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Harris MD, Gaffney BM, Clohisy JC, Pascual-Garrido C. Femurs in patients with hip dysplasia have fundamental shape differences compared with cam femoroacetabular impingement. J Hip Preserv Surg 2024; 11:132-139. [PMID: 39070210 PMCID: PMC11272640 DOI: 10.1093/jhps/hnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 07/30/2024] Open
Abstract
Femoral deformities are common in developmental dysplasia of the hip (DDH), but decisions about how to treat them are not standardized. Of interest are deformities that may be akin to cam femoroacetabular impingement (FAI). We used three-dimensional and two-dimensional measures to clarify the similarities and differences in proximal femur shape variation among female patients with DDH (n = 68) or cam FAI (n = 60). Three-dimensional measures included femoral head asphericity, as well as shape variation using statistical shape modeling and principal component analysis (PCA). Two-dimensional measures included the α-angle, head-neck offset (HNO) and the neck-shaft angle (NSA). Significant shape variations were captured in the first five PCA modes, with the greatest shared variation between groups being the length from the lesser trochanter to the femoral head and greater trochanter height. Variations unique to DDH were irregularities at different areas of the femoral head, but not at the lateral femoral head-neck junction where variation was strong in FAI. The FAI group also had unique variations in greater trochanter shape. DDH femoral heads were less spherical, as indicated by larger sphere-fitting errors (P < 0.001). Radiographically, the DDH group had significantly smaller α-angles (P < 0.001), larger head-neck offsets (P = 0.02) and larger NSAs (P < 0.001). Both the articular and extra-articular regions of the proximal femur have distinct shape features in DDH and cam FAI that can uniquely affect the biomechanics of each disorder. Accordingly, approaches to addressing each disorder should be unique.
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Affiliation(s)
- Michael D Harris
- Program in Physical Therapy, Department of Orthopaedic Surgery, Washington University School of Medicine, 4444 Forest Park Ave, St Louis, MO 63108, USA
| | - Brecca M.M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, 1200 Larimer St North Classroom Bldg, Denver, CO 80204, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
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O’Brien MJM, Semciw AI, Mechlenburg I, Tønning LCU, Stewart CJW, Kemp JL. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis. Hip Int 2024; 34:96-114. [PMID: 37306161 PMCID: PMC10787396 DOI: 10.1177/11207000231179610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. PURPOSE In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. METHODS A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. RESULTS From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. CONCLUSIONS Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. REGISTRATION PROSPERO (CRD42020144748).
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Affiliation(s)
- Michael JM O’Brien
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- MOG Sports Medicine, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa CU Tønning
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris JW Stewart
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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3
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Goronzy J, Günther KP. [Hip dysplasia: What influence do age, arthrosis and concomitant diseases have on the treatment result?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:282-292. [PMID: 36894594 DOI: 10.1007/s00132-023-04354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/11/2023]
Abstract
Pelvic osteotomies are an established treatment for symptomatic adult hip dysplasia with a promising long-term outcome. Results depend not only on the achieved acetabular reorientation but also on patient-factors like preoperative joint condition (degree of osteoarthritis and joint congruency) and age. Additionally, the diagnosis and appropriate therapy of impingement-associated hip deformities is essential in order to achieve good mid- and long-term outcomes. The influence of chondrolabral pathology on the outcome of pelvic osteotomies is not yet defined. Symptomatic patients with residual dysplasia after previous pelvic or acetabular osteotomies can benefit from an additional osteotomy, although results can be worse in comparison to prior unoperated joints. Obesity can make surgery more demanding and increases the complication profile of PAO, although it has no influence on the postoperative outcome. Regarding the overall prognosis after an osteotomy, the consideration of combined risk factors is superior to the concentration on individual factors alone.
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Affiliation(s)
- Jens Goronzy
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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4
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Orner CA, Haws BE, Reuter J, Kenney R, Cook PC, Giordano BD. Patient-Reported Outcomes are Similar in the First Two Years after Staged versus Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia. Arthroscopy 2023:S0749-8063(23)00197-4. [PMID: 36868528 DOI: 10.1016/j.arthro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to compare early patient reported outcomes after staged versus combined hip arthroscopy and periacetabular osteotomy for hip dysplasia. METHODS A prospective database was retrospectively reviewed to identify patients that underwent combined or staged hip arthroscopy and PAO from 2012-2020. Patients were excluded if they were >40 years of age, had prior ipsilateral hip surgery, or did not have at least 12-24 month postoperative PRO data. PROs included the Hip Outcomes Score (HOS) Activities of Daily Living (ADL) and Sports Subscale (SS), Non-Arthritic Hip Score (NAHS), and the Modified Harris Hip Score (mHHS). Paired t-tests were used to compare preoperative to postoperative scores for both groups. Outcomes were compared using linear regression adjusted for baseline characteristics including age, obesity, cartilage damage, acetabular index, and procedure timing (early vs. late practice). RESULTS Sixty-two hips were included in this analysis (39 combined, 23 staged). The average length of follow up was similar between the combined and staged groups (20.8 vs. 19.6 months, p=0.192). Both groups reported significant improvements in PROs at final follow up compared to preoperative scores (p<0.05 for all). There were no significant differences in HOS-ADL, HOS-SS, NAHS, or mHHS scores between groups preoperatively or at 3, 6, or 12 months postoperatively (p>0.05 for all). There was no significant difference in PROs between the combined and staged groups at the final postoperative time point: HOS-ADL (84.5 vs. 84.3, p=0.77), HOS-SS (76.0 vs. 79.2, p=0.68), NAHS (82.2 vs. 84.5, p=0.79), mHHS (71.0 vs. 71.0, p=0.75) respectively. CONCLUSION Staged hip arthroscopy and PAO for hip dysplasia leads to similar PROs at 12-24 months compared to combined procedures. This suggests that with careful and informed patient selection, staging these procedures is an acceptable option for these patients and does not change early outcomes. LEVEL OF EVIDENCE Level III Retrospective Comparative.
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Affiliation(s)
- Caitlin A Orner
- Cedars Sinai Kerlan Jobe Institute, Department of Orthopaedics, 6801 Park Terrace, Suite 140, Los Angeles, CA 90045, U.S.A
| | - Brittany E Haws
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - John Reuter
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Raymond Kenney
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - P Christopher Cook
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
| | - Brian D Giordano
- University of Rochester Medical Center, Department of Orthopaedics and Rehabilitation, 601 Elmwood Ave, Rochester, New York 14642, U.S.A
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O'Brien MJM, Jacobsen JS, Semciw AI, Mechlenburg I, Tønning LU, Stewart CJW, Heerey J, Kemp JL. Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:988-1001. [PMID: 36237653 PMCID: PMC9528691 DOI: 10.26603/001c.38166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a condition associated with hip pain and impairments. Periacetabular osteotomy (PAO) is a common surgical treatment for DDH. Outcomes following PAO have historically been based on radiology or patient reported outcomes, and not physical impairments. Objective To investigate differences in physical impairments in adults with DDH undergoing PAO compared with asymptomatic participants, and to investigate pre- to post-PAO changes in physical impairments. Design Systematic review with meta-analysis. Methods A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO), using the PRISMA checklist. Studies were considered eligible if patients were aged 15 years and older, treated with PAO for DDH and if they included a physical impairment outcome measure. Two independent reviewers performed data extraction and assessed methodological quality, using a modified version of the Downs and Black checklist. Results Of 5,017 studies, 24 studies were included with 2190 patients. The methodological quality scores ranged from 39% to 88%. With low level of evidence, meta-analysis showed 58% of patients had a positive anterior impingement test (95%CI: 39-76%), prior to PAO and one to three years after PAO. Five years after PAO, the proportion fell to 17% (95%CI: 11-24%). Prior to PAO, patients with DDH walked with a lower peak hip extension angle, compared to asymptomatic participants (SMD 0.65 (95%CI 0.21-1.10). Best evidence synthesis of non-pooled data showed limited evidence of increased walking velocity, stride length and improved hip flexion and extension moment 18-months post-PAO compared to pre-op. Cadence, hip abduction and hip flexion strength did not change. Conclusion Most patients with DDH have a positive hip impingement test, pre-PAO. Compared to asymptomatic participants, patients with DDH demonstrate physical impairments during walking which appear to improve after surgery. Hip abduction and flexion strength did not change pre- to post-PAO. Level of Evidence 1b.
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Affiliation(s)
- Michael J M O'Brien
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Julie S Jacobsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthortics, La Trobe University, Bundoora, Victoria, Australia
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa U Tønning
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Chris J W Stewart
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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6
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Aitken HD, Westermann RW, Bartschat NI, Clohisy JC, Willey MC, Goetz JE. Effect of modeling femoral version and head-neck offset correction on computed contact mechanics in dysplastic hips treated with periacetabular osteotomy. J Biomech 2022; 141:111207. [PMID: 35764011 PMCID: PMC9747059 DOI: 10.1016/j.jbiomech.2022.111207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
While correction of dysplastic acetabular deformity has been a focus of both clinical treatment and research, concurrent femoral deformities have only more recently received serious attention. The purpose of this study was to determine how including abnormalities in femoral head-neck offset and femoral version alter computationally derived contact stresses in patients with combined dysplasia and femoroacetabular impingement (FAI). Hip models with patient-specific bony anatomy were created from preoperative and postoperative CT scans of 20 hips treated with periacetabular osteotomy and femoral osteochondroplasty. To simulate performing only a PAO, a third model was created combining each patient's postoperative pelvis and preoperative femur geometry. These three models were initialized with the femur in two starting orientations: (1) standardized template orientation, and (2) using patient-specific anatomic landmarks. Hip contact stresses were computed in all 6 model sets during an average dysplastic gait cycle, an average FAI gait cycle, and an average stand-to-sit activity using discrete element analysis. No significant differences in peak contact stress (p = 0.190 to 1), mean contact stress (p = 0.273 to 1), or mean contact area (p = 0.050 to 1) were identified during any loading activity based on femoral alignment technique or inclusion of femoral osteochondroplasty. These findings suggest that presence of abnormal femoral version and/or head-neck offset deformities are not themselves predominant factors in intra-articular contact mechanics during gait and stand-to-sit activities. Inclusion of modified movement patterns caused by these femoral deformities may be necessary for models to adequately capture the mechanical effects of these clinically recognized risk factors for negative outcomes.
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Affiliation(s)
- Holly D Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Nicholas I Bartschat
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA 52242, USA.
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7
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A comparison of 6-month outcomes between periacetabular osteotomy with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement. Arch Orthop Trauma Surg 2022; 142:471-480. [PMID: 33866407 DOI: 10.1007/s00402-021-03886-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare early outcomes of periacetabular osteotomy (PAO) with concomitant hip arthroscopy to isolated hip arthroscopy for femoroacetabular impingement (FAI) and chondrolabral pathology using patient-reported outcomes measurement information system (PROMIS). MATERIALS AND METHODS Consecutive patients scheduled for PAO with concomitant hip arthroscopy (PAO + HA) or isolated hip arthroscopy (HA) between the ages of 15 and 30 years old were prospectively included in the study. Based on power analysis, subjects were recruited until there were 22 subjects in the PAO + HA group. These subjects were then gender matched to the HA group. The PROMIS, with six subscales and two global health measures, were completed during preoperative and 6-month follow-up visits. One-way ANOVA was performed to compare intake information of age, symptom duration, body mass index, and Beighton scores as well as preoperative and 6-month postoperative PROMIS scores between the PAO + HA and HA. RESULTS 22 consecutive subjects undergoing PAO + HA were all females (average age 20.0 years) and matched to 22 consecutive females (average age 22.6) in the HA group. ANOVA did not find a significant difference between the two groups when comparing intact information, with exception of age (p = 0.04). A significant difference was also not identified (p ≥ 0.05) between the two groups on preoperative or 6-month postoperative PROMIS scores. The largest difference in 6-month postoperative scores between the two groups was 4.4 points on physical function subscale. CONCLUSION Outcomes at 6 months were not significantly different when comparing PAO + HA to HA for FAI and chondrolabral pathology in females under 30 years of age. The more extensive surgery with a prolonged protective period associated with PAO do not seem to negatively impact outcomes at 6 months when compared to HA. These finding support the use of PAO + HA, particularly if the patient and/or surgeon were concerned about prolonged disability, metal health issues, and/or higher pain levels that might be associated with the PAO procedure.
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8
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Reorientierende Beckenosteotomie bei azetabulärer Dysplasie – Wo stehen wir heute? ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Natürlicher Verlauf, konservative Behandlungsmethoden und optimaler Operationszeitpunkt der symptomatischen Hüftgelenkdysplasie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Maldonado DR, Owens JS, Jimenez AE, Saks BR, Lall AC, Domb BG. Endoscopic Shelf Procedure and Ischiofemoral Decompression with Arthroscopic Acetabular Labral Reconstruction: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00048. [PMID: 34762605 DOI: 10.2106/jbjs.cc.21.00329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 43-year-old female patient complained of pain in the right hip. The diagnoses of hip dysplasia, ischiofemoral impingement (IFI), femoroacetabular (FAI) cam-type morphology, and labral tear were made. The patient underwent hip arthroscopy with labral reconstruction for an irreparable labral tear and cam-morphology correction, and hip endoscopy for shelf procedure and ischiofemoral decompression. Favorable outcomes were reported at 1-year follow-up. CONCLUSION Hip arthroscopy for FAI cam-type morphology with labral reconstruction and concomitant hip endoscopy for shelf and ischiofemoral decompression seem to be safe for the treatment of active young adult patients with FAI cam-type morphology, irreparable labral tear, dysplasia, and IFI diagnoses. Nevertheless, the results presented should not be extrapolated as this is a case report.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois.,Kerlan-Jobe Institute, Los Angeles, California
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois
| | | | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois.,American Hip Institute, Chicago, Illinois
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois.,American Hip Institute, Chicago, Illinois
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Panos JA, Gutierrez CN, Wyles CC, Bingham JS, Mara KC, Trousdale RT, Sierra RJ. Tönnis Grade 1 dysplastic hips have improved patient-reported outcome scores when intraarticular pathology is treated during periacetabular osteotomy. J Hip Preserv Surg 2021; 8:282-292. [PMID: 35414950 PMCID: PMC8994101 DOI: 10.1093/jhps/hnab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
It is unclear whether treatment of intraarticular pathology should be performed during periacetabular osteotomy (PAO) to improve outcomes. Therefore, we asked: (i) What are the clinical results of PAO in patients with and without intraarticular intervention? (ii) Is there a difference in reoperations with and without intraarticular intervention? and (iii) Is there a difference in clinical results and reoperations depending on preoperative Tönnis Grade if intraarticular intervention is performed? Prospective evaluation of 161 PAO in 146 patients was performed. The cohort was 84.5% female, mean age was 26.7 ± 7.9 years and mean follow-up was 2.4 years; 112 hips had Grade 0 changes and 49 hips had Grade 1 changes. Patients were classified into three groups based on treatments during PAO: major (labral repair, femoral head–neck osteochondroplasty), minor (labral debridement, femoral/acetabular chondroplasty) or no intervention. A subset of eight patient-reported outcome measures (PROMs) was analyzed to determine whether the minimal clinically important difference (MCID) was achieved. Major, minor and no intervention groups exceeded the MCID in 5, 8 and 8, of 8 PROMs (P ≥ 0.20), respectively; intraarticular interventions did not influence reoperation-free survival (P ≥ 0.35). By Tönnis Grade, PROMs exceeding MCID decreased in Grade 1 versus 0 receiving no intervention (P < 0.001) but did not decrease for either intervention (P ≥ 0.14); intraarticular interventions did not influence reoperation-free survival (P ≥ 0.38). Overall, intraarticular intervention was associated with excellent PROMs and reoperation-free survival. Although Grade 1 patients had fewer PROM which achieved MCID, intraarticular interventions attenuated this decrease, suggesting a therapeutic advantage of intraarticular procedures for more advanced pathology.
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Affiliation(s)
- Joseph A Panos
- Mayo Clinic Alix School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Claudia N Gutierrez
- Mayo Clinic Alix School of Medicine, 200 1st St. SW, Rochester, MN 55905, USA
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Joshua S Bingham
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
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Maldonado DR, Owens JS, Ouyang VW, Saks BR, Jimenez AE, Glein RM, Lall AC, Domb BG. Short-term patient-reported outcomes following concomitant hip arthroscopy and the endoscopic modified shelf procedure for the treatment of acetabular dysplasia and intra-articular pathology. J Hip Preserv Surg 2021; 8:105-118. [PMID: 34567605 PMCID: PMC8460173 DOI: 10.1093/jhps/hnab044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
The shelf procedure is a treatment of acetabular dysplasia, with the aim of increasing weight-bearing acetabular coverage. Although several shelf techniques have been described, the endoscopic procedure with concomitant hip arthroscopy is a new, less invasive alternative. Outcomes following this procedure are scarce. The purpose of this study was to report short-term patient-reported outcomes (PROs) following concomitant hip arthroscopy and endoscopic modified shelf procedure in the setting of acetabular dysplasia and labral tears. Patients that met extraordinarily selective surgical indications and underwent the abovementioned surgery between February 2016 and October 2019 and had minimum 1-year follow-up were included. There were five females with a mean age of 40.18 ± 5.05 years and follow-up of 21.55 ± 8.68 months. The lateral center-edge angle increased from 15.80° to 23.20° (P = 0.003), and vertical center-edge angle increased from 16.60° to 23.60° (P < 0.001). The Tönnis angle decreased from 15.40° to 3.74° (P < 0.001). The alpha angle decreased from 58.46° to 40.70° (P < 0.001). PROs demonstrated significant improvement at latest follow-up (modified Harris Hip Score, P = 0.042; Non-Arthritic Hip Score, P < 0.001; Hip Outcome Score–Sports Specific Subscale, P = 0.035; Visual Analog Scale, P < 0.001; International Hip Outcome Tool-12, P = 0.043), and satisfaction was 8.60 ± 0.89. No secondary surgeries were reported. Concomitant hip arthroscopy and endoscopic modified shelf procedure appears to be a safe and effective procedure for patients with acetabular dysplasia and labral tears yielding favorable outcomes and satisfaction at short-term follow-up.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Rachel M Glein
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA.,American Hip Institute, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA.,Department of Orthopedic Surgery, AMITA Health St. Alexius Medical Center, 1555 Barrington Rd Hoffman Estates, IL 60169, USA.,American Hip Institute, 999 E Touhy Ave Des Plaines, Chicago, IL 60018, USA
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13
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Goronzy J, Franken L, Hartmann A, Thielemann F, Blum S, Günther KP, Nowotny J, Postler A. Acetabular- and femoral orientation after periacetabular osteotomy as a predictor for outcome and osteoarthritis. BMC Musculoskelet Disord 2020; 21:846. [PMID: 33357245 PMCID: PMC7764525 DOI: 10.1186/s12891-020-03878-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Periacetabular osteotomy is a successful treatment for hip dysplasia. The results are influenced, however, by optimal positioning of the acetabular fragment, femoral head morphology and maybe even femoral version as well as combined anteversion have an impact. In order to obtain better insight on fragment placement, postoperative acetabular orientation and femoral morphology were evaluated in a midterm follow-up in regard to functional outcome and osteoarthritis progression. METHODS A follow-up examination with 49 prospectively documented patients (66 hips) after periacetabular osteotomy (PAO) was performed after 62.2 ± 18.6 months. Mean age of patients undergoing surgery was 26.7 ± 9.6 years, 40 (82%) of these patients were female. All patients were evaluated with an a.p. pelvic x-ray and an isotropic MRI in order to assess acetabular version, femoral head cover, alpha angle, femoral torsion and combined anteversion. The acetabular version was measured at the femoral head center as well as 0.5 cm below and 0.5 and 1 cm above the femoral head center and in addition seven modified acetabular sector angles were determined. Femoral torsion was assessed in an oblique view of the femoral neck. The combined acetabular and femoral version was calculated as well. To evaluate the clinical outcome the pre- and postoperative WOMAC score as well as postoperative Oxford Hip Score and Global Treatment Outcome were analyzed. RESULTS After PAO acetabular version at the femoral head center (31.4 ± 9.6°) was increased, the anterior cover at the 15 o'clock position (34.7 ± 15.4°) was reduced and both correlated significantly with progression of osteoarthritis, although not with the functional outcome. Combined acetabular and femoral torsion had no influence on the progression of osteoarthritis or outcome scores. CONCLUSION Long-term results after PAO are dependent on good positioning of the acetabular fragment in all 3 planes. Next to a good lateral coverage a balanced horizontal alignment without iatrogenic pincer impingement due to acetabular retroversion, or insufficient coverage of the anterior femoral head is important.
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Affiliation(s)
- Jens Goronzy
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Lea Franken
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Albrecht Hartmann
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Falk Thielemann
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Jörg Nowotny
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Anne Postler
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
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14
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Wyles CC, Vargas JS, Heidenreich MJ, Mara KC, Peters CL, Clohisy JC, Trousdale RT, Sierra RJ. Hitting the Target: Natural History of the Hip Based on Achieving an Acetabular Safe Zone Following Periacetabular Osteotomy. J Bone Joint Surg Am 2020; 102:1734-1740. [PMID: 33027126 DOI: 10.2106/jbjs.19.01503] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) remains the gold-standard treatment for acetabular dysplasia in skeletally mature patients with preserved cartilage. The purpose of this multicenter cohort study was to delineate the long-term radiographic natural history of the dysplastic hip following PAO based on the final position of the acetabular fragment. METHODS We evaluated patients who underwent PAO performed by 4 hip preservation surgeons to treat acetabular dysplasia with or without concomitant retroversion from 1996 to 2012 at 3 academic institutions. There were 288 patients with a mean clinical and radiographic follow-up of 9 years (range, 5 to 21 years). Postoperative radiographs made at the first clinical visit were used to determine if the acetabular fragment fell into a safe zone according to the absence of retroversion, a lateral center-edge angle (LCEA) of 25° to 40°, an anterior center-edge angle (ACEA) of 25° to 40°, and a Tönnis angle of 0° to 10°. Every available subsequent radiograph was assessed for degenerative changes by the Tönnis classification (grades 0 to 3). The time to progression was analyzed using Cox proportional hazards regression and multistate modeling. RESULTS Only the absence of retroversion was independently associated with a decreased risk of progressing at least 1 Tönnis grade during follow-up: hazard ratio (HR), 0.60 (95% confidence interval [CI], 0.38 to 0.94; p = 0.025). Achieving the ACEA safe zone yielded the greatest time increase for remaining in Tönnis grade 0 or 1 (43 years for having an ACEA in the safe zone compared with 28 years for not having an ACEA in the safe zone), followed by the absence of retroversion (34 years for the absence of retroversion compared with 24 years for the presence of retroversion). However, attaining the Tönnis angle or LCEA safe zones did not delay progression. The achievement of additional safe zones generally increased the length of time that patients spent in Tönnis grade 0 or 1: 25 years for 0 safe zones, 36 years for 1 safe zone, 29 years for 2 safe zones, 37 years for 3 safe zones, and 44 years for 4 safe zones. CONCLUSIONS This study demonstrates the importance of achieving appropriate acetabular reorientation to enhance the longevity of the native hip following PAO. Although the LCEA and the Tönnis angle are the most common metrics used to assess appropriate acetabular correction, this study shows that adequately addressing retroversion and the ACEA has a greater impact on improving the natural history. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
| | - Juan S Vargas
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
| | - Mark J Heidenreich
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
| | - Kristin C Mara
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
| | | | - John C Clohisy
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Robert T Trousdale
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota
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15
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Irie T, Espinoza Orías AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, Inoue N. Three-dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal-acetabular radius of curvature. J Orthop Res 2020; 38:2197-2205. [PMID: 32073168 DOI: 10.1002/jor.24631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
In theory, a hemispherical acetabulum provides the ideal hip congruity in any hip position. However, it remains unknown how the three-dimensional acetabular morphology of borderline dysplastic and frank dysplastic hips compare to normal hips. This study inquires if borderline dysplastic zonal-acetabular curvatures in the anterior, superior, and posterior zones are different from normal or dysplastic hips three-dimensionally. One-hundred and fifteen hips, grouped as control (25°≤ LCEA <40°), 36 hips; borderline (20°≤ LCEA <25°), 32 hips; dysplasia (LCEA ≤20°), 47 hips were analyzed. The radii of acetabular curvature for the anterior, superior, and posterior zones were calculated as the zonal-acetabular radius of curvature (ZARC). The mean acetabular roof obliquity of the borderline (10.6 ± 4.3 [SD]°) was significantly larger than the control (3.0° ± 5.4°; P < .001) and smaller than the dysplasia (19.3° ± 5.7°; P < .001). Although the mean acetabular anteversion angle of the borderline (21.3° ± 3.7°) was significantly larger than control (17.9 ± 3.5°; P = .001), that of the borderline was not different from the dysplasia (23.3° ± 4.0°; P = .053). The mean anterior ZARC in the borderline (29.8 ± 2.6 mm) was significantly larger than the control (28.0 ± 2.2 mm; P = .011) and smaller than the dysplasia (31.5 ± 2.7 mm; P = .009). The mean superior ZARC in the borderline (25.7 ± 3.0 mm) was not different from the control (25.9 ± 2.2 mm; P = .934) or the dysplasia (25.8 ± 2.5 mm; P = .991). Although the mean posterior ZARC in the borderline (27.2 ± 2.5 mm) was not different from the control (26.4 ± 1.9 mm; P = .455), that of the borderline group was significantly smaller than the dysplasia (30.4 ± 3.3 mm; P < .001); that is, the severity of lateral under-coverage affects the anterior and/or posterior zonal-acetabular curvature.
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Affiliation(s)
- Tohru Irie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Tomoyo Y Irie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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16
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Wilkin GP, Poitras S, Clohisy J, Belzile E, Zaltz I, Grammatopoulos G, Melkus G, Rakhra K, Ramsay T, Thavorn K, Beaulé PE. Periacetabular osteotomy with or without arthroscopic management in patients with hip dysplasia: study protocol for a multicenter randomized controlled trial. Trials 2020; 21:725. [PMID: 32811527 PMCID: PMC7433104 DOI: 10.1186/s13063-020-04592-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Hip dysplasia is one of the most common causes of hip arthritis. Its incidence is estimated to be between 3.6 and 12.8% (Canadian Institute for Health Information, Hip and knee replacements in Canada, 2017–2018: Canadian joint replacement registry annual report, 2019; Jacobsen and Sonne-Holm, Rheumatology 44:211–8, 2004). The Periacetabular Osteotomy (PAO) has been used successfully for over 30 years (Gosvig et al., J Bone Joint Surg Am 92:1162–9, 2010), but some patients continue to exhibit symptoms post-surgery (Wyles et al., Clin Orthop Relat Res 475:336–50, 2017). A hip arthroscopy, performed using a small camera, allows surgeons to address torn cartilage inside the hip joint. Although both procedures are considered standard of care treatment options, it is unknown whether the addition of hip arthroscopy improves patient outcomes compared to a PAO alone. To delay or prevent future joint replacement surgeries, joint preservation surgery is recommended for eligible patients. While previous studies found an added cost to perform hip arthroscopies, the cost-effectiveness to Canadian Health care system is not known. Methods Patients randomized to the experimental group will undergo central compartment hip arthroscopy prior to completion of the PAO. Patients randomized to the control group will undergo isolated PAO. Patient-reported quality of life will be the primary outcome used for comparison between the two treatment groups as measured by The International Hip Outcome Tool (iHOT-33) (Saberi Hosnijeh et al., Arthritis Rheum 69:86–93, 2017). Secondary outcomes will include the four-square step test and sit-to-stand (validated in patients with pre-arthritic hip pain) and hip-specific symptoms and impairment using the HOOS; global health assessment will be compared using the PROMIS Global 10 Score; health status will be assessed using the EQ-5D-5L and EQ VAS questionnaires (Ganz et al., Clin Orthop Relat Res 466:264–72, 2008) pre- and post-operatively. In addition, operative time, hospital length of stay, adverse events, and health services utilization will be collected. A sub-group of patients (26 in each group) will receive a T1rho MRI before and after surgery to study changes in cartilage quality over time. A cost-utility analysis will be performed to compare costs and quality-adjusted life years (QALYs) associated with the intervention. Discussion We hypothesize that (1) concomitant hip arthroscopy at the time of PAO to address central compartment pathology will result in clinically important improvements in patient-reported outcome measures (PROMs) versus PAO alone, that (2) additional costs associated with hip arthroscopy will be offset by greater clinical improvements in this group, and that (3) combined hip arthroscopy and PAO will prove to be a cost-effective procedure. Trial registration ClinicalTrials.gov NCT03481010. Registered on 6 March 2020. Protocol version: version 3.
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Affiliation(s)
- Geoffrey P Wilkin
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Stéphane Poitras
- School of Rehabilitation, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada
| | - John Clohisy
- Division of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, USA
| | - Etienne Belzile
- Division of Orthopaedic Surgery, Centre hospitalier de l'Université Laval, Québec, QC, Canada
| | - Ira Zaltz
- Division of Orthopaedic Surgery, William Beaumont Hospital (Troy Michigan), Royal Oak, MI, USA
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Gerd Melkus
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kawan Rakhra
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Tim Ramsay
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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17
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Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips. PLoS One 2020; 15:e0231001. [PMID: 32251468 PMCID: PMC7135075 DOI: 10.1371/journal.pone.0231001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA ≤ 20°), 47 hips; borderline (20° ≤ LCEA < 25°), 32 hips; and control (25° ≤ LCEA < 35°), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.
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18
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Dukas AG, Gupta AS, Peters CL, Aoki SK. Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty. Curr Rev Musculoskelet Med 2019; 12:281-290. [PMID: 31264173 PMCID: PMC6684728 DOI: 10.1007/s12178-019-09572-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To review the relevant literature and techniques regarding arthroscopic and open treatment of femoroacetabular impingement (FAI). To discuss both the senior authors' preferred method of arthroscopic and open treatment of FAI. RECENT FINDINGS Routine treatment of FAI has moved away from open techniques and is more focused arthroscopic methods. Arthroscopic treatment of FAI has more recently focused on differing techniques of hip access and capsular management. Open techniques still have a role in FAI, but indications for open management are focused on cases with more severe pathology. While arthroscopic techniques have shown better outcomes in the short term and higher return to play, it is not without risk and is a procedure with a steep learning curve. In cases of complex joint pathology, such as FAI coupled with dysplasia or Legg-Calve-Perthes, arthroscopy may be not indicated and an open approach preferred. We outline various techniques for both arthroscopic and open treatment of FAI and their outcomes when possible.
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Affiliation(s)
- Alex G Dukas
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew S Gupta
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher L Peters
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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19
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Goronzy J, Blum S, Hartmann A, Plodeck V, Franken L, Günther KP, Thielemann F. Is MRI an adequate replacement for CT scans in the three-dimensional assessment of acetabular morphology? Acta Radiol 2019; 60:726-734. [PMID: 30149750 DOI: 10.1177/0284185118795331] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Appropriate three-dimensional imaging of the hip joint is a substantial prerequisite for planning and performing surgical correction of deformities. Although surgeons still use computed tomography (CT), modern and fast acquisition techniques of volumetric imaging using magnetic resonance imaging (MRI) for pelvic measurements enable similar resolution. PURPOSE This study was designed to determine if already described measures of acetabular morphology are comparable in both techniques and if assessment can be performed with equal intra-observer and inter-observer reliability. MATERIAL AND METHODS Thirty-two hips (16 patients) were examined with a pelvic CT and a MRI with 3-T. Pelvic orientation was standardized by each observer in coronal, axial, and sagittal planes. Acetabular version as well as seven acetabular sector angles were measured by two observers twice with a minimum of four weeks between sessions. RESULTS Inter-rater reliability showed excellent results for intra- and inter-rater reliability for CT (0.977-0.999) and MRI (0.969-0.998) measuring acetabular version and sector angles. Evaluating the reliability of CT and MRI for each observer revealed excellent results (0.972-0.998). Evaluating the Bland-Altman plots for intra-observer reliability showed an equal distribution of angles, within acceptable 95% limits of agreement. The same results were observed for inter-observer reliability evaluating CT and MRI as well as inter-method reliability. CONCLUSION Modern MRI scans are equally applicable to assess the bony pelvis as CT scans. In addition, MRI would enable the examination of soft tissues such as chondrolabral structures and muscle in the same examination. Since hip-preserving surgery is mostly conducted in younger patients, the reduction of radiation exposure is a benefit.
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Affiliation(s)
- Jens Goronzy
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Albrecht Hartmann
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Verena Plodeck
- Department of Radiology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Lea Franken
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
| | - Falk Thielemann
- University Center of Orthopedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Germany
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20
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Vahedi H, Aalirezaie A, Rolo G, Parvizi J. Hip Dysplasia Compromises the Outcome of Femoroacetabular Impingement Surgery. J Arthroplasty 2019; 34:852-856. [PMID: 30755376 DOI: 10.1016/j.arth.2019.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The optimal treatment for patients with symptomatic hip dysplasia presenting with labral tear is unknown. Although femoroacetabular osteoplasty (FAO) has excellent outcome for most femoroacetabular impingement patients, the presence of concomitant hip dysplasia has been implicated as an adverse prognostic factor. This study evaluated the outcome of FAO in a group of dysplastic hips and compared the outcome to a cohort of patients without dysplasia. METHODS Seventy-three patients (38 males, 35 females) with hip dysplasia who underwent FAO between 2007 and 2015 were identified. The minimum 2-year clinical, functional (modified Harris Hip Score and Short-Form 36 Health Survey), and radiological outcome was compared with 550 patients without dysplasia who underwent FAO by the same surgeon. The preoperative and postoperative alpha angle, Tonnis grade, joint space, and presence of chondral lesion were determined and compared. Conversion to total hip arthroplasty or revision FAO was considered as treatment failure. RESULTS The mean age in the dysplasia cohort was 30.7 ± 11.8 years compared to 34.5 ± 11.2 in the nondysplastic group. The mean follow-up was 4.3 years for dysplasia cohort and 4.1 for the nondysplastic group. The mean modified Harris Hip Score and Short-Form 36 Health Survey6 was significantly lower in the dysplastic group at 75.1 and 74.3 compared to 83.4 and 85.6 for the comparison group. There was a higher percentage of failure at 28.8% among dysplasia patients compared to 2.5% in the nondysplastic group. CONCLUSION Although labral repair and FAO may be an option for patients with hip dysplasia, the outcome in this population appears to be less optimal compared to femoroacetabular impingement patients with no evidence of dysplasia. Labral repair and osteoplasty should be limited to those with mild and borderline dysplasia.
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Affiliation(s)
- Hamed Vahedi
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Arash Aalirezaie
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Gabriella Rolo
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Maldonado DR, LaReau JM, Perets I, Ortiz-Declet V, Laseter JR, Lall AC, Domb BG. Outcomes of Hip Arthroscopy With Concomitant Periacetabular Osteotomy, Minimum 5-Year Follow-Up. Arthroscopy 2019; 35:826-834. [PMID: 30733041 DOI: 10.1016/j.arthro.2018.10.143] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 5-year follow-up results of concomitant hip arthroscopy followed by periacetabular osteotomy (PAO) to treat acetabular dysplasia and intra-articular pathology, such as femoroacetabular impingement syndrome and labral tears. METHODS Data were prospectively collected from October 2010 to December 2012. Patients were included in this study if they underwent concomitant hip arthroscopy and PAO and if they had preoperative scores documented for the following measures: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and pain on a visual analog scale (VAS). Patients who underwent reverse PAO to address acetabular retroversion were excluded. Follow-up was considered complete with these outcomes collected after surgery, as well as the abbreviated International Hip Outcome Tool and patient satisfaction on a 0-10 scale. Significance was set at P = .05. RESULTS Sixteen patients were eligible, all of whom had complete follow-up at a minimum of 5 years after surgery. There were 13 female subjects. The average age of the patients was 23.5 ± 6.8 years (range, 12.3-35.3 years), and the average body mass index was 24.3 ± 5.6 (range, 14.8-34.2). The mean lateral center-edge angle increased from 14.2° to 31.8° (P < .0001), and the anterior center-edge angle increased from 11.9° to 28.6° (P < .0001). The Tönnis angle of acetabular inclination decreased from 19.3° to 2.6° (P < .0001). The alpha angle decreased from 55.7° to 41.0° (P < .0001). All preoperative radiographs were Tönnis ≤1, and there was no progression of arthritis in radiographs taken at the latest clinical visit. All patient-reported outcomes scores demonstrated significant improvement from preoperative baseline to the minimum 5-year follow-up scores (mHHS, P < .001; NAHS, P < .001; HOS-SSS, P = .001). The VAS score decreased from a preoperative mean of 5.8 to 3.1 at the latest follow-up (P = .007). No conversion to total hip arthroplasty was reported. CONCLUSIONS Concomitant hip arthroscopy and PAO appears to be a safe and effective procedure with favorable mid-term outcomes that are durable compared to the short-term. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Justin M LaReau
- American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A
| | - Itay Perets
- American Hip Institute, Westmont, Illinois, U.S.A.; Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Victor Ortiz-Declet
- American Hip Institute, Westmont, Illinois, U.S.A.; Kayal Orthopaedic Center, Westwood, New Jersey, U.S.A
| | | | - Ajay C Lall
- American Hip Institute, Westmont, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A..
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Adler KL, Giordano BD. The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review. Arthroscopy 2019; 35:237-248. [PMID: 30611355 DOI: 10.1016/j.arthro.2018.07.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare patient-reported outcomes, progression of osteoarthritis, and conversion to total hip replacement in a dysplastic population when hip arthroscopy was used as an isolated treatment or as an adjunct to pelvic reorientation osteotomy. METHODS An exhaustive search of the existing literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Embase) were searched for studies from January 1930 through January 2018 published in the English language concerning the use of hip arthroscopy with diagnostic and therapeutic intentions in individuals with acetabular dysplasia. We excluded studies that presented ambiguous data sets or in which clear identification of the strategy for arthroscopy was absent. RESULTS The selection criteria were defined, and 33 studies (1,368 hip arthroscopies) were included in the final analysis. Studies that met the inclusion criteria were classified within 5 different categories: (1) hip arthroscopy for screening, chondral mapping, and planning (9 studies, 729 hip arthroscopies); (2) isolated arthroscopic treatment (13 studies, 434 hip arthroscopies); (3) outcomes of hip arthroscopy after previous reorientation pelvic osteotomy for acetabular dysplasia (4 studies, 52 hip arthroscopies); (4) arthroscopy followed by unplanned hip-preservation surgery (3 studies, 48 hip arthroscopies); and (5) combined arthroscopy and periacetabular osteotomy (4 studies, 106 hip arthroscopies). A risk-of-bias analysis showed a moderate to high risk of bias (level 3 or 4) within and across the included studies. CONCLUSIONS Although hip arthroscopy can be used to accurately grade the severity of chondral injuries in the native hip and provide zone-specific geographic mapping that may aid in subsequent surgical planning, there is insufficient evidence to conclude that arthroscopic characterization alone has any bearing on the ultimate clinical outcomes after osseous structural correction. Isolated arthroscopic treatment is not recommended in the setting of moderate to severe dysplasia, given the inferior clinical outcomes and risk of iatrogenic instability reported for this group. However, there is limited evidence to suggest that the isolated use of hip arthroscopy may be considered in cases of borderline acetabular dysplasia when careful attention is paid to labral and capsular preservation. Limited evidence supports the conclusion that after prior reorientation pelvic osteotomy for acetabular dysplasia, hip arthroscopy leads to improved clinical and functional outcomes and should be considered in this setting. Furthermore, there is insufficient evidence to conclude that failed hip arthroscopy compromises or challenges the ultimate clinical outcomes in patients undergoing subsequent reorientation pelvic osteotomy. Last, there is insufficient evidence to conclude that the adjunctive use of hip arthroscopy with reorientation pelvic osteotomy produces superior clinical outcomes compared with pelvic osteotomy alone. In summary, arthroscopic techniques may provide a useful complement to the correction of acetabular dysplasia and should be thoughtfully considered on a case-by-case basis when designing a comprehensive treatment strategy in dysplastic populations. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Kelly L Adler
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A..
| | - Brian D Giordano
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
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23
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Scott EJ, Thomas-Aitken HD, Glass N, Westermann R, Goetz JE, Willey MC. Unaddressed Cam Deformity Is Associated with Elevated Joint Contact Stress After Periacetabular Osteotomy. J Bone Joint Surg Am 2018; 100:e131. [PMID: 30334890 DOI: 10.2106/jbjs.17.01631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Femoral cam deformity is frequently present in patients with acetabular dysplasia. Computational modeling can be used to identify how this deformity affects joint mechanics. Our purpose was to identify the relationship between cam deformity and joint contact stress after periacetabular osteotomy (PAO). We hypothesized that cam deformity is associated with an increase in peak joint contact stress after PAO. METHODS This was a retrospective review of patients treated for hip dysplasia with PAO without femoral osteochondroplasty. Patient-specific hip models created from preoperative and postoperative computed tomography (CT) scans were evaluated using discrete element analysis to determine maximum joint contact stress after PAO. Twenty hips with a postoperative increase in maximum contact stress were compared with 20 that demonstrated decreased maximum contact stress. Hips were assessed for cam deformity on cross-sectional imaging. Radiographic measures of acetabular dysplasia before and after PAO were assessed and compared with the change in maximum contact stress after PAO. RESULTS There was a moderate relationship between the change in maximum contact stress and the α angle (r = 0.31; p = 0.04), and the average α angle in the hips with increased maximum contact stress was significantly different from that in the hips with decreased joint contact stress (51° ± 11.4° versus 42° ± 5.1°; p = 0.04). All 6 hips with an α angle of >60° demonstrated increased joint contact stress. CONCLUSIONS Cam deformity is common in patients with hip dysplasia. In our study, α angles of >60° were associated with increased postoperative joint contact stress. The α angle should be assessed preoperatively, and deformity should be addressed for optimal joint mechanics after PAO. CLINICAL RELEVANCE A reduction in joint contact stress is a proposed mechanism for the increased joint longevity following periacetabular osteotomy for hip dysplasia. Impingement from abnormal femoral offset negatively impacts clinical outcome, but this finding has not been evaluated from a biomechanical perspective previously and a threshold for performing femoral osteochondroplasty has not been established previously. This study provides biomechanical evidence supporting surgical management of femoral cam deformity for an α angle of >60°.
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Affiliation(s)
- Elizabeth J Scott
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
| | - Holly D Thomas-Aitken
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
| | - Robert Westermann
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation (E.J.S., H.D.T.-A., N.G., R.W., J.E.G., and M.C.W.) and Department of Engineering (H.D.T.-A. and J.E.G.), University of Iowa, Iowa City, Iowa
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Günther KP, Goronzy J, Franken L, Hartmann A, Thielemann F. Natürlicher Verlauf bei Hüftdysplasie und Operationsergebnisse. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0232-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Is There an Association Between Borderline-to-mild Dysplasia and Hip Osteoarthritis? Analysis of CT Osteoabsorptiometry. Clin Orthop Relat Res 2018; 476:1455-1465. [PMID: 29698301 PMCID: PMC6437563 DOI: 10.1097/01.blo.0000533619.50951.e3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The definitive treatment of borderline-to-mild dysplasia remains controversial. A more comprehensive understanding of the etiology of osteoarthritis (OA) and clarification of any possible association between borderline-to-mild dysplasia and the pathogenesis of OA are essential. QUESTIONS/PURPOSES (1) Does the distribution of acetabular subchondral bone density increase according to dysplasia severity? (2) Is there an association between borderline-to-mild dysplasia and OA pathogenesis? METHODS We evaluated bilateral hips of patients with developmental dysplasia of the hip who underwent eccentric rotational acetabular osteotomy (ERAO) for inclusion in the dysplasia group and contralateral hips of patients with unilateral idiopathic osteonecrosis of the femoral head (ONFH) who underwent curved intertrochanteric varus osteotomy (CVO) for the control group. ERAO was performed in 46 patients and CVO was performed in 32 patients between January 2013 and August 2016 at our institution. All patients underwent bilateral hip CT. The study included 55 hips categorized according to dysplasia severity: (1) borderline-mild, 19 hips (15° ≤ lateral center-edge angle [LCEA] < 25°); (2) moderate, 20 hips (5° ≤ LCEA < 15°); (3) severe, 16 hips (LCEA < 5°); and (4) control, 15 hips. Thirty-seven dysplastic hips (age < 15 or > 50 years old, prior hip surgery, subluxation, aspherical femoral head, cam deformity, and radiographic OA) and 17 control hips (age < 15 or > 50 years old, bilateral ONFH, LCEA < 25° or ≥ 35°, cam deformity, and radiographic OA) were excluded. CT-osteoabsorptiometry (OAM) predicts physiologic biomechanical conditions in joints by evaluating subchondral bone density. We evaluated the distribution of subchondral bone densities in the acetabulum with CT-OAM, dividing the stress distribution map into six segments: anteromedial, anterolateral, centromedial, centrolateral, posteromedial, and posterolateral. We calculated the percentage of high-density area, which was defined as the upper 30% of Hounsfield units values in each region and compared least square means difference estimated by the random intercept model among the four groups. RESULTS In all regions, the percentage of high-density area did not differ between the borderline-mild group and the control (eg, anterolateral, 16.2 ± 5.6 [95% CI, 13.4 to 18.9] versus 15.5 ± 5.7 [95% CI, 12.4 to 18.5, p = 0.984]; centrolateral, 39.1 ± 5.7 [95% CI, 36.4 to 41.8] versus 39.5 ± 4.7 [95% CI, 36.6 to 42.5, p = 0.995]; posterolateral, 10.9 ± 5.2 [95% CI, 8.0 to 13.8] versus 15.1 ± 6.8 [95% CI, 11.7 to 18.5, p = 0.389]). In the anterolateral region, a smaller percentage of high-density area was observed in the borderline-mild group than in both the moderate group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 28.2 ± 5.1 [95% CI, 25.5-30.9], p < 0.001) and the severe group (16.2 ± 5.6 [95% CI, 13.4-18.9] versus 22.2 ± 6.8 [95% CI, 19.2-25.2, p = 0.026). CONCLUSIONS Our results suggest that the cumulative hip stress distribution in borderline-to-mild dysplasia was not concentrated on the lateral side of the acetabulum, unlike severe dysplasia. CLINICAL RELEVANCE Based on the stress distribution pattern, our results may suggest that there is no association between borderline-to-mild dysplasia and the pathogenesis of OA. Further studies are needed to evaluate the association between borderline-to-mild dysplasia and instability of the hip.
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26
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Maldonado DR, Ortiz-Declet V, Chen AW, Lall AC, Mohr MR, Laseter JR, Domb BG. Modified Shelf Acetabuloplasty Endoscopic Procedure With Allograft for Developmental Hip Dysplasia Treatment. Arthrosc Tech 2018; 7:e779-e784. [PMID: 30094151 PMCID: PMC6074611 DOI: 10.1016/j.eats.2018.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/26/2018] [Indexed: 02/03/2023] Open
Abstract
Hip dysplasia has been identified as one of the leading causes of osteoarthritis. However, hip arthroscopy alone, in the setting of hip dysplasia, remains controversial. In borderline hip dysplasia, with lateral center-edge angle (LCEA) between 18° and 25°, good outcomes have been reported with appropriate capsular and labral management. However, in severe hip dysplasia, with LCEA below 18°, there is an acetabular bony structural deficiency that must be addressed. Even with the potential benefit of hip arthroscopy in addressing intra-articular injuries related to the instability, it cannot be used for soft-tissue procedures. Periacetabular osteotomy remains the gold standard to address that matter; however, its invasive nature along with the long recovery time leaves some patients unwilling to undergo this procedure. New minimally invasive endoscopic procedures, derived from open techniques, describe acetabular autologous bone grafting as an alternative. Donor-side morbidity is always a concern when using autografts; we believe that the use of bone allograft will decrease this potential issue and make the procedure itself less invasive. This Technical Note will describe a type of endoscopic shelf acetabuloplasty using an allograft iliac bone graft.
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Affiliation(s)
| | - Victor Ortiz-Declet
- American Hip Institute, Westmont, Illinois, U.S.A.,Gotham City Orthopedics, New York, New York, U.S.A
| | - Austin W. Chen
- American Hip Institute, Westmont, Illinois, U.S.A.,BoulderCentre for Orthopedics, Boulder, Colorado, U.S.A
| | - Ajay C. Lall
- American Hip Institute, Westmont, Illinois, U.S.A
| | | | | | - Benjamin G. Domb
- American Hip Institute, Westmont, Illinois, U.S.A.,Hinsdale Orthopaedics, Hinsdale, Illinois, U.S.A.,Address correspondence to Dr. Benjamin G. Domb, Hinsdale Orthopaedics, American Hip Institute, 1010 Executive Court, Ste 250, Westmont, IL 60559, U.S.A.
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Wyles CC, Hevesi M, Bartels DW, Larson DR, Sierra RJ, Trousdale RT. Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes. J Hip Preserv Surg 2018; 5:282-295. [PMID: 30393556 PMCID: PMC6206691 DOI: 10.1093/jhps/hny022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Periacetabular osteotomy (PAO) remains the gold standard procedure for joint preservation in symptomatic developmental dysplasia of the hip (DDH). Hip arthroscopy (HA) and open arthrotomy have been used to correct intra-articular pathology at the time of PAO, but there is limited data regarding differences in outcomes between these techniques when performed at the time of PAO. The aim of this study was to determine if short-term clinical outcomes differed between patients managed with HA versus arthrotomy to evaluate and treat intra-articular pathology at the time of PAO to discern if one technique is associated with better pain and functional results. Data were retrospectively reviewed from two surgeons at one institution managing DDH patients from September 2013 to December 2015. One surgeon treated patients with PAO and arthrotomy (N = 32), while the other performed PAO and HA (N = 39). There were 87% women, median age was 28 years and mean BMI was 25. Seventy-five percent of all patients received an intra-articular intervention. Patients completed 13 PROs at the pre-operative and 1-year post-operative clinical visits. Pre-operatively, there were no differences in any of the 13 PROs between patients treated with HA versus arthrotomy (P ≥ 0.076). Patients treated with PAO and arthrotomy experienced greater mean improvement in two out of the 13 PROs; the other 11 showed no differences. No treatment effect was observed for any of the 13 PROs using multivariable modelling that accounted for severity of dysplasia and degree of arthritis. Few differences were shown in short-term clinical outcomes between HA and arthrotomy at the time of PAO. This work highlights the need for a high quality randomized clinical trial to provide definitive guidance on whether hip preservation surgeons should address intra-articular pathology at the time of PAO for DDH and which technique best serves this purpose.
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Affiliation(s)
- Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Douglas W Bartels
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Dirk R Larson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
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Mimura T, Mori K, Furuya Y, Itakura S, Kawasaki T, Imai S. Prevalence and morphological features of acetabular dysplasia with coexisting femoroacetabular impingement-related findings in a Japanese population: a computed tomography-based cross-sectional study. J Hip Preserv Surg 2018; 5:137-149. [PMID: 29876130 PMCID: PMC5961138 DOI: 10.1093/jhps/hny006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 01/14/2018] [Accepted: 02/11/2018] [Indexed: 11/13/2022] Open
Abstract
The coexistence of acetabular dysplasia (AD) and femoroacetabular impingement (FAI) has not been well discussed. This study was performed to elucidate the prevalence and morphological features of AD with coexisting FAI-related findings in a Japanese population. Computed tomography images were retrospectively evaluated. AD was classified as definite or borderline. The morphological findings that defined cam deformity were an α angle of ≥55°, head–neck offset ratio (HNOR) of <0.13, pistol grip deformity positivity and herniation pit positivity. The morphological findings that defined pincer deformity were acetabular index of ≤0° and a retroverted acetabulum. In total, 128 hips (male, 64; female, 64) were analyzed. The prevalence of coexistence of AD and FAI-related findings was detected in 23.4% of hips (definite AD and FAI, 7.8%; borderline AD and FAI, 15.6%). The percentages of hips with AD containing cam or pincer deformities among all were 54.3% and 4.3%, respectively. The percentage of AD with coexisting cam and that of AD with coexisting combined deformities was significantly higher in men, respectively. On the other hand, the most major morphological feature of FAI detected in hips with AD was a HNOR of <0.13. The coexistence of AD and FAI-related findings was common in a Japanese population, and 65.2% of hips with AD had some FAI-related findings. In discussing and managing AD, we recommend paying attention to the coexistence with FAI-related findings, especially in men and in borderline AD. In such hips, the most notable parameter as a morphological feature of FAI is a reduced HNOR.
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Affiliation(s)
- Tomohiro Mimura
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Kanji Mori
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Yuki Furuya
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Shin Itakura
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Taku Kawasaki
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Shinji Imai
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
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Periazetabuläre Osteotomie – Welchen Einfluss hat das Alter auf patientenrelevante Ergebnisse? DER ORTHOPADE 2018; 47:228-237. [DOI: 10.1007/s00132-017-3523-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Pascual-Garrido C, Harris MD, Clohisy JC. Innovations in Joint Preservation Procedures for the Dysplastic Hip "The Periacetabular Osteotomy". J Arthroplasty 2017; 32:S32-S37. [PMID: 28318866 DOI: 10.1016/j.arth.2017.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 02/01/2023] Open
Abstract
The Bernese periacetabular osteotomy is an effective treatment for symptomatic developmental dysplasia in the prearthritic young adult hip. Refinements in the periacetabular osteotomy technique and perioperative management have markedly improved the clinical outcomes and recovery in these patients. We will review the clinical presentation of acetabular dysplasia, indications for surgery, perioperative management, and contemporary refinements in technique including refined acetabular reduction, adjunctive hip arthroscopy, femoral head-neck osteochondroplasty, femoral procedures, and rapid recovery protocols. In well-selected patients, this reconstructive osteotomy should be considered safe and effective in alleviating pain and improving hip function in patients with symptomatic acetabular dysplasia.
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Affiliation(s)
- Cecilia Pascual-Garrido
- Adult Reconstruction and Adolescent and Young Adult Hip Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Michael D Harris
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri; Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - John C Clohisy
- Adult Reconstruction and Adolescent and Young Adult Hip Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
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