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Massè A, Giachino M, Audisio A, Donis A, Giai Via R, Secco DC, Limone B, Turchetto L, Aprato A. Ganz femoral head reduction associated with coverage and containment procedures improve radiological and functional outcomes in Perthes' disease. Bone Joint J 2024; 106-B:40-46. [PMID: 38688483 DOI: 10.1302/0301-620x.106b5.bjj-2023-0853.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Ganz's studies made it possible to address joint deformities on both the femoral and acetabular side brought about by Perthes' disease. Femoral head reduction osteotomy (FHRO) was developed to improve joint congruency, along with periacetabular osteotomy (PAO), which may enhance coverage and containment. The purpose of this study is to show the clinical and morphological outcomes of the technique and the use of an implemented planning approach. Methods From September 2015 to December 2021, 13 FHROs were performed on 11 patients for Perthes' disease in two centres. Of these, 11 hips had an associated PAO. A specific CT- and MRI-based protocol for virtual simulation of the corrections was developed. Outcomes were assessed with radiological parameters (sphericity index, extrusion index, integrity of the Shenton's line, lateral centre-edge angle (LCEA), Tönnis angle), and clinical parameters (range of motion, visual analogue scale (VAS) for pain, Merle d'Aubigné-Postel score, modified Harris Hip Score (mHHS), and EuroQol five-dimension five-level health questionnaire (EQ-5D-5L)). Early and late complications were reported. Results The mean follow-up was 39.7 months (standard deviation (SD) 26.4). The mean age at surgery was 11.4 years (SD 1.6). No major complications were recorded. One patient required a total hip arthroplasty. Mean femoral head sphericity increased from 46.8% (SD 9.34%) to 70.2% (SD 15.44; p < 0.001); mean LCEA from 19.2° (SD 9.03°) to 44° (SD 10.27°; p < 0.001); mean extrusion index from 37.8 (SD 8.70) to 7.5 (SD 9.28; p < 0.001); and mean Tönnis angle from 16.5° (SD 12.35°) to 4.8° (SD 4.05°; p = 0.100). The mean VAS improved from 3.55 (SD 3.05) to 1.22 (1.72; p = 0.06); mean Merle d'Aubigné-Postel score from 14.55 (SD 1.74) to 16 (SD 1.6; p = 0.01); and mean mHHS from 60.6 (SD 18.06) to 81 (SD 6.63; p = 0.021). The EQ-5D-5L also showed significant improvements. Conclusion FHRO associated with periacetabular procedures is a safe technique that showed improved functional, clinical, and morphological outcomes in Perthes' disease. The newly introduced simulation and planning algorithm may help to further refine the technique.
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Affiliation(s)
- Alessandro Massè
- Ortopedia e Traumatologia 1U, Centro Traumatologico Ortopedico, Città della Salute e della Scienza, Torino, Italy
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
| | - Matteo Giachino
- Ortopedia e Traumatologia 1U, Centro Traumatologico Ortopedico, Città della Salute e della Scienza, Torino, Italy
| | - Andrea Audisio
- Ortopedia e Traumatologia Pediatrica, Ospedale Infantile Regina Margherita, Torino, Italy
| | - Andrea Donis
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
| | - Riccardo Giai Via
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
| | - Davide C Secco
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
| | - Beatrice Limone
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
| | - Luigino Turchetto
- UOC Ortopedia e Traumatologia, Ospedale di Portogruaro, Portogruaro, Italy
| | - Alessandro Aprato
- Ortopedia e Traumatologia 1U, Centro Traumatologico Ortopedico, Città della Salute e della Scienza, Torino, Italy
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Torino, Italy
- Ortopedia e Traumatologia Pediatrica, Ospedale Infantile Regina Margherita, Torino, Italy
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Newhouse AC, Alter TD, Handoklow LA, Espinoza Orías AA, Inoue N, Nho SJ. 3.0T magnetic resonance imaging-based hip bone models for femoroacetabular impingement syndrome are equivalent to computed tomography-based models. J Orthop Res 2024. [PMID: 38564320 DOI: 10.1002/jor.25845] [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: 04/12/2023] [Revised: 02/16/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
This study aimed to compare three-dimensional (3D) proximal femoral and acetabular surface models generated from 3.0T magnetic resonance imaging (MRI) to the clinical gold standard of computed tomography (CT). Ten intact fresh-frozen cadaveric hips underwent CT and 3.0T MRI scans. The CT- and MRI-based segmented models were superimposed using a validated 3D-3D registration volume-merge method to compare them. The least surface-to-surface distance between the models was calculated by a point-to-surface calculation algorithm using a custom-written program. The variables of interest were the signed and absolute surface-to-surface distance between the paired bone models. One-sample t-tests were performed using a signed and absolute test value of 0.16 mm and 0.37 mm, respectively, based on a previous study that validated 1.5T MRI bone models by comparison with CT bone models. For the femur, the average signed and absolute surface-to-surface distance was 0.18 ± 0.09 mm and 0.30 ± 0.06 mm, respectively. There was no difference in the signed surface-to-surface distance and the 0.16 mm test value (t = 0.650, p = 0.532). However, the absolute surface-to-surface difference was less than the 0.37 mm test value (t = -4.025, p = 0.003). For the acetabulum, the average signed and absolute surface-to-surface distance was -0.06 ± 0.06 mm and 0.26 ± 0.04 mm, respectively. The signed (t = -12.569, p < 0.001) and absolute (t = -8.688, p < 0.001) surface-to-surface difference were less than the 0.16 mm and 0.37 mm test values, respectively. Our data shows that 3.0T MRI bone models are more similar to CT bone models than previously validated 1.5T MRI bone models. This is likely due to the higher resolution of the 3T data.
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Affiliation(s)
- Alexander C Newhouse
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Lyla A Handoklow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Bioengineering, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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3
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Guidetti M, Malloy P, Alter TD, Newhouse AC, Nho SJ, Espinoza Orías AA. Noninvasive shape-fitting method quantifies cam morphology in femoroacetabular impingement syndrome: Implications for diagnosis and surgical planning. J Orthop Res 2022; 41:1256-1265. [PMID: 36227086 DOI: 10.1002/jor.25469] [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: 02/01/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
There are considerable limitations associated with the standard 2D imaging currently used for the diagnosis and surgical planning of cam-type femoroacetabular impingement syndrome (FAIS). The aim of this study was to determine the accuracy of a new patient-specific shape-fitting method that quantifies cam morphology in 3D based solely on preoperative MRI imaging. Preoperative and postoperative 1.5T MRI scans were performed on n = 15 patients to generate 3D models of the proximal femur, in turn used to create the actual and the virtual cam. The actual cams were reconstructed by subtracting the postoperative from the preoperative 3D model and used as reference, while the virtual cams were generated by subtracting the preoperative 3D model from the virtual shape template produced with the shape-fitting method based solely on preoperative MRI scans. The accuracy of the shape-fitting method was tested on all patients by evaluating the agreement between the metrics of height, surface area, and volume that quantified virtual and actual cams. Accuracy of the shape-fitting method was demonstrated obtaining a 97.8% average level of agreement between these metrics. In conclusion, the shape-fitting technique is a noninvasive and patient-specific tool for the quantification and localization of cam morphology. Future studies will include the implementation of the technique within a clinically based software for diagnosis and surgical planning for cam-type FAIS.
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Affiliation(s)
- Martina Guidetti
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro A Espinoza Orías
- Section of Young Adult Hip Surgery, Department of Orthopedic Surgery, Division of Sports Medicine, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Alter TD, Knapik DM, Lambers F, Sivasundaram L, Malloy P, Chahla J, Nho SJ. Outcomes for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome With Acetabular Retroversion: A 3D Computed Tomography Analysis. Am J Sports Med 2022; 50:2155-2164. [PMID: 35604075 DOI: 10.1177/03635465221097118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased attention has been directed toward the acetabular morphology in the management of patients with femoroacetabular impingement syndrome (FAIS). Whether acetabular version influences patient-reported outcomes remains poorly understood. PURPOSE To use computed tomography (CT)-based 3-dimensional (3D) bone models to (1) quantify acetabular version in patients with FAIS, (2) compare acetabular version on 3D bone models with current plain radiographic parameters, and (3) explore the relationship between the magnitude of acetabular version and minimum 2-year clinical outcomes after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Three-dimensional models of the pelvis and femur were generated by semiautomated segmentation and aligned to a standard coordinate system. Acetabular version was quantified at the 3-o'clock position, and 3 groups were identified: acetabular retroversion (AR; <15°), normal acetabular version (NV; 15°-25°), and acetabular anteversion (AA; >25°). Patient demographic characteristics, plain radiographic parameters, and clinical outcomes were analyzed, including the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. RESULTS Preoperative CT scans were acquired in 105 consecutive patients before hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum 2-year patient-reported outcomes. The mean ± SD age and body mass index of patients were 33.9 ± 12.6 years and 26.0 ± 5.4, respectively; 70.2% were female. The number of patients and the mean central acetabular version within each group were as follows: AR (n = 12; 11.3°± 2.7°), NV (n = 56; 20.7°± 2.9°), and AA (n = 16; 28.5°± 2.7°). Posterior wall sign was the only plain radiographic parameter that was significantly more observed in the AR group than in the other 2 groups. At minimum 2-year follow-up, significant between-group differences in the mHHS, iHOT-12, and VAS for pain and satisfaction (P < .05) were appreciated, while post hoc analysis with Bonferroni correction (P < .0167) found lower scores on the mHHS, iHOT-12, and VAS for pain and satisfaction in patients with AR as compared with NV. Lower scores on the VAS for satisfaction were reported in patients with AR when compared with AA (P = .006) but not on the mHHS (P = .023), iHOT-12 (P = .032), or VAS for pain (P = .072). CONCLUSION Traditional plain radiographic indices to describe AR, including crossover sign and ischial spine sign, were not reliable in defining AR according to 3D models derived from CT scans. Only the posterior wall sign was observed in a higher proportion in the AR group. Patients with AR demonstrated inferior outcomes when compared with patients with NV and AA after hip arthroscopy for FAIS.
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Affiliation(s)
- Thomas D Alter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Derrick M Knapik
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | | | | | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Arcadia University, Montgomery, Pennsylvania, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Alter TD, Kunze KN, Newhouse AC, Bessa F, DeFroda S, Williams J, Nho SJ. Assessment of Femoral Torsion on Magnetic Resonance Imaging is More Reliable Using Axial-Oblique Sequences Compared With Standard Axial Slices in Patients With Femoroacetabular Impingement Syndrome. Arthroscopy 2022; 38:1857-1866. [PMID: 34838988 DOI: 10.1016/j.arthro.2021.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the agreeability of femoral torsion measurements on axial and oblique axial magnetic resonance imaging (MRI) sequences in patients with femoroacetabular impingement syndrome (FAIS). METHODS Patients who underwent primary hip arthroscopy for FAIS between January 2012 to January 2019 were identified. Inclusion criteria were all patients with an MRI scan containing the pelvis and knee imaging. MRI-based measurements of femoral torsion were performed on axial and oblique-axial slices by 2 raters, and inter-rater and intrarater reliability was assessed. Bland Altman plots were constructed to evaluate the agreeability between femoral torsion measurements performed using axial and oblique-axial slices. Bivariate correlation analyses were performed to assess the relationship between measurement methods on each respective scan. A linear regression was performed between measurements performed using axial and oblique-axial sequences. RESULTS A total of 164 patients were included. The mean true-axial and oblique axial femoral torsion were 12.2° ± 9.9° and 11.1° ± 9.2°, respectively. The intrarater reliability for axial and oblique-axial measurements were 0.993 and 0.997, respectively. The inter-rater reliability for axial and oblique-axial measurements were 0.925 and 0.965, respectively. The number of differences within the limits of agreement for axial and oblique-axial femoral torsion measurements was 58.54%. On Pearson correlation analysis, strong positive correlations were found between oblique-axial measurements at multiple time points (r = 0.994, P < .001), as well as axial measurements at multiple time points (r = 0.986, P < .001). A strong positive correlation was found between axial and oblique-axial measurements (r = 0.894, P < .001). A significant regression equation indicated that for each additional increase in axial femoral torsion, the oblique-axial femoral torsion increased 0.837 (95% confidence interval 0.772-0.901). CONCLUSIONS Femoral torsion values measured on oblique-axial sequences are smaller than on true-axial sequences. Femoral torsion measurements on axial and oblique-axial MRI sequences exhibit poor agreement. Oblique-axial sequences demonstrated greater measurement consistency at multiple timepoints. When evaluating torsional measurements, it is important to delineate which axial sequence was used, especially in patients with suspected severe femoral antetorsion. Standardization of MRI femoral version protocols within one's practice can ensure more consistent decision-making, especially in patients with suspected femoral antetorsion. LEVEL OF EVIDENCE Retrospective cohort, level III.
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Affiliation(s)
- Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois.
| | - Kyle N Kunze
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
| | - Felipe Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
| | - Steven DeFroda
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
| | - Joel Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
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Alter TD, Knapik DM, Guidetti M, Espinoza A, Chahla J, Nho SJ, Malloy P. Three-Dimensional Quantification of Cam Resection Using MRI Bone Models: A Comparison of 2 Techniques. Orthop J Sports Med 2022; 10:23259671221095417. [PMID: 35547617 PMCID: PMC9083056 DOI: 10.1177/23259671221095417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The current clinical standard for the evaluation of cam deformity in femoroacetabular impingement syndrome is based on radiographic measurements, which limit the ability to quantify the complex 3-dimensional (3D) morphology of the proximal femur. Purpose: To compare magnetic resonance imaging (MRI)–based metrics for the quantification of cam resection as derived using a best-fit sphere alpha angle (BFS-AA) method and using 3D preoperative-postoperative surface model subtraction (PP-SMS). Study Design: Descriptive laboratory study. Methods: Seven cadaveric hemipelvises underwent 1.5-T MRI before and after arthroscopic femoral osteochondroplasty, and 3D bone models of the proximal femur were reconstructed from the MRI scans. The alpha angles were measured radially along clockfaces using a BFS-AA method from the literature and plotted as continuous curves for the pre- and postoperative models. The difference between the areas under the curve for the pre- and postoperative models was then introduced in the current study as the BFS-AA–based metric to quantify the cam resection. The cam resection was also quantified using a 3D PP-SMS method, previously described in the literature using the metrics of surface area (FSA), volume (FV), and height (maximum [FHmax] and mean [FHmean]). Bivariate correlation analyses were performed to compare the metrics quantifying the cam resection as derived from the BFS-AA and PP-SMS methods. Results: The mean ± standard deviation maximum pre- and postoperative alpha angle measurements were 59.73° ± 15.38° and 48.02° ± 13.14°, respectively. The mean for each metric quantifying the cam resection with the PP-SMS method was as follows: FSA, 540.9 ± 150.7 mm2; FV, 1019.2 ± 486.2 mm3; FHmax, 3.6 ± 1.0 mm; and FHmean, 1.8 ± 0.5 mm. Bivariate correlations between the BFS-AA–based and PP-SMS–based metrics were strong: FSA (r = 0.817, P = .012), FV (r = 0.888, P = .004), FHmax (r = 0.786, P = .018), and FHmean (r = 0.679, P = .047). Conclusion: Strong positive correlations were appreciated between the BFS-AA and PP-SMS methods quantifying the cam resection. Clinical Relevance: The utility of the BFS-AA technique is primarily during preoperative planning. The utility of the PP-SMS technique is in the postoperative setting when evaluating the adequacy of resection or in patients with persistent hip pain with suspected residual impingement. In combination, the techniques allow surgeons to develop a planned resection while providing a means to evaluate the depth of resection postoperatively.
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Thomas D. Alter, MS, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA ()
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alejandro Espinoza
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
- Arcadia University, Glenside, Pennsylvania, USA
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Guidetti M, Malloy P, Alter TD, Newhouse AC, Espinoza Orías AA, Inoue N, Nho SJ. MRI-- and CT--based metrics for the quantification of arthroscopic bone resections in femoroacetabular impingement syndrome. J Orthop Res 2022; 40:1174-1181. [PMID: 34192370 DOI: 10.1002/jor.25139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
The purpose of this in vitro study was to quantify the bone resected from the proximal femur during hip arthroscopy using metrics generated from magnetic resonance imaging (MRI) and computed tomography (CT) reconstructed three-dimensional (3D) bone models. Seven cadaveric hemi-pelvises underwent both a 1.5 T MRI and CT scan before and following an arthroscopic proximal femoral osteochondroplasty. The images from MRI and CT were segmented to generate 3D proximal femoral surface models. A validated 3D--3D registration method was used to compare surface--to--surface distances between the 3D models before and following surgery. The new metrics of maximum height, mean height, surface area and volume, were computed to quantify bone resected during osteochondroplasty. Stability of the metrics across imaging modalities was established through paired sample t--tests and bivariate correlation. Bivariate correlation analyses indicated strong correlations between all metrics (r = 0.728--0.878) computed from MRI and CT derived models. There were no differences in the MRI- and CT-based metrics used to quantify bone resected during femoral osteochondroplasty. Preoperative- and postoperative MRI and CT derived 3D bone models can be used to quantify bone resected during femoral osteochondroplasty, without significant differences between the imaging modalities.
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Affiliation(s)
- Martina Guidetti
- 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, Illinois, USA
| | - Philip Malloy
- 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, Illinois, USA.,Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Thomas D Alter
- 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, Illinois, USA
| | - Alexander C Newhouse
- 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, Illinois, USA
| | - Alejandro A Espinoza Orías
- 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, Illinois, USA
| | - Nozomu Inoue
- 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, Illinois, 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, Illinois, USA
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Florkow MC, Willemsen K, Zijlstra F, Foppen W, van der Wal BCH, van der Voort van Zyp JRN, Viergever MA, Castelein RM, Weinans H, van Stralen M, Sakkers RJB, Seevinck PR. MRI-based synthetic CT shows equivalence to conventional CT for the morphological assessment of the hip joint. J Orthop Res 2022; 40:954-964. [PMID: 34191351 PMCID: PMC9291600 DOI: 10.1002/jor.25127] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
This study evaluated the accuracy of synthetic computed tomography (sCT), as compared to CT, for the 3D assessment of the hip morphology. Thirty male patients with asymptomatic hips, referred for magnetic resonance (MR) imaging and CT, were included in this retrospective study. sCT images were generated from three-dimensional radiofrequency-spoiled T1-weighted multi-echo gradient-echo MR images using a commercially available deep learning-enabled software and were compared with CT images through mean error and surface distance computation and by means of eight clinical morphometric parameters relevant for hip care. Parameters included center-edge angle (CEA), sharp angle, acetabular index, extrusion index, femoral head center-to-midline distance, acetabular version (AV), and anterior and posterior acetabular sector angles. They were measured by two senior orthopedic surgeons and a radiologist in-training on CT and sCT images. The reliability and agreement of CT- and sCT-based measurements were assessed using intraclass correlation coefficients (ICCs) for absolute agreement, Bland-Altman plots, and two one-sided tests for equivalence. The surface distance between CT- and sCT-based bone models were on average submillimeter. CT- and sCT-based measurements showed moderate to excellent interobserver and intraobserver correlation (0.56 < ICC < 0.99). In particular, the inter/intraobserver agreements were good for AV (ICC > 0.75). For CEA, the intraobserver agreement was good (ICC > 0.75) and the interobserver agreement was moderate (ICC > 0.69). Limits of agreements were similar between intraobserver CT and intermodal measurements. All measurements were found statistically equivalent, with average intermodal differences within the intraobserver limits of agreement. In conclusion, sCT and CT were equivalent for the assessment of the hip joint bone morphology.
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Affiliation(s)
- Mateusz C. Florkow
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Koen Willemsen
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Frank Zijlstra
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Wouter Foppen
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | - Max A. Viergever
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René M. Castelein
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijn van Stralen
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| | - Ralph J. B. Sakkers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter R. Seevinck
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
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Florkow MC, Willemsen K, Mascarenhas VV, Oei EHG, van Stralen M, Seevinck PR. Magnetic Resonance Imaging Versus Computed Tomography for Three-Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review. J Magn Reson Imaging 2022; 56:11-34. [PMID: 35044717 PMCID: PMC9305220 DOI: 10.1002/jmri.28067] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly utilized as a radiation‐free alternative to computed tomography (CT) for the diagnosis and treatment planning of musculoskeletal pathologies. MR imaging of hard tissues such as cortical bone remains challenging due to their low proton density and short transverse relaxation times, rendering bone tissues as nonspecific low signal structures on MR images obtained from most sequences. Developments in MR image acquisition and post‐processing have opened the path for enhanced MR‐based bone visualization aiming to provide a CT‐like contrast and, as such, ease clinical interpretation. The purpose of this review is to provide an overview of studies comparing MR and CT imaging for diagnostic and treatment planning purposes in orthopedic care, with a special focus on selective bone visualization, bone segmentation, and three‐dimensional (3D) modeling. This review discusses conventional gradient‐echo derived techniques as well as dedicated short echo time acquisition techniques and post‐processing techniques, including the generation of synthetic CT, in the context of 3D and specific bone visualization. Based on the reviewed literature, it may be concluded that the recent developments in MRI‐based bone visualization are promising. MRI alone provides valuable information on both bone and soft tissues for a broad range of applications including diagnostics, 3D modeling, and treatment planning in multiple anatomical regions, including the skull, spine, shoulder, pelvis, and long bones.
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Affiliation(s)
- Mateusz C Florkow
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Hospital da Luz, Lisbon, Portugal
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance BV, Utrecht, The Netherlands
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10
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Alter TD, Malloy P, Newhouse AC, Suppauksorn S, Orias AE, Chahla J, Inoue N, Nho SJ. Three-Dimensional Measures of Bony Resection During Femoral Osteochondroplasty Are Related to Alpha Angle Measures: A Cadaveric Study. Arthrosc Sports Med Rehabil 2021; 3:e1857-e1863. [PMID: 34977641 PMCID: PMC8689252 DOI: 10.1016/j.asmr.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Address correspondence to Thomas Alter, 1611 W Harrison St, Chicago, IL 60612.
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
- Department of Physical Therapy, Arcadia University, Pennsylvania, U.S.A
| | - Alex C. Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Sunikom Suppauksorn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Alejandro Espinzoa Orias
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Nozomu Inoue
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University, Chicago, Illinois
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11
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Lockard CA, Stake IK, Brady AW, DeClercq MG, Tanghe KK, Douglass BW, Nott E, Ho CP, Clanton TO. Accuracy of MRI-Based Talar Cartilage Thickness Measurement and Talus Bone and Cartilage Modeling: Comparison with Ground-Truth Laser Scan Measurements. Cartilage 2021; 13:674S-684S. [PMID: 33269605 PMCID: PMC8808841 DOI: 10.1177/1947603520976774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this work was to compare measurements of talar cartilage thickness and cartilage and bone surface geometry from clinically feasible magnetic resonance imaging (MRI) against high-accuracy laser scan models. Measurement of talar bone and cartilage geometry from MRI would provide useful information for evaluating cartilage changes, selecting osteochondral graft sources or creating patient-specific joint models. DESIGN Three-dimensional (3D) bone and cartilage models of 7 cadaver tali were created using (1) manual segmentation of high-resolution volumetric sequence 3T MR images and (2) laser scans. Talar cartilage thickness was compared between the laser scan- and MRI-based models for the dorsal, medial, and lateral surfaces. The laser scan- and MRI-based cartilage and bone surface models were compared using model-to-model distance. RESULTS Average cartilage thickness within the dorsal, medial, and lateral surfaces were 0.89 to 1.05 mm measured with laser scanning, and 1.10 to 1.22 mm measured with MRI. MRI-based thickness was 0.16 to 0.32 mm higher on average in each region. The average absolute surface-to-surface differences between laser scan- and MRI-based bone and cartilage models ranged from 0.16 to 0.22 mm for bone (MRI bone models smaller than laser scan models) and 0.35 to 0.38 mm for cartilage (MRI bone models larger than laser scan models). CONCLUSIONS This study demonstrated that cartilage and bone 3D modeling and measurement of average cartilage thickness on the dorsal, medial, and lateral talar surfaces using MRI were feasible and provided similar model geometry and thickness values to ground-truth laser scan-based measurements.
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Affiliation(s)
| | - Ingrid K. Stake
- Steadman Philippon Research Institute,
Vail, CO, USA
- Department of Orthopaedic Surgery,
Ostfold Hospital Trust, Grålum, Norway
| | - Alex W. Brady
- Steadman Philippon Research Institute,
Vail, CO, USA
| | | | | | | | | | - Charles P. Ho
- Steadman Philippon Research Institute,
Vail, CO, USA
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12
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Preoperative Dynamic Hip Examination Under Fluoroscopic Guidance Enhances the Understanding of Femoroacetabular Impingement Pathology and Treatment Planning. Arthrosc Sports Med Rehabil 2021; 3:e1599-e1606. [PMID: 34977611 PMCID: PMC8689150 DOI: 10.1016/j.asmr.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose To review the relative accuracy of preoperative magnetic resonance imaging (MRI) and fluoroscopically guided examination-under-sedation (EUS) findings and to explore the validity of the anterior acetabular sector angle (AASA) as a radiologic MRI-based marker of anterior acetabular coverage in pincer-type impingement. Methods A cohort of 150 consecutive patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) in 2018 to 2019 was reviewed. The inclusion criteria were pure FAI unilateral symptomatic pathology and the availability of complete data sets (MRI, EUS, and intraoperative records). Preoperative MRI and EUS findings were compared with gold-standard intraoperative arthroscopic findings, specifically evaluating the alpha angle in the presence of cam lesions, AASA in the presence of pincer lesions, as well as soft-tissue lesions. An alpha angle greater than 50° and an AASA greater than 65° were deemed pathologic. Results The patient cohort included 78 women and 72 men with an average age of 38 years (range, 18-53 years). Intraoperatively, pincer lesions were present in 20% of patients; cam lesions, 26%; and mixed impingement, 54%. MRI versus EUS correctly identified pincer lesions in 36% versus 89% of cases and identified cam lesions in 44% versus 77% of cases. MRI findings characterizing labral tears and articular cartilage pathology were accurate in 80% and 10% of cases, respectively. Although there was no difference in the AASA between pure pincer- and mixed-type impingements (62° and 63°, respectively; P = .62), there was a statistically significant difference in reported AASA values between pure cam-type impingement and impingement involving the presence of pincer lesions (57° and 63°, respectively; P = .03). Furthermore, 31% of patients with intraoperatively identified pincer lesions had an AASA of 60° to 65°. Conclusions Fluoroscopic EUS is accurate in characterizing FAI pathology. In addition, MRI is useful to diagnose or rule out non-FAI pathology, ascertain labral pathology, and outline hip alignment. These methods of preoperative planning are complementary. Level of Evidence Level IV, therapeutic case series.
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13
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Abstract
Computed tomography (CT) is most commonly used to produce three-dimensional (3D) models for evaluating bone and joint morphology in clinical practice. However, 3D models created from magnetic resonance imaging (MRI) data can be equally effective for comprehensive and accurate assessment of osseous and soft tissue structure morphology and pathology. The quality of 3D MRI models has steadily increased over time, with growing potential to replace 3D CT models in various musculoskeletal (MSK) applications. In practice, a single MRI examination for two-dimensional and 3D assessments can increase the value of MRI and simplify the pre- and postoperative imaging work-up. Multiple studies have shown excellent performance of 3D MRI models in shoulder injuries, in the hip in the setting of femoroacetabular impingement, and in the knee for the creation of bone surface models. Therefore, the utility of 3D MRI postprocessed models is expected to continue to rise and broaden in applications. Computer-based and artificial intelligence-assisted postprocessing techniques have tremendous potential to improve the efficiency of 3D model creation, opening many research avenues to validate the applicability of 3D MRI and establish 3D-specific quantitative assessment criteria. We provide a practice-focused overview of 3D MRI acquisition strategies, postprocessing techniques for 3D model creation, MSK applications of 3D MRI models, and an illustration of cases from our daily clinical practice.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, NYU Langone Medical Center, New York, New York
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Häller TV, Schenk P, Jud L, Hoch A, Götschi T, Zingg PO. Consistency of 3D femoral torsion measurement from MRI compared to CT gold standard. BMC Musculoskelet Disord 2021; 22:739. [PMID: 34454445 PMCID: PMC8403345 DOI: 10.1186/s12891-021-04633-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
Background Several hip and knee pathologies are associated with aberrant femoral torsion. Diagnostic workup includes computed tomography (CT) and magnetic resonance imaging (MRI). For three-dimensional (3D) analysis of complex deformities it would be desirable to measure femoral torsion from MRI data to avoid ionizing radiation of CT in a young patient population. 3D measurement of femoral torsion from MRI has not yet been compared to measurements from CT images. We hypothesize that agreement will exist between MRI and CT 3D measurements of femoral torsion. Methods CT and MRI data from 29 hips of 15 patients with routine diagnostic workup for suspected femoroacetabular impingement (FAI) were used to generate 3D bone models. 3D measurement of femoral torsion was performed by two independent readers using the method of Kim et al. which is validated for CT. Inter-modalitiy and inter-reader intraclass correlation coefficients (ICC) were calculated. Results Between MRI and CT 3D measurements an ICC of 0.950 (0.898; 0.976) (reader 1) respectively 0.950 (0.897; 0.976) (Reader 2) was found. The ICC (95% CI) expressing the inter-reader reliability for both modalities was 0.945 (0.886; 0.973) for MRI and 0.957 (0.910; 0.979) for CT, respectively. Mean difference between CT and MRI measurement was 0.42° (MRI – CT, SD: 2.77°, p = 0.253). Conclusions There was consistency between 3D measurements of femoral torsion between computer rendered MRI images compared to measurements with the “gold standard” of CT images. ICC for inter-modality and inter-reader consistency indicate excellent reliability. Accurate, reliable and reproducible 3D measurement of femoral torsion is possible from MRI images.
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Affiliation(s)
- Thomas Vincent Häller
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Pascal Schenk
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Tobias Götschi
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Oliver Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips. PLoS One 2020; 15:e0231001. [PMID: 32251468 PMCID: PMC7135075 DOI: 10.1371/journal.pone.0231001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA ≤ 20°), 47 hips; borderline (20° ≤ LCEA < 25°), 32 hips; and control (25° ≤ LCEA < 35°), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.
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