- Thomas Alter
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
| | - Ashlyn Fitch
- School of Medicine, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
| | - E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
| | - Joel C Williams
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
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Aitken HD, Westermann RW, Bartschat NI, Meyer AM, Brouillette MJ, Glass NA, Clohisy JC, Willey MC, Goetz JE. Chronically elevated contact stress exposure correlates with intra-articular cartilage degeneration in patients with concurrent acetabular dysplasia and femoroacetabular impingement. J Orthop Res 2022; 40:2632-2645. [PMID: 35088436 PMCID: PMC9325915 DOI: 10.1002/jor.25285] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Hip dysplasia is known to lead to premature osteoarthritis. Computational models of joint mechanics have documented elevated contact stresses in dysplastic hips, but elevated stress has not been directly associated with regional cartilage degeneration. The purpose of this study was to determine if a relationship exists between elevated contact stress and intra-articular cartilage damage in patients with symptomatic dysplasia and femoroacetabular impingement. Discrete element analysis was used to compute hip contact stresses during the stance phase of walking gait for 15 patients diagnosed with acetabular dysplasia and femoral head-neck offset deformity. Contact stresses were summed over the duration of the walking gait cycle and then scaled by patient age to obtain a measure of chronic cartilage contact stress exposure. Linear regression analysis was used to evaluate the relationship between contact stress exposure and cartilage damage in each of six acetabular subregions that had been evaluated arthroscopically for cartilage damage at the time of surgical intervention. A significant correlation (R2 = 0.423, p < 0.001) was identified between chondromalacia grade and chronic stress-time exposure above both a 1 MPa damage threshold and a 2 MPa-years accumulated damage threshold. Furthermore, an over-exposure threshold of 15% regional contact area exceeding the 1 and 2 MPa-years threshold values resulted in correct identification of cartilage damage in 83.3% (55/66) of the acetabular subregions loaded during gait. These results suggest corrective surgery to alleviate impingement and reduce chronic contact stress exposures below these damage-inducing thresholds could mitigate further cartilage damage in patients with hip dysplasia.
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Affiliation(s)
- Holly D. Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Robert W. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Nicholas I. Bartschat
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Alex M. Meyer
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Marc J. Brouillette
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Natalie A. Glass
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Michael C. Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
| | - Jessica E. Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, 52242, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
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Ahmad SS, Haertlé M, Konrads C, Derksen A, Windhagen H, Wirries N. The Scientific Evolution of Periacetabular Osteotomy: A Global Review. J Clin Med 2022; 11:jcm11206099. [PMID: 36294420 PMCID: PMC9604972 DOI: 10.3390/jcm11206099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022] Open
Abstract
It is well-known that hip disorders are frequently of bony origin related to an underlying pathomorphology. A fundamental understanding of morphology and biomechanics is therefore of essential importance for a targeted approach in defining treatment plans. Treatment is frequently based on altering bony morphology, for which a set of effective techniques have been proposed. Periacetabular osteotomy (PAO) allows for reorientation of the acetabulum and powerful correction of acetabular coverage. The revolutionary aspect of PAO compared to prior osteotomies lies in maintenance of the integrity of the posterior column. This allows for a substantial increase in primary stability, a larger bony surface for healing, and simple reorientation of the acetabular fragment that is free of posterior ligamentous restraints. The results for dysplasia are very promising. Indications have been refined by studies revealing that the presence of degenerative changes and age > 40 years at the time of surgery represent prognostic factors of poorer outcome. Indications have also been broadened to include acetabular retroversion (with posterolateral dysplasia) and borderline hip dysplasia. A glimpse at the future would reflect major advances related to individual planning, surgical training, and precise surgical conduction. In the era of digitalization, augmented reality may assist in performing bony cuts and act as an aid for some of the blind ischial and retro-acetabular cuts. Innovations in perioperative management will enhance recovery after the procedure and allow for early recovery programs with optimized protocols of pain management. Considering that the success of PAO in the young is comparable to the success of hip arthroplasty in the old, PAO should be considered one of the pillars of modern orthopedic surgery.
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Affiliation(s)
- Sufian S. Ahmad
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Marco Haertlé
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Christian Konrads
- Department of Orthopaedic Surgery, University of Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Alexander Derksen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Nils Wirries
- Department of Orthopaedic Surgery, Hannover Medical School, 30625 Hannover, Germany
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Periacetabular osteotomy to treat hip dysplasia: a systematic review of harms and benefits. Arch Orthop Trauma Surg 2022; 143:3637-3648. [PMID: 36175675 DOI: 10.1007/s00402-022-04627-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and benefits of PAO in patients with hip dysplasia in studies reporting both adverse events and patient-reported hip pain and function. MATERIALS AND METHODS A systematic search combing PAO and patient-reported outcomes was performed in the databases MEDLINE, CINAHL, EMBASE, Sports Discuss and PsychINFO. Studies including both harms and benefits defined as adverse events and patient-reported hip pain and function were included. Risk of bias was assessed using The Cochrane Risk of Bias In Non-Randomized Studies - of Interventions. RESULTS Twenty-nine cohort studies were included, of which six studies included a comparison group. The majority of studies had serious risk of bias and the certainty of evidence was very low. The proportion of adverse events was 4.3 (95% CI 3.7; 4.9) for major adverse events and 14.0 (95% CI 13.0; 15.1) for minor adverse events. Peroneal nerve dysfunction was the most frequent adverse event among the major adverse events, followed by acetabular necrosis and delayed union or non-union. All patient-reported hip pain and function scores improved and exceeded the minimal clinically important differences after PAO. After 5 years, scores were still higher than the preoperative scores. CONCLUSION PAO surgery has a 4% risk of major, and 14% risk of minor adverse events and a positive effect on patient-reported hip pain and function among patients with hip dysplasia.
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Morris WZ, Justo PGS, Williams KA, Kim YJ, Millis MB, Novais EN. The incidence and risk factors for stress fracture following periacetabular osteotomy. Bone Joint J 2022; 104-B:1017-1024. [PMID: 36047021 DOI: 10.1302/0301-620x.104b9.bjj-2021-1391.r3] [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: 11/05/2022]
Abstract
AIMS The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. METHODS We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union. RESULTS A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001). CONCLUSION Stress fracture of the posterior column may be an under-recognized complication following PAO, and the rate may be influenced by surgical technique. Consideration should be given to using a narrow chisel during the ischial cut to reduce the risk of stress propagation through the posterior column.Cite this article: Bone Joint J 2022;104-B(9):1017-1024.
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Affiliation(s)
- William Z Morris
- Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, USA.,Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Pedro G S Justo
- Instituto de Ortopedia e Traumatologia, Santa Catarina, Brazil
| | - Kathryn A Williams
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael B Millis
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
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Jimenez AE, Lee MS, Owens JS, Maldonado DR, LaReau JM, Domb BG. Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up. Arthroscopy 2022; 38:2649-2658. [PMID: 35257741 DOI: 10.1016/j.arthro.2022.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/22/2021] [Accepted: 02/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 2-year follow-up patient-reported outcomes and return-to-sport (RTS) rates in athletes undergoing concomitant hip arthroscopy and periacetabular osteotomy (PAO) to treat acetabular dysplasia and intra-articular pathologies such as cam deformity and labral tears. METHODS We reviewed the data of consecutive athletes undergoing concomitant primary hip arthroscopy and PAO for acetabular dysplasia and cam deformity from November 2010 to December 2018. Patients were included in the study if they had the following preoperative and minimum 2-year postoperative scores: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS). The percentage of patients who achieved the minimal clinically important difference was recorded, in addition to RTS status. RESULTS A total of 29 athletes (29 hips) were included, with a mean follow-up time of 34.1 ± 7.9 months, mean age of 26.0 ± 8.7 years, and mean body mass index of 23.7 ± 3.4. These athletes showed significant improvements in the mHHS, NAHS, and HOS-SSS from baseline to latest follow-up (P < .001). The minimal clinically important difference was achieved at high rates for the mHHS (82.8%), NAHS (86.2%), and HOS-SSS (79.3%). Athletes who attempted to RTS successfully returned at a rate of 81.8%. CONCLUSIONS Athletes undergoing concomitant hip arthroscopy and PAO showed significant improvements in patient-reported outcomes at minimum 2-year follow-up and had an RTS rate of 81.8%. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Justin M LaReau
- AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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Thummala AR, Xi Y, Middleton E, Kohli A, Chhabra A, Wells J. Does surgery change pelvic tilt? : an investigation in patients with osteoarthritis of the hip, dysplasia, and femoroacetabular impingement. Bone Joint J 2022; 104-B:1025-1031. [PMID: 36047020 DOI: 10.1302/0301-620x.104b9.bjj-2022-0095.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. METHODS The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). RESULTS The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). CONCLUSION There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: Bone Joint J 2022;104-B(9):1025-1031.
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Affiliation(s)
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Middleton
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Kohli
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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35
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Bech-Jørgensen S, Larsen JB, Barroso J, Jakobsen SS, Mechlenburg I. Trajectory for 66 patients treated with periacetabular osteotomy (PAO) and subsequent total hip arthroplasty: a follow-up study including 1378 hips from the Aarhus PAO database. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04590-3. [PMID: 35986746 DOI: 10.1007/s00402-022-04590-3] [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: 03/07/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Outcomes for patients treated with PAO and subsequent total hip arthroplasty (THA) remain unclear. We evaluated patient-reported outcomes among patients treated with PAO and subsequent THA and investigated differences in the number of additional surgical procedures after PAO among patients treated with PAO and subsequent THA and patients treated with PAO only. MATERIALS AND METHODS 1378 hips underwent PAO and subsequently 66 hips were treated with THA. We evaluated the Hip disability and Osteoarthritis Outcome Score (HOOS) and physical activity questions for the 66 hips. Additional surgery after PAO was identified through inquiry to the Danish National Patient Registry. RESULTS 13% undergoing PAO and subsequent THA reported a HOOS pain score ≤ 50 indicating a clinical failure. The risk difference for hip arthroscopy after PAO within 2 and 4 years was 14% (CI 5-23%) and 26% (CI 15-38%) in favor of hips treated with PAO only. Similarly, the risk difference for screw removal within 2 and 4 years was 19% (CI 8-29%) and 23% (CI 12-34%). CONCLUSION 87% of patients undergoing PAO and subsequent THA had little or no hip pain. However, these patients received a high number of additional surgeries after PAO. Surgeons and patients may consider if additional surgery after PAO may be the first choice in a series of actions leading to conversion to THA.
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Affiliation(s)
- Sofie Bech-Jørgensen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
| | - Josefine Beck Larsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - João Barroso
- Orthopaedic Department, Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - Stig Storgaard Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus N, Denmark
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36
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Schömig F, Hipfl C, Löchel J, Perka C, Hardt S, Leopold VJ. Periacetabular Osteotomy and Postoperative Pregnancy—Is There an Influence on the Mode of Birth? J Clin Med 2022; 11:jcm11164836. [PMID: 36013074 PMCID: PMC9410101 DOI: 10.3390/jcm11164836] [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: 06/14/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
As a surgical treatment option in symptomatic developmental dysplasia of the hip, periacetabular osteotomy (PAO) is often performed in female patients of childbearing age. Yet, to date, little is known about the procedure’s influence on postoperative pregnancies and the mode of delivery. Our study’s aim therefore was to investigate patient and physician decision making in women after PAO. We invited all patients who had undergone PAO in our institution from January 2015 to June 2017 to participate in a paper-based survey. Of these, we included all female patients and performed a retrospective chart review as well as analysis of pre- and postoperative radiological imaging. A total of 87 patients were included, 20 of whom gave birth to 26 children after PAO. The mean overall follow-up was 5.3 ± 0.8 years. Four (20.0%) patients reported that their obstetrician was concerned due to their history of PAO. The mean time before the first child’s birth was 2.9 ± 1.3 years. Eleven (55.0%) patients underwent cesarean section for the first delivery after PAO, three of whom reported their history of PAO as the reason for this type of delivery. Patients with a history of PAO have a higher risk of delivering a child by cesarean section compared with the general population, in which the rate of cesarean section is reported to be 29.7%. As cesarean sections are associated with increased morbidity and mortality compared with vaginal deliveries, evidence-based recommendations for pregnancies after pelvic osteotomy are needed.
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37
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Aitken HD, Westermann RW, Bartschat NI, Clohisy JC, Willey MC, Goetz JE. Effect of modeling femoral version and head-neck offset correction on computed contact mechanics in dysplastic hips treated with periacetabular osteotomy. J Biomech 2022; 141:111207. [PMID: 35764011 PMCID: PMC9747059 DOI: 10.1016/j.jbiomech.2022.111207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
While correction of dysplastic acetabular deformity has been a focus of both clinical treatment and research, concurrent femoral deformities have only more recently received serious attention. The purpose of this study was to determine how including abnormalities in femoral head-neck offset and femoral version alter computationally derived contact stresses in patients with combined dysplasia and femoroacetabular impingement (FAI). Hip models with patient-specific bony anatomy were created from preoperative and postoperative CT scans of 20 hips treated with periacetabular osteotomy and femoral osteochondroplasty. To simulate performing only a PAO, a third model was created combining each patient's postoperative pelvis and preoperative femur geometry. These three models were initialized with the femur in two starting orientations: (1) standardized template orientation, and (2) using patient-specific anatomic landmarks. Hip contact stresses were computed in all 6 model sets during an average dysplastic gait cycle, an average FAI gait cycle, and an average stand-to-sit activity using discrete element analysis. No significant differences in peak contact stress (p = 0.190 to 1), mean contact stress (p = 0.273 to 1), or mean contact area (p = 0.050 to 1) were identified during any loading activity based on femoral alignment technique or inclusion of femoral osteochondroplasty. These findings suggest that presence of abnormal femoral version and/or head-neck offset deformities are not themselves predominant factors in intra-articular contact mechanics during gait and stand-to-sit activities. Inclusion of modified movement patterns caused by these femoral deformities may be necessary for models to adequately capture the mechanical effects of these clinically recognized risk factors for negative outcomes.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Nicholas I Bartschat
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA.
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38
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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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Kriechling P, Leoty L, Fürnstahl P, Rahbani D, Zingg PO, Vlachopoulos L. A Statistical Shape Model-Based Analysis of Periacetabular Osteotomies: Technical Considerations to Achieve the Targeted Correction. J Bone Joint Surg Am 2022; 104:1107-1115. [PMID: 35363641 DOI: 10.2106/jbjs.21.00454] [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 Classic and reverse Bernese periacetabular osteotomy (PAO) have been shown to be effective for the treatment of developmental dysplasia of the hip (by classic PAO), severe acetabular retroversion (by reverse PAO), and some protrusio acetabuli (by reverse PAO). Especially in severe cases with higher degrees of correction, a relevant overlap between the osteotomized fragment and the pelvis might occur, leading to necessary fragment translation. The aim of the present study was to analyze the necessary translation as a function of the degree of correction using a statistical mean model of the pelvis according to the technique (classic PAO or reverse PAO). METHODS A mean statistical shape model of the pelvis and 2 extreme models were used to simulate rotation of the osteotomized fragment during a classic or reverse PAO and to calculate rotations from -20° to 20° in the frontal, sagittal, and transverse planes and a combination thereof. The depth and volume of the intersection between the mobilized fragment and the pelvis were calculated, and the minimum translation of the fragment necessary to avoid segment overlap was determined. RESULTS The maximum intersection distances between the pelvis and the 20° rotated fragment were 6.7 and 15.3 mm for adduction and abduction (frontal plane), 6.4 and 4.5 mm for internal and external rotation (transverse plane), and 27.8 and 9.2 mm for extension and flexion (sagittal plane). The necessary translations for 20° of fragment rotation were 7.0 and 12.8 mm for adduction and abduction (frontal plane), 4.8 and 5.0 mm for internal and external rotation (transverse plane), and 18.5 mm and 8.8 mm for extension and flexion (sagittal plane). CONCLUSIONS Acetabular reorientation with the classic or reverse PAO results in translation of the fragment and in a consequent change in the rotational center. This finding is more pronounced with higher degrees of fragment reorientation in abduction and extension; it becomes especially pronounced in reverse PAO for acetabular retroversion or protrusio acetabuli, and might limit the ability to achieve the intended improvement in overall hip biomechanics.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Laura Leoty
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dana Rahbani
- Graphics and Vision Research Group (GraVis), University of Basel, Basel, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Shi A, Sun J, Chhabra A, Thakur U, Xi Y, Kohli A, Wells J. Functional outcomes are preserved in adult acetabular dysplasia with radiographic evidence of lumbosacral spine anomalies: an investigation in hip-spine syndrome. BMC Musculoskelet Disord 2022; 23:385. [PMID: 35468787 PMCID: PMC9040209 DOI: 10.1186/s12891-022-05334-5] [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: 01/18/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Acetabular dysplasia (AD) is a debilitating condition which results in impaired hip function, leading to hip-spine syndrome with anomalies identifiable on plain radiographs. However, no study to date has investigated the association between radiographic spine anomalies and functional outcomes in AD. We hypothesize that AD patients with radiographic evidence of lumbar spine anomalies are associated with decreased function in comparison to those without such radiographic findings. Patients and methods One hundred thirty-five hips underwent a full four-view hip radiograph series, and two observers analyzed hip and spine variables using standard radiographs and obtained Castellvi grade, assessment of spondylolisthesis, and L4-S1 interpedicular distance. A comprehensive hip questionnaire was administered which included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) to assess patient function. Correlations between HHS and HOOS and radiographic spinal measurements were calculated, and p-values were corrected for multiple comparison using the Holm’s method. Results Out of 135 patients, 119 were female (88.1%) and 16 were male (11.9%). Average age of presentation was 34.2 years, and average BMI was 26. There was no statistically significant correlation between Castellvi grade, presence of spondylolisthesis, or L4-S1 interpedicular distance and the patient-reported outcome measures HHS or HOOS. Conversely, a significant correlation was observed between Femoro-Epiphyseal Acetabular Roof (FEAR) index and HOOS of the contralateral hip (correlation coefficient = 0.38, adjusted p = 0.03) and Tönnis angle of AD severity and HHS of the contralateral hip (correlation coefficient = − 0.33, adjusted p = 0.04). Conclusion Severity of spinal anomalies measured by Castellvi grade and spondylolisthesis in patients with AD was not associated with decreased patient function in the ipsilateral diseased hip. To our knowledge, this is the first study to date to report the relationship between radiographically identifiable lumbosacral abnormalities and hip function in AD.
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Affiliation(s)
- Aaron Shi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joshua Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Uma Thakur
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Yin Xi
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Ajay Kohli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.,Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8883, USA.
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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: 8] [Impact Index Per Article: 4.0] [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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EREN MB, BİLGİÇ E, AŞÇI M, BOSTAN B, GÜNEŞ T. Improvement in clinical and radiological scores after Bernese periacetabular osteotomy does not stop radiological osteoarthritis progression. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hayashi S, Hashimoto S, Kuroda Y, Matsumoto T, Kamenaga T, Kuroda R. Combination of Anterior Acetabular Coverage and Femoral Head Shape Predicts Femoroacetabular Impingement After Periacetabular Osteotomy. J Arthroplasty 2022; 37:219-225. [PMID: 34718108 DOI: 10.1016/j.arth.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) after periacetabular osteotomy (PAO) may be affected by both anterior acetabular coverage and femoral head shape. This study aimed to radiographically evaluate the relationship of the combination of acetabular coverage and femoral head shape with the occurrence of FAI after curved PAO. METHODS In this study, 76 hip joints from patients with symptomatic developmental dysplasia of the hip underwent curved PAO. The relationship between the combined postoperative anterior center-edge and alpha angles (ie, the combination angle) and the occurrence of postoperative FAI was evaluated. Clinical factors and the preoperative and postoperative 3-dimensional center-edge angles, acetabular versions, femoral versions, radiographic alpha angles of the femoral head, and the combination angle were measured and compared to clinical outcomes. RESULTS The modified Harris Hip Scores, University of California, Los Angeles activity scores, and acetabular coverage angles were significantly improved following curved PAO. Receiver operator characteristic curve analysis demonstrated that the combination angle over 108° may be a predictive factor for the occurrence of FAI after curved PAO. Multivariate analysis demonstrated that an age <40 years (odds ratio 6.6, 95% confidence interval 1.2-36.4, P = .037) and a combination angle <108° (odds ratio 9.2, 95% confidence interval 1.7-50.0, P = .010) were significantly associated with modified Harris Hip Scores ≧90 points. CONCLUSION A combination angle >108° may be a predictive factor for the occurrence of FAI after curved PAO and impaired clinical outcomes. To avoid postoperative FAI, we propose that osteochondroplasty of the femoral head should be performed for patients with preoperative combination angles >90°.
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Affiliation(s)
- Shinya Hayashi
- 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
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- 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
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Everett BP, Nakonezny PA, Mulligan EP, Chhabra A, Wells J. The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia. J Hip Preserv Surg 2022; 9:44-50. [PMID: 35651711 PMCID: PMC9142189 DOI: 10.1093/jhps/hnac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.
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Affiliation(s)
- Brandon P Everett
- Medical School, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Edward P Mulligan
- School of Health Professions, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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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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Kitamura K, Fujii M, Iwamoto M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Is Anterior Rotation of the Acetabulum Necessary to Normalize Joint Contact Pressure in Periacetabular Osteotomy? A Finite-element Analysis Study. Clin Orthop Relat Res 2022; 480:67-78. [PMID: 34228657 PMCID: PMC8673984 DOI: 10.1097/corr.0000000000001893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inappropriate sagittal plane correction can result in an increased risk of osteoarthritis progression after periacetabular osteotomy (PAO). Individual and postural variations in sagittal pelvic tilt, along with acetabular deformity, affect joint contact mechanics in dysplastic hips and may impact the direction and degree of acetabular correction. Finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the effect of PAO on the contact mechanics of dysplastic hips, which may lead to improved acetabular correction during PAO. QUESTIONS/PURPOSES We performed virtual PAO using finite-element models with reference to the standing pelvic position to clarify (1) whether lateral rotation of the acetabulum normalizes the joint contact pressure, (2) risk factors for abnormal contact pressure after lateral rotation of the acetabulum, and (3) whether additional anterior rotation of the acetabulum further reduces contact pressure. METHODS Between 2016 and 2020, 85 patients (92 hips) underwent PAO to treat hip dysplasia. Eighty-two patients with hip dysplasia (lateral center-edge angle < 20°) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or spine surgery, or poor-quality images were excluded. Thirty-eight patients (38 hips) were eligible to participate in this study. All patients were women, with a mean age of 39 ± 10 years. Thirty-three women volunteers without a history of hip disease were reviewed as control participants. Individuals with a lateral center-edge angle < 25° or poor-quality images were excluded. Sixteen individuals (16 hips) with a mean age of 36 ± 7 years were eligible as controls. Using CT images, we developed patient-specific three-dimensional surface hip models with the standing pelvic position as a reference. The loading scenario was based on single-leg stance. Four patterns of virtual PAO were performed in the models. First, the acetabular fragment was rotated laterally in the coronal plane so that the lateral center-edge angle was 30°; then, anterior rotation in the sagittal plane was added by 0°, 5°, 10°, and 15°. We developed finite-element models for each acetabular position and performed a nonlinear contact analysis to calculate the joint contact pressure of the acetabular cartilage. The normal range of the maximum joint contact pressure was calculated to be < 4.1 MPa using a receiver operating characteristic curve. A paired t-test or Wilcoxon signed rank test with Bonferroni correction was used to compare joint contact pressures among acetabular positions. We evaluated the association of joint contact pressure with the patient-specific sagittal pelvic tilt and acetabular version and coverage using Pearson or Spearman correlation coefficients. An exploratory univariate logistic regression analysis was performed to identify which of the preoperative factors (CT measurement parameters and sagittal pelvic tilt) were associated with abnormal contact pressure after lateral rotation of the acetabulum. Variables with p values < 0.05 (anterior center-edge angle and sagittal pelvic tilt) were included in a multivariable model to identify the independent influence of each factor. RESULTS Lateral rotation of the acetabulum decreased the median maximum contact pressure compared with that before virtual PAO (3.7 MPa [range 2.2-6.7] versus 7.2 MPa [range 4.1-14 MPa], difference of medians 3.5 MPa; p < 0.001). The resulting maximum contact pressures were within the normal range (< 4.1 MPa) in 63% of the hips (24 of 38 hips). The maximum contact pressure after lateral acetabular rotation was negatively correlated with the standing pelvic tilt (anterior pelvic plane angle) (ρ = -0.52; p < 0.001) and anterior center-edge angle (ρ = -0.47; p = 0.003). After controlling for confounding variables such as the lateral center-edge angle and sagittal pelvic tilt, we found that a decreased preoperative anterior center-edge angle (per 1°; odds ratio 1.14 [95% CI 1.01-1.28]; p = 0.01) was independently associated with elevated contact pressure (≥ 4.1 MPa) after lateral rotation; a preoperative anterior center-edge angle < 32° in the standing pelvic position was associated with elevated contact pressure (sensitivity 57%, specificity 96%, area under the curve 0.77). Additional anterior rotation further decreased the joint contact pressure; the maximum contact pressures were within the normal range in 74% (28 of 38 hips), 76% (29 of 38 hips), and 84% (32 of 38 hips) of the hips when the acetabulum was rotated anteriorly by 5°, 10°, and 15°, respectively. CONCLUSION Via virtual PAO, normal joint contact pressure was achieved in 63% of patients by normalizing the lateral acetabular coverage. However, lateral acetabular rotation was insufficient to normalize the joint contact pressure in patients with more posteriorly tilted pelvises and anterior acetabular deficiency. In patients with a preoperative anterior center-edge angle < 32° in the standing pelvic position, additional anterior rotation is expected to be a useful guide to normalize the joint contact pressure. CLINICAL RELEVANCE This virtual PAO study suggests that biomechanics-based planning for PAO should incorporate not only the morphology of the hip but also the physiologic pelvic tilt in the weightbearing position in order to customize acetabular reorientation for each patient.
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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
| | - Miho Iwamoto
- 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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Fan Y, Li W, Wu Y, Li R, Hong G, Li Z, Chen L, Fang H, Zhou C, He W, Chen Z. The association the patient-reported outcomes after periacetabular osteotomy with radiographic features: a short-term retrospective study. J Orthop Surg Res 2021; 16:718. [PMID: 34924013 PMCID: PMC8684642 DOI: 10.1186/s13018-021-02858-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bernese periacetabular osteotomy (PAO) is an effective treatment for patients with developmental dysplasia of the hip (DDH). PAO has been widely used in China, but few follow-up outcomes have been reported in the international community. Moreover, the risk factors affecting patient-reported outcomes have not been discussed in recent studies. In this study, patient-reported outcomes after PAO were reported, and risk factors affecting patient-reported outcomes were analyzed. METHODS Patients who underwent PAO for DDH from January 2014 to January 2020 were selected as the study subjects, and 66 hips were included in the analysis after screening (59 patients, with an average follow-up time of 3.01 years). The Harris Hip Score (HHS) and International Hip Outcome Instrument-12 (iHOT-12) were used to assess hip function and patient quality of life. The changes of preoperative and latest follow-up HHSs less than 9 were defined as symptomatic hips, that is, an adverse outcome; otherwise, the score indicates preserved hips. Also, the changes of preoperative and latest follow-up iHOT-12 were defined as symptomatic hips and preserved hips. Multivariate logistic regression analysis was used to predict the risk factors influencing the patient-reported outcomes, and receiver operating characteristic (ROC) curve analysis was performed on the risk factors to determine their sensitivity, specificity and cutoff value. RESULTS Clinical outcome analysis demonstrates marked improvements in patient-reported outcomes. The multivariate logistic regression analysis showed that when the postoperative LCEA was > 38°, adverse outcomes were much more likely. However, a Tönnis angle of - 10° to 0° was a protective factor. In addition, hips with fair or poor joint congruency were more likely to develop negative outcomes. The ROC curve analysis showed that the optimal thresholds for the LCEA and Tönnis angles used to predict outcomes after PAO were 38.2° and - 9°, respectively. Based on the results of the ROC curve analysis, among hips with poor or fair joint congruency preoperatively treated by surgeons who obtained the improper postoperative LCEAs and Tönnis angles, bad patient-reported outcomes will most likely be obtained. CONCLUSIONS Our results demonstrate marked improvements in patient-reported outcomes. Among hips with preoperative excellent or good joint congruency treated by experienced surgeons who obtain the proper postoperative LCEA and Tönnis angles, good patient-reported outcomes can be expected.
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Affiliation(s)
- Yinuo Fan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Weifeng Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Yunlong Wu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Ruoyu Li
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Guoju Hong
- Candidate, Research Fellow, Division of Orthopaedic Surgery, The University of Alberta, Edmonton, Canada
- Institute of Orthopedics, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Zhongfeng Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Lixin Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 12 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Hanjun Fang
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, People's Republic of China
| | - Chi Zhou
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, People's Republic of China.
| | - Wei He
- Department of Joint Diseases, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 261 Longxi Road, Liwan District, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhenqiu Chen
- The Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong Province, People's Republic of China.
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48
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Saks BR, Fox JD, Owens JS, Maldonado DR, Jimenez AE, Ankem HK, Lall AC, Domb BG. One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy. Am J Sports Med 2021; 49:3906-3914. [PMID: 34694159 DOI: 10.1177/03635465211043510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sex-based differences have been largely uncharacterized for patients with borderline hip dysplasia (BHD) undergoing hip arthroscopy. PURPOSE To evaluate for sex-based differences in clinical and pathologic characteristics as well as surgical outcomes in patients with BHD undergoing hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between January 2011 and December 2018, data were prospectively collected on all patients with BHD undergoing primary hip arthroscopy. Patients were included if they had preoperative and minimum 2-year postoperative scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain. Patients with previous ipsilateral hip conditions or surgery, Tönnis grade >1, lateral center-edge angle <18° or >25°, or workers' compensation status were excluded. Patients were then divided by sex and propensity score matched in a 1:1 ratio for body mass index, age, and Tönnis grade. The rates of patients who achieved the minimal clinically important difference were recorded for the mHHS and NAHS. The rates of achieving the patient acceptable symptomatic state for the mHHS were calculated. RESULTS A total of 344 hips met the inclusion criteria, and 317 hips (92%) had adequate follow-up. Propensity score matching created cohorts of 109 male and 109 female patients. Male patients had significantly higher preoperative average alpha angles (69.79° vs 58.17°, P < .001), more often requiring a femoroplasty (97.2% vs 83.5%, P < .001), and had higher rates of complex labral tearing (50.5% vs 33.0%, P < .001). Male patients also had higher rates of grade 3 and 4 acetabular labral articular disruption (62.4% vs 19.3%, P < .001) and higher rates of grade 3 and 4 acetabular cartilage injury (59.6% vs 20.2%, P < .001) requiring a microfracture more frequently (32.1% vs 7.3%, P < .001). Female patients more typically had painful internal snapping requiring iliopsoas fractional lengthening (60.6% vs 32.1%, P < .001). Female patients also underwent capsular plication more regularly to address hip instability (79.8% vs 45.9%, P < .001). Male and female patients showed significant improvements in all outcome scores after surgery (P < .001). Female patients achieved the minimal clinically important difference for the NAHS at higher rates (85.3% vs 71.6%, P = .020). CONCLUSION Female and male patients with BHD who underwent hip arthroscopy achieved favorable outcomes but had notably dissimilar pathology. Hence, although they share similar acetabular bony morphology, male and female patients with BHD may represent 2 very different pathologic entities.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - James D Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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49
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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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50
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Gu Y, Jin W, Zhang H, Shi Z, Yue Y, Yan Z, Zhao Z, Li S, Yan X. What are the significant factors affecting pain in patients with Hartofilakidis type Ι developmental dysplasia of the hip? J Orthop Surg Res 2021; 16:611. [PMID: 34663364 PMCID: PMC8522044 DOI: 10.1186/s13018-021-02761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To explore the influencing factors of age at onset of pain and severe pain in patients with Hartofilakidis type I developmental dysplasia of the hip (DDH). Methods A retrospective study of 83 patients with DDH treated at our hospital from January 2017 to June 2021 was conducted. The age at onset of pain, patients’ demographic data, and radiographic parameters were collected. Multiple linear regression was used to determine the influencing factors of age at onset of pain. Cox regression analysis was used to determine the influencing factors of severe pain attacks. Results According to the results of multiple linear regression analysis, when the distance between the medial femoral head and the ilioischial line increased by one millimetre, the age at onset of pain decreased by 1.7 years (β = − 1.738, 95% CI − 1.914–[− 1.561], p < 0.001). When the sharp angle increases by one degree, the age at onset of pain decreases by 0.3 years (β = − 0.334, 95% CI − 0.496–[− 0.171], p < 0.001). According to the results of the Cox regression analysis, for each additional degree of the lateral centre-edge angle (LCEA), the probability of severe pain was reduced by 5% (Exp [β]: = 0.947, 95% CI 0.898–0.999, p = 0.044). For each additional millimetre in the distance between the medial femoral head and the ilioischial line, the likelihood of severe pain increased by 2.4 times (Exp [β]: 2.417, 95% CI 1.653–3.533, p < 0.001). Conclusion Larger distances between the medial femoral head and the ilioischial line and sharp angle can lead to an earlier age at onset of pain in patients with DDH. Small LCEA and excessive distance between the medial femoral head and the ilioischial line are risk factors for severe pain.
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Affiliation(s)
- Yange Gu
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China
| | - Wenshu Jin
- School of Sports Medicine and Rehabilitation, Shandong First Medical University & Shandong Academy of Medical Sciences, 619 Great Wall Road, Tai'an, 271000, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Han Zhang
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China
| | - Zhiwei Shi
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Yaohui Yue
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China.,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Zhaolong Yan
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Zhang Zhao
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Shufeng Li
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China
| | - Xinfeng Yan
- Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250014, Shandong, China. .,Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jing Shi Road, Jinan, 250014, Shandong, China.
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