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Zhai H, Huang J, Li L, Tao H, Wang J, Li K, Shao M, Cheng X, Wang J, Wu X, Wu C, Zhang X, Wang H, Xiong Y. Deep learning-based workflow for hip joint morphometric parameter measurement from CT images. Phys Med Biol 2023; 68:225003. [PMID: 37852280 DOI: 10.1088/1361-6560/ad04aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective.Precise hip joint morphometry measurement from CT images is crucial for successful preoperative arthroplasty planning and biomechanical simulations. Although deep learning approaches have been applied to clinical bone surgery planning, there is still a lack of relevant research on quantifying hip joint morphometric parameters from CT images.Approach.This paper proposes a deep learning workflow for CT-based hip morphometry measurement. For the first step, a coarse-to-fine deep learning model is designed for accurate reconstruction of the hip geometry (3D bone models and key landmark points). Based on the geometric models, a robust measurement method is developed to calculate a full set of morphometric parameters, including the acetabular anteversion and inclination, the femoral neck shaft angle and the inclination, etc. Our methods were validated on two datasets with different imaging protocol parameters and further compared with the conventional 2D x-ray-based measurement method.Main results. The proposed method yields high bone segmentation accuracies (Dice coefficients of 98.18% and 97.85%, respectively) and low landmark prediction errors (1.55 mm and 1.65 mm) on both datasets. The automated measurements agree well with the radiologists' manual measurements (Pearson correlation coefficients between 0.47 and 0.99 and intraclass correlation coefficients between 0.46 and 0.98). This method provides more accurate measurements than the conventional 2D x-ray-based measurement method, reducing the error of acetabular cup size from over 2 mm to less than 1 mm. Moreover, our morphometry measurement method is robust against the error of the previous bone segmentation step. As we tested different deep learning methods for the prerequisite bone segmentation, our method produced consistent final measurement results, with only a 0.37 mm maximum inter-method difference in the cup size.Significance. This study proposes a deep learning approach with improved robustness and accuracy for pelvis arthroplasty planning.
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Affiliation(s)
- Haoyu Zhai
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Jin Huang
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Lei Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116024, People's Republic of China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiao Tong University Shcool of Medicine, Shanghai 200011, People's Republic of China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiaotong University School of Medicine Department of Orthopaedics & Bone and Joint Research Center, Shanghai 200011, People's Republic of China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Moyu Shao
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Xiaomin Cheng
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Jing Wang
- Xi'an JiaoTong University. School of Chemical Engineering and Technology, Xi'an 710049, People's Republic of China
| | - Xiang Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Chuan Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Xiao Zhang
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Hongkai Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
- Liaoning Key Laboratory of Integrated Circuit and Biomedical Electronic System, Dalian 116024, People's Republic of China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
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2
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Harris MD, Shepherd MC, Song K, Gaffney BM, Hillen TJ, Harris-Hayes M, Clohisy JC. The biomechanical disadvantage of dysplastic hips. J Orthop Res 2022; 40:1387-1396. [PMID: 34415648 PMCID: PMC8858333 DOI: 10.1002/jor.25165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is strongly associated with an increased risk for hip osteoarthritis. Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (N = 20) to healthy controls (N = 15). Femoral coverage was significantly less in patients (p < 0.001, Cohen's d effect size = 2.2), femoral neck-shaft angles were larger (p = 0.001, d = 1.3), and hip joint centers (HJCs) were more lateral (p = 0.001, d = 1.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]: p = 0.001, d = 1.2). Patients with DDH also had larger GMED volumes (p = 0.02, d = 0.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.
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Affiliation(s)
- Michael D. Harris
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Molly C. Shepherd
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Ke Song
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Brecca M.M. Gaffney
- Department of Mechanical Engineering, University of Colorado-Denver, Denver, CO
| | - Travis J. Hillen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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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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Mozingo JD, Schuring LL, Mortensen AJ, Anderson AE, Aoki SK. Effect of Patient Positioning on Measurement of the Anterior Center-Edge Angle on False-Profile Radiographs and Its 3-Dimensional Mapping to the Acetabular Rim. Orthop J Sports Med 2022; 10:23259671211073834. [PMID: 35141341 PMCID: PMC8819774 DOI: 10.1177/23259671211073834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The anterior center-edge angle (ACEA) is used to quantify anterior coverage of the femoral head by the acetabulum. However, its measurement has not been evaluated in a manner consistent with routine use, and the precise 3-dimensional (3D) anatomic location where it measures coverage is not known. Purpose: To determine the effect of patient positioning on ACEA measurement reliability, magnitude, and 3D location. Study Design: Descriptive laboratory study. Methods: Included were 18 adults; 7 participants had cam morphology and femoroacetabular impingement syndrome, and 11 participants had no radiographic evidence of hip abnormalities and no history of hip pain or injuries. Ultimately, 3D femur and pelvis models were generated from computed tomography images. Radiographs were generated with the models in different degrees of pelvic rotation, tilt, and obliquity relative to the standard false-profile view. The ACEA was measured by 2 raters by selecting the location of the bone edge on each radiograph. Selections were projected onto the pelvis model and expressed as a clockface location on the acetabular rim. The clockface was mirrored on left hips to allow a direct comparison of locations between hips. Interrater and intrarater reliability were quantified via the intraclass correlation coefficient (ICC). The effect of position on ACEA measurements and clockface locations was determined via linear regression. Results: Intrarater and interrater reliability were excellent (ICC ≥0.97 for all). For every degree increase in rotation, tilt, and obliquity, the ACEA changed by +0.53°, +0.93°, and –0.04°, respectively. The mean clockface location (hour:minute:second) in the false-profile view was 2:09:32 ± 0:12:00 and changed by +0:02:08, –0:00:35, and –0:00:05 for every degree increase in rotation, tilt, and obliquity, respectively. Conclusion: ACEA measurements were reliable even with differences in patient positioning. Rotation and tilt were associated with notable changes in ACEA measurements. ACEA bone edge measurements mapped to the anterosuperior acetabular rim, typically in proximity to the anterior inferior iliac spine. Mapped location was most sensitive to rotation. Clinical Relevance: Pelvic rotation and tilt affected ACEA measurements, which could alter the clinical classification and treatment of borderline abnormalities. Rotation in particular must be well controlled during patient imaging to preserve measurement reliability and accuracy and to describe coverage from the intended 3D rim location.
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Affiliation(s)
- Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Lindsay L. Schuring
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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5
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Image based quantification of the proximal femur shape deformities in 3D by using the contralateral healthy shape structure: A preliminary study. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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6
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Horenstein RE, Meslier Q, Spada JA, Halverstadt A, Lewis CL, Gimpel M, Birchall R, Wedatilake T, Fernquest S, Palmer A, Glyn-Jones S, Shefelbine SJ. Measuring 3D growth plate shape: Methodology and application to cam morphology. J Orthop Res 2021; 39:2398-2408. [PMID: 33368641 PMCID: PMC8222423 DOI: 10.1002/jor.24972] [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: 03/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
Physeal changes corresponding to cam morphology are currently measured using two-dimensional (2D) methods. These methods are limited by definitions of the femoral neck axis and head center that are dependent on the radiographic plane of view. To address these limitations, we developed three-dimensional (3D) methods for analyzing continuous growth plate shape using magnetic resonance imaging scans. These new methods rely on a single definition of the femoral neck axis and head center that are both nondependent on the radiographic plane of view and allow for analysis of growth plate shape across the growth plate surface (performed using statistical parametric mapping). Using our 3D method, we analyzed the position of the growth plate in the femoral head (relative to a plane tangent to the femoral head) and the curvature of the growth plate (relative to a plane through the center of the growth plate) in 9-16-year-old males at risk for cam morphology and their recreationally active peers (n = 17/cohort). These two measurements provide an avenue to separately analyze the effects of these variables in the overall growth plate shape. We detected differences in growth plate shape with age in recreationally active adolescents but did not detect differences between at risk and recreationally adolescents.
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Affiliation(s)
- Rachel E. Horenstein
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Quentin Meslier
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Julia A. Spada
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Anne Halverstadt
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Cara L. Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | - Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sandra J. Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA,Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
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7
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Fischer M, Walter SS, Hepp T, Zimmer M, Notohamiprodjo M, Schick F, Yang B. Automated Morphometric Analysis of the Hip Joint on MRI from the German National Cohort Study. Radiol Artif Intell 2021; 3:e200213. [PMID: 34617023 DOI: 10.1148/ryai.2021200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
Purpose To develop and validate an automated morphometric analysis framework for the quantitative analysis of geometric hip joint parameters in MR images from the German National Cohort (GNC) study. Materials and Methods A secondary analysis on 40 participants (mean age, 51 years; age range, 30-67 years; 25 women) from the prospective GNC MRI study (2015-2016) was performed. Based on a proton density-weighted three-dimensional fast spin-echo sequence, a morphometric analysis approach was developed, including deep learning-based landmark localization, bone segmentation of the femora and pelvis, and a shape model for annotation transfer. The centrum-collum-diaphyseal, center-edge (CE), three alpha angles, head-neck offset (HNO), and HNO ratio along with the acetabular depth, inclination, and anteversion were derived. Quantitative validation was provided by comparison with average manual assessments of radiologists in a cross-validation format. Paired-sample t tests with a Bonferroni-corrected significance level of .005 were employed alongside mean differences and 10th/90th percentiles, median absolute deviations (MADs), and intraclass correlation coefficients (ICCs). Results High agreement in mean Dice similarity coefficients was achieved (average of 97.52% ± 0.46 [standard deviation]). The subsequent morphometric analysis produced results with low mean MAD values, with the highest values of 3.34° (alpha 03:00 o'clock position) and 0.87 mm (HNO) and ICC values ranging between 0.288 (HNO ratio) and 0.858 (CE) compared with manual assessments. These values were in line with interreader agreements, which at most had MAD values of 4.02° (alpha 12:00 o'clock position) and 1.07 mm (HNO) and ICC values ranging between 0.218 (HNO ratio) and 0.777 (CE). Conclusion Automatic extraction of geometric hip parameters from MRI is feasible using a morphometric analysis approach with deep learning.Keywords: Computer-Aided Diagnosis (CAD), Interventional-MSK, MR-Imaging, Neural Networks, Skeletal-Appendicular, Hip, Anatomy, Computer Applications-3D, Segmentation, Vision, Application Domain, Quantification Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Marc Fischer
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Sven S Walter
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Tobias Hepp
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Manuela Zimmer
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Mike Notohamiprodjo
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Fritz Schick
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Bin Yang
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
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Bhalodia R, Elhabian S, Kavan L, Whitaker R. Leveraging unsupervised image registration for discovery of landmark shape descriptor. Med Image Anal 2021; 73:102157. [PMID: 34293535 PMCID: PMC8489970 DOI: 10.1016/j.media.2021.102157] [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: 02/09/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
In current biological and medical research, statistical shape modeling (SSM) provides an essential framework for the characterization of anatomy/morphology. Such analysis is often driven by the identification of a relatively small number of geometrically consistent features found across the samples of a population. These features can subsequently provide information about the population shape variation. Dense correspondence models can provide ease of computation and yield an interpretable low-dimensional shape descriptor when followed by dimensionality reduction. However, automatic methods for obtaining such correspondences usually require image segmentation followed by significant preprocessing, which is taxing in terms of both computation as well as human resources. In many cases, the segmentation and subsequent processing require manual guidance and anatomy specific domain expertise. This paper proposes a self-supervised deep learning approach for discovering landmarks from images that can directly be used as a shape descriptor for subsequent analysis. We use landmark-driven image registration as the primary task to force the neural network to discover landmarks that register the images well. We also propose a regularization term that allows for robust optimization of the neural network and ensures that the landmarks uniformly span the image domain. The proposed method circumvents segmentation and preprocessing and directly produces a usable shape descriptor using just 2D or 3D images. In addition, we also propose two variants on the training loss function that allows for prior shape information to be integrated into the model. We apply this framework on several 2D and 3D datasets to obtain their shape descriptors. We analyze these shape descriptors in their efficacy of capturing shape information by performing different shape-driven applications depending on the data ranging from shape clustering to severity prediction to outcome diagnosis.
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Affiliation(s)
- Riddhish Bhalodia
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA.
| | - Shireen Elhabian
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA
| | - Ladislav Kavan
- School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA
| | - Ross Whitaker
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, Utah-84112, USA
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A three-dimensional measurement method on MR arthrography of the hip to classify femoro-acetabular impingement. Jpn J Radiol 2021; 39:1175-1185. [PMID: 34181177 PMCID: PMC8639539 DOI: 10.1007/s11604-021-01162-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/20/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE (1) To investigate correlations between different types of FAI and the ratio of acetabular volume (AV) to femoral head volume (FV) on MR arthrography. (2) To assess 2D/3D measurements in identifying different types of FAI by means of cut-off values of AV/FV ratio (AFR). MATERIALS AND METHODS Alpha angle, cranial acetabular version, acetabular depth, lateral center edge angle, AV, and FV of 52 hip MR arthrography were measured. ANOVA test correlated different types of FAI with AFR. ROC curves classified FAI by cut-off values of AFR. Accuracy of 2D/3D measurements was calculated. RESULTS ANOVA test showed a significant difference of AFR (p value < 0.001) among the three types of FAI. The mean values of AFR were 0.64, 0.74, and 0.89 in cam, mixed, and pincer types, respectively. Cut-off values of AFR were 0.70 to distinguish cam types from mixed and pincer types, and 0.79 to distinguish pincer types from cam and mixed types. Cut-off values identified 100%, 73.9%, and 55.6% of pincer, cam, and mixed types. 2D and 3D classifications of FAI showed accuracy of 40.4% and 73.0%. CONCLUSIONS 3D measurements were clearly more accurate than 2D measurements. Distinct cut-off values of AFR discriminated cam types from pincer types and identified pincer types in all cases. Cam and mixed types were not accurately recognized.
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10
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The safety and accuracy of the fluoroscopic imaging during proximal femoral fixation: A computerized 3D reappraisal of the joint penetration risk. Injury 2021; 52:1450-1455. [PMID: 33257021 DOI: 10.1016/j.injury.2020.11.064] [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: 06/09/2020] [Revised: 10/28/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To assess the success of proximal cephalomedullary nailing operations for treating trochanteric fractures, surgeons utilize 2D fluoroscopy to observe the relative positions of the femoral head and the implant. One distance-based risk parameter, observed from the AP and Lateral projections, is the Tip-Surface Distance(TSD) that dictates how close to the outer cortex should the implant tip be residing to avoid post-surgical complications such as cut-out or joint penetration. In this study, the safety and the accuracy of the orthogonal fluoroscopic imaging were evaluated. METHODS A femoral head model was created and the risk zone was defined as a hemispherical shell of 5 mm thickness beneath the subchondral cortex, which should not be violated during screw insertion. The remaining hemisphere beneath the risk zone was designated as the safe zone. To assess the effect of head size, each simulation was conducted for 34, 47, and 60 mm diameter(Dfemur) femoral heads. The rate of safe zone violation was calculated for all possible screw endpoints with a TSD of at least 5 mm on fluoroscopic orthogonal views (TSDAP and TSDLat). RESULTS The minimum risk of joint penetration was achieved when the TSDAP/TSDLat ratio was 1. For Dfemur of 34 mm there was a risk of 91.7% of the safe zone violation when each TSDAP and TSDLat were 5 mm and 0% for 9 mm. For Dfemur of 47 mm, the risk was 92.2% for 5 mm and 0% for 11 mm. For Dfemur of 60 mm, the risk was 92.3% for 5 mm and 0% for 13 mm. Safety maps were constructed for all possible TSD combinations for 34, 47, and 60 mm femoral heads. CONCLUSIONS Depending solely on the orthogonal fluoroscopic images is not a safe and accurate technique for assessing joint penetration risk during proximal femoral fixation due to the spherical geometry of the femoral head. The screw tip can lie completely outside of the femoral head even when it appears inside, in both orthogonal fluoroscopic views. Evidently, when using TSD, more stringent distance limits should be chosen, contrary to the recommended 5 mm limit. Our safety maps for TSD combinations may be used to check the security of the implantation.
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11
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Gaffney BM, Van Dillen LR, Foody JN, Burnet PE, Clohisy JC, Chen L, Harris MD. Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip. Clin Biomech (Bristol, Avon) 2021; 84:105335. [PMID: 33812201 PMCID: PMC8845490 DOI: 10.1016/j.clinbiomech.2021.105335] [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] [Received: 09/03/2020] [Revised: 01/22/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage. METHODS Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05). FINDINGS During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking. INTERPRETATION Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.
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Affiliation(s)
- Brecca M.M. Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Linda R. Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Paige E. Burnet
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D. Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA,Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, USA,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA,Corresponding author at: Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO 63108, United States. (M.D. Harris)
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12
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Westermann RW, Schaver A. Editorial Commentary: With Properly Indicated and Performed Surgery, We Can (Hopefully) Prevent Osteoarthritis in Patients With Hip Femoroacetabular Impingement. Arthroscopy 2021; 37:1026-1027. [PMID: 33673957 DOI: 10.1016/j.arthro.2020.12.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
Surgical treatment of femoroacetabular impingement (FAI) syndrome has been proven to be tremendously successful, outperforming the best conservative care and physical therapy in several prospective multicenter randomized controlled trials. The durability of this operation over time is less commonly reported on. We do know that FAI is associated with the development of hip osteoarthritis, and this is well established. We also know that surgical FAI treatment results in good short-term return to function/sport and improvements in patient-reported outcomes. We do not yet know if we are able to alter the natural history of FAI and prevent or delay conversion to total hip arthroplasty in this population.
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13
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Schauwecker N, Xi Y, Slepicka C, Dessouky R, Fey N, Chatzinoff Y, Chopra R, Wells J, Chhabra A. Quantifying differences in femoral head and neck asphericity in CAM type femoroacetabular impingement and hip dysplasia versus controls using radial 3DCT imaging and volumetric segmentation. Br J Radiol 2020; 93:20190039. [PMID: 32142363 PMCID: PMC10993221 DOI: 10.1259/bjr.20190039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/22/2020] [Accepted: 03/02/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Femoroacetabular impingement (FAI) and hip dysplasia are the most common causes of groin pain originating from the hip joint. To date, there is controversy over cut-off values for the evaluation of abnormal femoral head-neck anatomy with significant overlap between the normal and abnormal hips. Our aim was to perform three-dimensional CT analysis of femoral head and bump anatomy to quantify common hip pathologies (FAI and hip dysplasia) vs controls. METHODS Consecutive patients who underwent three-dimensional CT imaging for hip dysplasia or CAM type FAI were compared to asymptomatic controls. α angles on radial CT and 3D volumetric femoral head and bump segmentations were performed by two readers. Inter- and intrapatient comparisons were performed including interreader and receiver operating characteristic analyses. RESULTS 25 FAI patients, 16 hip dysplasia patients and 38 controls were included. FAI and dysplasia patients exhibited higher α angles and higher bump-head volume ratios than the controls (p < 0.05). Larger bump volumes were found among FAI than dysplasia patients and contralateral hips of FAI patients were also different than the controls. α angle at 2 o'clock and bump to head ratio showed the highest area under the curve for patients vs controls. The interreader reliability was better for volumetric segmentation (intraclass correlation coefficient = 0.35-0.84) as compared to the α angles (intraclass correlation coefficient = 0.11-0.44). CONCLUSION Patients with FAI and dysplasia exhibit different femoral head anatomy than asymptomatic controls. Volumetric segmentation of femoral head and bump is more reliable and better demonstrates the bilateral femoral head anatomy differences in hip patients vs controls. ADVANCES IN KNOWLEDGE Utilizing information from 3D volumetric bump assessment in patients with FAI and dysplasia, the physicians may be able to more objectively and reliably evaluate the altered anatomy for better pre-surgical evaluation.
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Affiliation(s)
| | - Yin Xi
- Radiology Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
| | - Chenelle Slepicka
- Radiology Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
| | - Riham Dessouky
- Radiology Department, Faculty of Medicine, Zagazig
University, Zagazig,
Egypt
| | - Nicholas Fey
- Physical Medicine and Rehabilitation Department, UT
Southwestern Medical Center, Dallas,
Texas, USA
| | - Yonatan Chatzinoff
- Radiology Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
| | - Rajiv Chopra
- Radiology Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
| | - Joel Wells
- Orthopedic Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
| | - Avneesh Chhabra
- Radiology Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
- Orthopedic Department, UT Southwestern Medical
Center, Dallas, Texas,
USA
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14
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Gaffney BMM, Clohisy JC, Van Dillen LR, Harris MD. The association between periacetabular osteotomy reorientation and hip joint reaction forces in two subgroups of acetabular dysplasia. J Biomech 2020; 98:109464. [PMID: 31708245 PMCID: PMC6930321 DOI: 10.1016/j.jbiomech.2019.109464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
Acetabular dysplasia is primarily characterized by an altered acetabular geometry that results in deficient coverage of the femoral head, and is a known cause of hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical reorientation of the acetabulum to normalize coverage, yet its effect on joint loading is unknown. Our objective was to establish how PAO, simulated with a musculoskeletal model and probabilistic analysis, alters hip joint reaction forces (JRF) in two representative patients of two different acetabular dysplasia subgroups: anterolateral and posterolateral coverage deficiencies. PAO reorientation was simulated within the musculoskeletal model by adding three surgical degrees of freedom to the acetabulum relative to the pelvis (acetabular adduction, acetabular extension, medial translation of the hip joint center). Monte Carlo simulations were performed to generate 2000 unique PAO reorientations for each patient; from which 99% confidence bounds and sensitivity factors were calculated to assess the influence of input variability (PAO reorientation) on output (hip JRF) during gait. Our results indicate that reorientation of the acetabulum alters the lines of action of the hip musculature. Specifically, as the hip joint center was medialized, the moment arm of the hip abductor muscles was increased, which in turn increased the mechanical force-generating capacity of these muscles and decreased joint loading. Independent of subgroup, hip JRF was most sensitive to hip joint center medialization. Results from this study improve understanding of how PAO reorientation affects muscle function differently dependent upon acetabular dysplasia subgrouping and can be used to inform more targeted surgical interventions.
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Affiliation(s)
- Brecca M M Gaffney
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Michael D Harris
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States.
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15
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Uemura K, Atkins PR, Peters CL, Anderson AE. The effect of pelvic tilt on three-dimensional coverage of the femoral head: A computational simulation study using patient-specific anatomy. Anat Rec (Hoboken) 2019; 304:258-265. [PMID: 31755243 DOI: 10.1002/ar.24320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023]
Abstract
Improved understanding of how three-dimensional (3D) femoral head coverage changes as the pelvic sagittal inclination (PSI) is altered would advance clinical diagnosis of hip pathoanatomy. Herein, we applied computer modeling of 3D computed tomography reconstructions of the pelvis and proximal femur to quantify relationships between the PSI and regional 3D femoral head coverage. Eleven healthy, young adult participants with typically developed hip anatomy were analyzed. The orientation of the pelvis was altered to define a PSI of -30° to 30° at 1° increments. Hip adduction and rotation were fixed in a standing position, which was measured by direct in vivo imaging of the pelvis and femur bones using dual fluoroscopy. Femoral head coverage was quantified in the anterior, superior, posterior, and inferior regions for each PSI position. Change in coverage was largest in the anterior region (29.8%) and smallest in the superior region (6.5%). Coverage increased linearly in the anterior region as the PSI increased, while a linear decrease was found in the posterior region and the inferior region (all p < .001). The slopes of the regression line for these regions were 0.513, -0.316, and -0.255, respectively. For the superior region, coverage increased when the PSI was altered from -30° to 5° and decreased when the PSI was larger than 5°. Overall, a 1° increase in PSI resulted in an increase of 0.5% in anterior coverage and a decrease of 0.3% in posterior coverage. Our findings provide baseline data that improve understanding of the effect of PSI on femoral coverage.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | | | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah.,Department of Physical Therapy, University of Utah, Salt Lake City, Utah
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16
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Predicting growth plate orientation with altered hip loading: potential cause of cam morphology. Biomech Model Mechanobiol 2019; 19:701-712. [DOI: 10.1007/s10237-019-01241-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
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17
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The effect of using different coordinate systems on in-vivo hip angles can be estimated from computed tomography images. J Biomech 2019; 95:109318. [PMID: 31471111 DOI: 10.1016/j.jbiomech.2019.109318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
Measurements of hip kinematics inherently depend on the coordinate system in which they are derived, yet the effect of the coordinate system definition on calculations of hip angles is not well-understood. Herein, hip angles calculated during dynamic activities were compared using coordinate systems described in the literature. In-vivo kinematic data of 24 participants (13 males) were analyzed during gait and the anterior impingement test using dual fluoroscopy and model-based tracking. Two coordinate systems for the pelvis (anterior pelvic plane, International Society of Biomechanics [ISB]) and three coordinate systems for the femur (table top plane with two definitions of the superior-inferior axis, ISB) were evaluated. Bony landmarks visible on computed tomography (CT) images were identified to establish each coordinate system and used as the basis to calculate differences in hip angles between coordinate system pairs. In the analysis during gait, the maximum differences derived from various coordinate system definitions were 6.7° ± 5.5° for flexion, 7.7° ± 2.1° for rotation, and 5.5° ± 0.7° for adduction. For the anterior impingement test, the differences were 8.1° ± 5.9°, 7.1° ± 1.2°, and 5.3° ± 0.7°, respectively. Landmark-based analysis using CT images could estimate these dynamic differences with errors less than 1.0°. Our results indicate that hip angles can be accurately transformed to angles calculated in different coordinate systems by accounting for the inherent bony anatomy. This information may aid in the interpretation of results across biomechanical studies of the hip.
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18
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Do Your Routine Radiographs to Diagnose Cam Femoroacetabular Impingement Visualize the Region of the Femoral Head-Neck Junction You Intended? Arthroscopy 2019; 35:1796-1806. [PMID: 31072720 DOI: 10.1016/j.arthro.2018.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/13/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To use computer models and image analysis to identify the position on the head-neck junction visualized in 10 radiographic views used to quantify cam morphology. METHODS We generated 97 surface models of the proximal femur from computed tomography scans of 59 control femurs and 38 femurs with cam morphology-a flattening or convexity at the femoral head-neck junction. Each model was transformed to a position that represents the anteroposterior, Meyer lateral, 45° Dunn, modified false-profile, Espié frog-leg, modified 45° Dunn, frog-leg lateral, cross-table, 90° Dunn, and false-profile views. The position on the head-neck junction visualized from each view was identified on the surfaces. This position was then quantified by a clock face generated on the plane of the head-neck junction, in which the 12-o'clock position indicated the superior head-neck junction and the 3-o'clock position indicated the anterior head-neck junction. The mean visualized clock-face position was calculated for all subjects. Analysis was repeated to account for variability in femoral version. A general linear model with repeated measures was used to compare each radiographic view and anteversion angle. RESULTS Each radiographic view provided visualization of the mean clock-face position as follows: anteroposterior view, 12:01; Meyer lateral view, 1:08; 45° Dunn view, 1:40; modified false-profile view, 2:01; Espié frog-leg view, 2:14; modified 45° Dunn view, 2:35; frog-leg lateral view, 2:45; cross-table view, 3:00; 90° Dunn view, 3:13; and false-profile view, 3:44. Each view visualized a different position on the clock face (all P < .001). Increasing simulated femoral anteversion by 10° changed the visualized position of the head-neck junction to a more clockwise position (range, 0:07 to 0:29; all P < .001), whereas decreasing anteversion by 10° visualized a more counterclockwise position (range, -0:23 to -0:08; all P < .001). CONCLUSIONS Ten common radiographic views used to identify cam morphology visualized different clock-face positions of the head-neck junction. Our data will help clinicians to understand the position of the head-neck junction visualized for each radiographic view and make educated decisions in the selection of radiographs acquired in the clinic. CLINICAL RELEVANCE Our findings will aid clinicians in choosing a set of radiographs to capture cam morphology in the assessment of patients with hip pain.
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19
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Samim M, Eftekhary N, Vigdorchik JM, Elbuluk A, Davidovitch R, Youm T, Gyftopoulos S. 3D-MRI versus 3D-CT in the evaluation of osseous anatomy in femoroacetabular impingement using Dixon 3D FLASH sequence. Skeletal Radiol 2019; 48:429-436. [PMID: 30182297 DOI: 10.1007/s00256-018-3049-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if hip 3D-MR imaging can be used to accurately demonstrate femoral and acetabular morphology in the evaluation of patients with femoroacetabular impingement. MATERIALS AND METHODS We performed a retrospective review at our institution of 17 consecutive patients (19 hips) with suspected femoroacetabular impingement who had both 3D-CT and 3D-MRI performed of the same hip. Two fellowship-trained musculoskeletal radiologists reviewed the imaging for the presence and location of cam deformity, anterior-inferior iliac spine variant, lateral center-edge angle, and neck-shaft angle. Findings on 3D-CT were considered the reference standard. The amount of radiation that was spared following introduction of 3D-MRI was also assessed. RESULTS All 17 patients suspected of FAI had evidence for cam deformity on 3D-CT. There was 100% agreement for diagnosis (19 out of 19) and location (19 out of 19) of cam deformity when comparing 3D-MRI with 3D-CT. There were 3 type I and 16 type II anterior-inferior iliac spine variants on 3D-CT imaging with 89.5% (17 out of 19) agreement for the anterior-inferior iliac spine characterization between 3D-MRI and 3D-CT. There was 64.7% agreement when comparing the neck-shaft angle (11 out of 17) and LCEA (11 out of 17) measurements. The use of 3D-MRI spared each patient an average radiation effective dose of 3.09 mSV for a total reduction of 479 mSV over a 4-year period. CONCLUSION 3D-MR imaging can be used to accurately diagnose and quantify the typical osseous pathological condition in femoroacetabular impingement and has the potential to eliminate the need for 3D-CT imaging and its associated radiation exposure, and the cost for this predominantly young group of patients.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, New York University Langone Medical Center, 333 East 38th street, New York, NY, 10016, USA.
| | - Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Ameer Elbuluk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Roy Davidovitch
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA
| | - Soterios Gyftopoulos
- Department of Radiology, New York University Langone Medical Center, 333 East 38th street, New York, NY, 10016, USA
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20
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CORR Insights®: Which Two-dimensional Radiographic Measurements of Cam Femoroacetabular Impingement Best Describe the Three-dimensional Shape of the Proximal Femur? Clin Orthop Relat Res 2019; 477:254-256. [PMID: 30516653 PMCID: PMC6345309 DOI: 10.1097/corr.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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21
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Uemura K, Atkins PR, Maas SA, Peters CL, Anderson AE. Three-dimensional femoral head coverage in the standing position represents that measured in vivo during gait. Clin Anat 2018; 31:1177-1183. [PMID: 30117200 DOI: 10.1002/ca.23262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
Individuals with over- or under-covered hips may develop hip osteoarthritis. Femoral head coverage is typically evaluated using radiographs, and/or computed tomography (CT) or magnetic resonance images obtained supine. Yet, these static assessments of coverage may not provide accurate information regarding the dynamic, three-dimensional (3-D) relationship between the femoral head and acetabulum. The objectives of this study were to: (1) quantify total and regional 3-D femoral head coverage in a standing position and during gait, and (2) quantify the relationship between 3-D femoral head coverage in standing to that measured during gait. The kinematic position of the hip during standing and gait was measured in vivo for 11 asymptomatic morphologically normal subjects using dual fluoroscopy and model-based tracking of 3-D CT models. Percent coverage in the standing position and during gait was measured overall and on a regional basis (anterior, superior, posterior, inferior). Coverage in standing was correlated with that measured during gait. For total coverage, very little change in coverage occurred during gait (range: 35.0-36.7%; mean: 36.2%). Coverage at each time point of gait strongly correlated with coverage during standing (r = 0.929-0.989). The regions thought to play an important role in weight bearing (i.e. anterior, superior, posterior) were significantly correlated with coverage in standing during the stance phase. Our results suggest that coverage measured in a standing position is a good surrogate for coverage measured during gait. Clin. Anat. 31:1177-1183, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Musculoskeletal Research Laboratories, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA
| | - Christopher L Peters
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Andrew E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Department of Physical Therapy, University of Utah, Dumke Health Professions Building, 520 Wakara Way, Suite 240, Salt Lake City, Utah, 84108, USA
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22
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Zhang L, Wells JE, Dessouky R, Gleason A, Chopra R, Chatzinoff Y, Fey NP, Xi Y, Chhabra A. 3D CT segmentation of CAM type femoroacetabular impingement-reliability and relationship of CAM lesion with anthropomorphic features. Br J Radiol 2018; 91:20180371. [PMID: 30168728 DOI: 10.1259/bjr.20180371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE: Evaluate feasibility and reliability of 3DCT semi-automatic segmentation and volumetrics of CAM lesions in femoroacetabular impingement and determine correlations with anthropometrics. METHODS: A consecutive series of 43 patients with CAM type FAI underwent 3DCT. 20 males and 23 females (30 unilateral and 13 bilateral symptomatic hips) were included. 56 CAM lesions and femoral heads were segmented by two readers. Radial images were obtained for alpha angles. Pearson and ICC correlations were used for analysis. RESULTS: In 43 patients (male: female = 1 : 1.15), mean ± SD of age, height, BMI were 36.6 ± 11.47 years, 1.72 ± 0.10 meters and 26.25 ± 4.31 kg m-². Femoral head and bumps were segmented in 4 min. Inter reader reliability was good to excellent for volumetrics and poor for alpha angles. Mean ± SD of CAM lesion and femoral head volumes were significantly larger (6.7 ± 2.5 cc3 and 62.9 ± 10.8 cc3) for males than females (p < 0.001) and these increased with increasing patient height (Pearson correlation and p-values = 0.45, 0.0006; 0.82, < 0.0001 respectively). CONCLUSION: Volumetric analysis of CAM lesion shows better inter reader reliability than alpha angle measurements. CAM and femoral head volumes exhibit significant positive correlations with patient heights and male gender that may aid in pre-operative planning for femoroplasty. ADVANCES IN KNOWLEDGE: Femoral head & CAM volumes are segmented three times faster than alpha angles with superior inter reader reliability than alpha angles. Femoral head & CAM volumes are significantly larger in males and positively correlate with patients' heights.
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Affiliation(s)
- Lihua Zhang
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Joel E Wells
- 2 Department of Orthopedic Surgery, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Riham Dessouky
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA.,3 Department of Radiology, Faculty of Medicine, Zagazig University , Zagazig , Egypt
| | - Adam Gleason
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Rajiv Chopra
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA.,4 Departments of Bioengineering and Mechanical Engineering, University of Texas atDallas , Richardson, TX , USA
| | - Yonatan Chatzinoff
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Nicholas P Fey
- 4 Departments of Bioengineering and Mechanical Engineering, University of Texas atDallas , Richardson, TX , USA
| | - Yin Xi
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Avneesh Chhabra
- 1 Department of Radiology, University of Texas Southwestern Medical Center , Dallas, TX , USA.,2 Department of Orthopedic Surgery, University of Texas Southwestern Medical Center , Dallas, TX , USA
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Lopes DS, Pires SM, Mascarenhas VV, Silva MT, Jorge JA. On a “Columbus’ Egg”: Modeling the shape of asymptomatic, dysplastic and impinged hip joints. Med Eng Phys 2018; 59:50-55. [DOI: 10.1016/j.medengphy.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 01/25/2023]
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Modified False-Profile Radiograph of the Hip Provides Better Visualization of the Anterosuperior Femoral Head-Neck Junction. Arthroscopy 2018; 34:1236-1243. [PMID: 29289395 DOI: 10.1016/j.arthro.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantify the amount of internal femur rotation required to visualize the 12 to 3 o'clock positions of the femoral head-neck junction as seen on the false-profile radiograph. METHODS Computed tomography (CT) images of the femur were retrospectively reviewed from control subjects and cam femoroacetabular impingement (FAI) patients. Using an automatically determined clockface, the positions between 12 and 3 o'clock were determined. The optimal femoral rotation angle to visualize each clockface position on the femoral head-neck junction was calculated based on the CT surface data. RESULTS Fifty-nine control subjects and 38 cam FAI patients were evaluated for this study. The mean (95% confidence interval) internal femur rotation needed to optimally visualize the clockface positions of the femoral head-neck junction on the modified false-profile radiograph were 0.9° (0.8°-1.0°) for 3:00, 10.3° (10.0°-10.6°) for 2:30, 21.6° (21.0°-22.1°) for 2:00, 34.3° (33.6°-35.1°) for 1:30, 49.6° (48.6°-50.4°) for 1:00, 68.4° (67.7°-69.0°) for 12:30, and 90.1° (89.9°-90.4°) for 12:00. CONCLUSIONS Internal femur rotation of 35° during the false-profile radiograph may better visualize the femoral head-neck junction in the anterosuperior (1 to 2 o'clock) region commonly associated with the cam lesion. From this view, rotation angles between 0° and 90° can be used to visualize other regions of the anterosuperior femoral head-neck junction. CLINICAL RELEVANCE The internal rotation of the affected femur for a modified false-profile radiograph may provide a new radiographic view that can be used to quantify anterosuperior femoral head-neck morphology.
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Atkins PR, Aoki SK, Whitaker RT, Weiss JA, Peters CL, Anderson AE. Does Removal of Subchondral Cortical Bone Provide Sufficient Resection Depth for Treatment of Cam Femoroacetabular Impingement? Clin Orthop Relat Res 2017; 475:1977-1986. [PMID: 28342138 PMCID: PMC5498381 DOI: 10.1007/s11999-017-5326-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/16/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Residual impingement resulting from insufficient resection of bone during the index femoroplasty is the most-common reason for revision surgery in patients with cam-type femoroacetabular impingement (FAI). Development of surgical resection guidelines therefore could reduce the number of patients with persistent pain and reduced ROM after femoroplasty. QUESTIONS/PURPOSES We asked whether removal of subchondral cortical bone in the region of the lesion in patients with cam FAI could restore femoral anatomy to that of screened control subjects. To evaluate this, we analyzed shape models between: (1) native cam and screened control femurs to observe the location of the cam lesion and establish baseline shape differences between groups, and (2) cam femurs with simulated resections and screened control femurs to evaluate the sufficiency of subchondral cortical bone thickness to guide resection depth. METHODS Three-dimensional (3-D) reconstructions of the inner and outer cortical bone boundaries of the proximal femur were generated by segmenting CT images from 45 control subjects (29 males; 15 living subjects, 30 cadavers) with normal radiographic findings and 28 nonconsecutive patients (26 males) with a diagnosis of cam FAI based on radiographic measurements and clinical examinations. Correspondence particles were placed on each femur and statistical shape modeling (SSM) was used to create mean shapes for each cohort. The geometric difference between the mean shape of the patients with cam FAI and that of the screened controls was used to define a consistent region representing the cam lesion. Subchondral cortical bone in this region was removed from the 3-D reconstructions of each cam femur to create a simulated resection. SSM was repeated to determine if the resection produced femoral anatomy that better resembled that of control subjects. Correspondence particle locations were used to generate mean femur shapes and evaluate shape differences using principal component analysis. RESULTS In the region of the cam lesion, the median distance between the mean native cam and control femurs was 1.8 mm (range, 1.0-2.7 mm). This difference was reduced to 0.2 mm (range, -0.2 to 0.9 mm) after resection, with some areas of overresection anteriorly and underresection superiorly. In the region of resection for each subject, the distance from each correspondence particle to the mean control shape was greater for the cam femurs than the screened control femurs (1.8 mm, [range, 1.1-2.9 mm] and 0.0 mm [range, -0.2-0.1 mm], respectively; p < 0.031). After resection, the distance was not different between the resected cam and control femurs (0.3 mm; range, -0.2-1.0; p > 0.473). CONCLUSIONS Removal of subchondral cortical bone in the region of resection reduced the deviation between the mean resected cam and control femurs to within a millimeter, which resulted in no difference in shape between patients with cam FAI and control subjects. Collectively, our results support the use of the subchondral cortical-cancellous bone margin as a visual intraoperative guide to limit resection depth in the correction of cam FAI. CLINICAL RELEVANCE Use of the subchondral cortical-cancellous bone boundary may provide a method to guide the depth of resection during arthroscopic surgery, which can be observed intraoperatively without advanced tooling, or imaging.
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Affiliation(s)
- Penny R. Atkins
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA
| | - Stephen K. Aoki
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA
| | - Ross T. Whitaker
- 0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eSchool of Computing, University of Utah, Salt Lake City, UT USA
| | - Jeffrey A. Weiss
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eSchool of Computing, University of Utah, Salt Lake City, UT USA
| | - Christopher L. Peters
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA
| | - Andrew E. Anderson
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eDepartment of Physical Therapy, University of Utah, Salt Lake City, UT USA
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WANG MONAN. OPTIMIZATION OF FEMORAL PROSTHESIS BASED ON COMPREHENSIVE EVALUATION OF STRUCTURE AND MATERIAL PROPERTIES. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, the optimized structure of a femoral prosthesis for a patient was determined by biomechanical analysis, and the materials that match the model of the prosthesis were determined by multi-objective comprehensive evaluation using a fuzzy matter-element method. The suitable material for the ellipsoidal femoral head of the prosthesis was determined to be a carbon-fiber-enhanced polyether-ketone (CF/PEK) composite, and that for the stem was determined to be a zirconium–niobium alloy (Zr–Nb alloy). The study successfully demonstrated the potential of the developed method for use in selecting the best structure and materials for fabricating a customized prosthesis.
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Affiliation(s)
- MONAN WANG
- Robotics Institute, Harbin University of Science and Technology, Harbin 150080, P. R. China
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Fiorentino NM, Atkins PR, Kutschke MJ, Foreman KB, Anderson AE. In-vivo quantification of dynamic hip joint center errors and soft tissue artifact. Gait Posture 2016; 50:246-251. [PMID: 27693944 PMCID: PMC5119549 DOI: 10.1016/j.gaitpost.2016.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
Hip joint center (HJC) measurement error can adversely affect predictions from biomechanical models. Soft tissue artifact (STA) may exacerbate HJC errors during dynamic motions. We quantified HJC error and the effect of STA in 11 young, asymptomatic adults during six activities. Subjects were imaged simultaneously with reflective skin markers (SM) and dual fluoroscopy (DF), an x-ray based technique with submillimeter accuracy that does not suffer from STA. Five HJCs were defined from locations of SM using three predictive (i.e., based on regression) and two functional methods; these calculations were repeated using the DF solutions. Hip joint center motion was analyzed during six degrees-of-freedom (default) and three degrees-of-freedom hip joint kinematics. The position of the DF-measured femoral head center (FHC), served as the reference to calculate HJC error. The effect of STA was quantified with mean absolute deviation. HJC errors were (mean±SD) 16.6±8.4mm and 11.7±11.0mm using SM and DF solutions, respectively. HJC errors from SM measurements were all significantly different from the FHC in at least one anatomical direction during multiple activities. The mean absolute deviation of SM-based HJCs was 2.8±0.7mm, which was greater than that for the FHC (0.6±0.1mm), suggesting that STA caused approximately 2.2mm of spurious HJC motion. Constraining the hip joint to three degrees-of-freedom led to approximately 3.1mm of spurious HJC motion. Our results indicate that STA-induced motion of the HJC contributes to the overall error, but inaccuracies inherent with predictive and functional methods appear to be a larger source of error.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Liu Q, Wang W, Thoreson AR, Zhao C, Zhu W, Dou P. Finite element prediction of contact pressures in cam-type femoroacetabular impingement with varied alpha angles. Comput Methods Biomech Biomed Engin 2016; 20:294-301. [PMID: 27539713 DOI: 10.1080/10255842.2016.1224861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Three dimensional finite element models of cam-type FAI with alpha angles of 60°, 70°, 80°, and 90° were created to investigate the cartilage contact mechanics in daily activities. Intra-articular cartilage contact pressures during routine daily activities were assessed and cross-compared with a normal control hip. Alpha angles and hip range of motion were found to have a combined influence on the cartilage contact mechanics in hips with cam-type FAI, thereby resulting in abnormally high pressures and driving the cartilage damage. In particular, alpha angles of 80° or greater contribute to substantial pressure increase under certain types of daily activities.
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Affiliation(s)
- Qian Liu
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Wanchun Wang
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Andrew R Thoreson
- b Biomechanics Laboratory, Division of Orthopedic Research , Mayo Clinic , Rochester , MN , USA
| | - Chunfeng Zhao
- b Biomechanics Laboratory, Division of Orthopedic Research , Mayo Clinic , Rochester , MN , USA
| | - Weihong Zhu
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Pengcheng Dou
- a Department of Orthopaedics, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
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Three-dimensional Imaging and Computer Navigation in Planning for Hip Preservation Surgery. Sports Med Arthrosc Rev 2016; 23:e31-8. [PMID: 26524559 DOI: 10.1097/jsa.0000000000000094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hip preservation surgery is performed to address femoroacetabular impingement, alleviate any associated pain, and reduce the risk of early onset of osteoarthritis. In the last decade, arthroscopy has become more popular in addressing femoroacetabular impingement, due to its minimally invasive approach. However, poor visualization and limited spatial awareness of the joint make arthroscopy of the hip difficult, resulting in a steep learning curve. This paper reviews the utility and benefits of 3-dimensional imaging and computer navigation and what these tools may add to the preoperative planning stages of hip preservation surgery.
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Accuracy of Functional and Predictive Methods to Calculate the Hip Joint Center in Young Non-pathologic Asymptomatic Adults with Dual Fluoroscopy as a Reference Standard. Ann Biomed Eng 2015; 44:2168-80. [PMID: 26645080 DOI: 10.1007/s10439-015-1522-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
Predictions from biomechanical models of gait may be sensitive to joint center locations. Most often, the hip joint center (HJC) is derived from locations of reflective markers adhered to the skin. Here, predictive techniques use regression equations of pelvic anatomy to estimate the HJC, whereas functional methods track motion of markers placed at the pelvis and femur during a coordinated motion. Skin motion artifact may introduce errors in the estimate of HJC for both techniques. Quantifying the accuracy of these methods is an area of open investigation. In this study, we used dual fluoroscopy (DF) (a dynamic X-ray imaging technique) and three-dimensional reconstructions from computed tomography images, to measure HJC locations in vivo. Using dual fluoroscopy as the reference standard, we then assessed the accuracy of three predictive and two functional methods. Eleven non-pathologic subjects were imaged with DF and reflective skin marker motion capture. Additionally, DF-based solutions generated virtual markers placed on bony landmarks, which were input to the predictive and functional methods to determine if estimates of the HJC improved. Using skin markers, functional methods had better mean agreement with the HJC measured by DF (11.0 ± 3.3 mm) than predictive methods (18.1 ± 9.5 mm); estimates from functional and predictive methods improved when using the DF-based solutions (1.3 ± 0.9 and 17.5 ± 8.6 mm, respectively). The Harrington method was the best predictive technique using both skin markers (13.2 ± 6.5 mm) and DF-based solutions (10.6 ± 2.5 mm). The two functional methods had similar accuracy using skin makers (11.1 ± 3.6 and 10.8 ± 3.2 mm) and DF-based solutions (1.2 ± 0.8 and 1.4 ± 1.0 mm). Overall, functional methods were superior to predictive methods for HJC estimation. However, the improvements observed when using the DF-based solutions suggest that skin motion artifact is a large source of error for the functional methods.
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Xia Y, Fripp J, Chandra SS, Walker D, Crozier S, Engstrom C. Automated 3D quantitative assessment and measurement of alpha angles from the femoral head-neck junction using MR imaging. Phys Med Biol 2015; 60:7601-16. [DOI: 10.1088/0031-9155/60/19/7601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015; 24:e149-58. [PMID: 25591458 PMCID: PMC4433827 DOI: 10.1016/j.jse.2014.10.021] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accurate assessment of the critical shoulder angle (CSA) is important in clinical evaluation of degenerative rotator cuff tears. This study analyzed the influence of radiographic viewing perspective on the CSA, developed a classification system to identify malpositioned radiographs, and assessed the relationship between the CSA and demographic factors. METHODS Glenoid height, width, and retroversion were measured on 3-dimensional computed tomography reconstructions of 68 cadaver scapulae. A digitally reconstructed radiograph was aligned perpendicular to the scapular plane, and retroversion was corrected to obtain a true anteroposterior (AP) view. In 10 scapulae, incremental anteversion/retroversion and flexion/extension views were generated. The CSA was measured, and a clinically applicable classification system was developed to detect views with >2° change in CSA vs. true AP view. RESULTS The average CSA was 33° ± 4°. Intraobserver and interobserver reliability was high (intraclass correlation coefficient ≥ 0.81) but decreased with increasing viewing angle. Views beyond 5° anteversion, 8° retroversion, 15° flexion, and 26° extension resulted in >2° deviation of the CSA compared with the true AP view. The classification system was capable of detecting aberrant viewing perspectives with sensitivity of 95% and specificity of 53%. Correlations between glenoid size and CSA were small (R ≤ 0.3), and CSA did not vary by gender (P = .426) or side (P = .821). CONCLUSIONS The CSA was most susceptible to malposition in anteversion/retroversion. Deviations as little as 5° in anteversion resulted in a CSA >2° from true AP view. A new classification system refines the ability to collect true AP radiographs of the scapula. The CSA was unaffected by demographic factors.
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Affiliation(s)
- Thomas Suter
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Ariane Gerber Popp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
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Patient-specific anatomical and functional parameters provide new insights into the pathomechanism of cam FAI. Clin Orthop Relat Res 2015; 473:1289-96. [PMID: 25048279 PMCID: PMC4353517 DOI: 10.1007/s11999-014-3797-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) represents a constellation of anatomical and clinical features, but definitive diagnosis is often difficult. The high prevalence of cam deformity of the femoral head in the asymptomatic population as well as clinical factors leading to the onset of symptoms raises questions as to what other factors increase the risk of cartilage damage and hip pain. QUESTIONS/PURPOSES The purpose was to identify any differences in anatomical parameters and squat kinematics among symptomatic, asymptomatic, and control individuals and if these parameters can determine individuals at risk of developing symptoms of cam FAI. METHODS Forty-three participants (n = 43) were recruited and divided into three groups: symptomatic (12), asymptomatic (17), and control (14). Symptomatic participants presented a cam deformity (identified by an elevated alpha angle on CT images), pain symptoms, clinical signs, and were scheduled for surgery. The other recruited volunteers were blinded and unaware whether they had a cam deformity. After the CT data were assessed for an elevated alpha angle, participants with a cam deformity but who did not demonstrate any clinical signs or symptoms were considered asymptomatic, whereas participants without a cam deformity and without clinical signs or symptoms were considered healthy control subjects. For each participant, anatomical CT parameters (axial alpha angle, radial alpha angle, femoral head-neck offset, femoral neck-shaft angle, medial proximal femoral angle, femoral torsion, acetabular version) were evaluated. Functional squat parameters (maximal squat depth, pelvic range of motion) were determined using a motion capture system. A stepwise discriminant function analysis was used to determine which of the parameters were most suitable to classify each participant with their respective subgroup. RESULTS The symptomatic group showed elevated alpha angles and lower femoral neck-shaft angles, whereas the asymptomatic group showed elevated alpha angles in comparison with the control group. The best discriminating parameters to determine symptoms were radial alpha angle, femoral neck-shaft angle, and pelvic range of motion (p < 0.001). CONCLUSIONS In the presence of a cam deformity, indications of a decreased femoral neck-shaft angle and reduced pelvic range of motion can identify those at risk of symptomatic FAI.
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Henak CR, Abraham CL, Peters CL, Sanders RK, Weiss JA, Anderson AE. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum. Clin Radiol 2014; 69:e381-91. [PMID: 25070373 DOI: 10.1016/j.crad.2014.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/20/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
AIM To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. MATERIALS AND METHODS Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. RESULTS Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98-6.7 mm (2.46 ± 1.16 mm). CONCLUSIONS When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required.
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Affiliation(s)
- C R Henak
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - C L Abraham
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - C L Peters
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - R K Sanders
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - J A Weiss
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - A E Anderson
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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Harris MD, Kapron AL, Peters CL, Anderson AE. Correlations between the alpha angle and femoral head asphericity: Implications and recommendations for the diagnosis of cam femoroacetabular impingement. Eur J Radiol 2014; 83:788-96. [PMID: 24613175 DOI: 10.1016/j.ejrad.2014.02.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the strength of common radiographic and radial CT views for measuring true femoral head asphericity. PATIENTS AND METHODS In 15 patients with cam femoroacetabular impingement (FAI) and 15 controls, alpha angles were measured by two observers using radial CT (0°, 30°, 60°, 90°) and digitally reconstructed radiographs (DRRs) for the: anterior-posterior (AP), standing frog-leg lateral, 45° Dunn with neutral rotation, 45° Dunn with 40° external rotation, and cross-table lateral views. A DRR validation study was performed. Alpha angles were compared between groups. Maximum deviation from a sphere of each subject was obtained from a previous study. Alpha angles from each view were correlated with maximum deviation. RESULTS There were no significant differences between alpha angles measured on radiographs and the corresponding DRRs (p=0.72). Alpha angles were significantly greater in patients for all views (p≤0.002). Alpha angles from the 45° Dunn with 40° external rotation, cross-table lateral, and 60° radial views had the strongest correlations with maximum deviation (r=0.831; r=0.823; r=0.808, respectively). The AP view had the weakest correlation (r=0.358). CONCLUSION DRRs were a validated means to simulate hip radiographs. The 45° Dunn with 40° external rotation, cross-table lateral, and 60° radial views best visualized femoral asphericity. Although commonly used, the AP view did not visualize cam deformities well. Overall, the magnitude of the alpha angle may not be indicative of the size of the deformity. Thus, 3D reconstructions and measurements of asphericity could improve the diagnosis of cam FAI.
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Affiliation(s)
- Michael D Harris
- Department of Orthopaedics, Department of Bioengineering, University of Utah, 590 Wakara Way A-100, Salt Lake City, UT 84108, USA.
| | - Ashley L Kapron
- Department of Orthopaedics, Department of Bioengineering, University of Utah, 590 Wakara Way A-100, Salt Lake City, UT 84108, USA.
| | - Christopher L Peters
- Department of Orthopaedics, 590 Wakara Way A-100, Salt Lake City, UT 84108, USA.
| | - Andrew E Anderson
- Department of Orthopaedics, Department of Bioengineering, Department of Physical Therapy, Scientific Computing and Imaging Institute, University of Utah, 590 Wakara Way A-100, Salt Lake City, UT 84108, USA.
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Harris MD, Datar M, Whitaker RT, Jurrus ER, Peters CL, Anderson AE. Statistical shape modeling of cam femoroacetabular impingement. J Orthop Res 2013; 31:1620-6. [PMID: 23832798 PMCID: PMC4137561 DOI: 10.1002/jor.22389] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 04/23/2013] [Indexed: 02/04/2023]
Abstract
Statistical shape modeling (SSM) was used to quantify 3D variation and morphologic differences between femurs with and without cam femoroacetabular impingement (FAI). 3D surfaces were generated from CT scans of femurs from 41 controls and 30 cam FAI patients. SSM correspondence particles were optimally positioned on each surface using a gradient descent energy function. Mean shapes for groups were defined. Morphological differences between group mean shapes and between the control mean and individual patients were calculated. Principal component analysis described anatomical variation. Among all femurs, the first six modes (or principal components) captured significant variations, which comprised 84% of cumulative variation. The first two modes, which described trochanteric height and femoral neck width, were significantly different between groups. The mean cam femur shape protruded above the control mean by a maximum of 3.3 mm with sustained protrusions of 2.5-3.0 mm along the anterolateral head-neck junction/distal anterior neck. SSM described variations in femoral morphology that corresponded well with areas prone to damage. Shape variation described by the first two modes may facilitate objective characterization of cam FAI deformities; variation beyond may be inherent population variance. SSM could characterize disease severity and guide surgical resection of bone.
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Affiliation(s)
- Michael D. Harris
- Department of Bioengineering, University of Utah, Salt Lake City, Utah,Department of Orthopaedics, 590 Wakara Way A-100, Salt Lake City, Utah, 84107,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Manasi Datar
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah,School of Computing, University of Utah, Salt Lake City, Utah
| | - Ross T. Whitaker
- Department of Bioengineering, University of Utah, Salt Lake City, Utah,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah,School of Computing, University of Utah, Salt Lake City, Utah
| | - Elizabeth R. Jurrus
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | | | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah,Department of Orthopaedics, 590 Wakara Way A-100, Salt Lake City, Utah, 84107,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah,Department of Physical Therapy, University of Utah, Salt Lake City, Utah
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