1
|
García Martín I, Cariati P, Martínez-Sauquillo Rico A, Cabello Serrano A, García Medina B. Arthroscopic osteoplasty of the medial and anteromedial wall of temporomandibular joint: surgical technique and anatomical considerations. Br J Oral Maxillofac Surg 2023; 61:72-77. [PMID: 36535863 DOI: 10.1016/j.bjoms.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications.
Collapse
Affiliation(s)
- Irene García Martín
- Department of Oral and Maxillofacial Surgery, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Paolo Cariati
- Hospital General Universitario de Albacete, Departamento de Cirugía Oral y Maxilofacial, Albacete, Spain.
| | | | - Almudena Cabello Serrano
- Hospital Universitario Virgen de las Nieves de Granada, Departamento de Cirugía Oral y Maxilofacial, Granada, Spain
| | - Blas García Medina
- Hospital Universitario Virgen de las Nieves de Granada, Departamento de Cirugía Oral y Maxilofacial, Granada, Spain
| |
Collapse
|
2
|
Cho YJ, Rhyu KH, Chun YS, Kim MS. Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia. J Hip Preserv Surg 2022; 9:151-157. [PMID: 35992029 PMCID: PMC9389910 DOI: 10.1093/jhps/hnac026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to assess injury patterns and risk factors of the acetabular labrum and associated cartilage in patients with femoroacetabular impingement (FAI) versus dysplasia. We retrospectively reviewed 137 patients diagnosed with labral tears and FAI or dysplasia (74 or 63 cases, respectively) through an arthroscopic procedure. Labral and concomitant cartilage injuries were evaluated. Demographics and radiological variables [lateral center-edge angle (LCEA), anterior center-edge angle, acetabular index (AI), acetabular version and alpha angle] were evaluated as risk factors for labral and cartilage injuries. Detachment of acetabular cartilage with intact labro-cartilaginous junction was the most common in dysplasia, whereas cartilage delamination from the labro-cartilaginous junction was more common in FAI (P < 0.001). A higher body mass index was significantly associated with delamination injury in FAI (odds ratio 1.226; 95% CI 1.043–1.441; P = 0.013). A significant correlation was evident between detachment injury and a larger AI in dysplasia (odds ratio 1.127; 95% CI 1.000–1.270; P = 0.049). In addition, symptom duration was positively correlated with the extent of labral tearing in FAI (P = 0.013), whereas the smaller LCEA was correlated with the larger extent of labral tearing in dysplasia (P = 0.044). FAI and dysplasia patients exhibited different labral and cartilage injury patterns. Increased body mass index was correlated with delamination injury in FAI, whereas an increased AI was associated with detachment injury in dysplasia. Greater tearing was associated with a longer symptom duration in FAI, and a decreased LCEA was a risk factor for the extent of tearing in dysplasia.
Level of evidence
Level III. Case–control study.
Collapse
Affiliation(s)
- Yoon-Je Cho
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemoon-ku, Seoul 02447, Republic of Korea
| | - Kee-Hyung Rhyu
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemoon-ku, Seoul 02447, Republic of Korea
| | - Young-Soo Chun
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul 05278, Republic of Korea
| | - Myung-Seo Kim
- Department of Orthopaedic Surgery, College of Medicine , Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul 05278, Republic of Korea
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Rayes J, Sparavalo S, Wong I. Biological Augments for Acetabular Chondral Defects in Hip Arthroscopy-A Scoping Review of the Current Clinical Evidence. Curr Rev Musculoskelet Med 2021; 14:328-339. [PMID: 34778917 PMCID: PMC8733143 DOI: 10.1007/s12178-021-09721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW A wide array of joint-preserving surgical techniques exists in the management of acetabular chondral defects (ACDs). The purpose of this review is to summarize the clinical outcomes of the recent biologics used to treat ACDs during hip arthroscopy. RECENT FINDINGS Increasing evidence is available for different biological solutions used in the hip. Studies have shown promising outcomes with minimal complications when using biologics as augmentation to microfracture (MF), including different scaffolds or stem cells, or to enhance autologous chondrocyte implantation (ACI). However, data so far is scarce, and more trials and longer follow-ups are needed to better delineate the appropriate indications and benefits for each technique. Presently, the level of evidence is low, but in general, biologics appear safe and trend toward beneficial compared to standard surgical techniques. Augmented MF is recommended for small to medium ACDs, and matrix-assisted ACI or three-dimensional ACI is recommended for medium to large defects.
Collapse
Affiliation(s)
- Johnny Rayes
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada.
| |
Collapse
|
5
|
Kawamura Y, Tetsunaga T, Akazawa H, Yamada K, Sanki T, Sato Y, Nakata E, Ozaki T. Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction. J Pediatr Orthop B 2021; 30:509-514. [PMID: 32804881 PMCID: PMC8480518 DOI: 10.1097/bpb.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.
Collapse
Affiliation(s)
| | | | - Hirofumi Akazawa
- Department of Orthopaedic Surgery, Asahigawasou Rehabilitation and Medical Center, Kitaku, Okayama, Japan
| | - Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University
| | | | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University
| | | |
Collapse
|
6
|
Martín IG, Cariati P, Rico AMS, Medina BG. Osteoplasty of Medial Temporomandibular Joint Wall. A New Strategy for Treating Disc Displacement. J Craniofac Surg 2021; 33:e322-e326. [DOI: 10.1097/scs.0000000000008217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Gu YG, Shi ZW, Yue YH, Yan ZL, Yin LX, Zhang YY, Sun HQ, Li SF, Yan XF. Analysis of Factors Affecting Early Functional Recovery of Bernese Periacetabular Osteotomy. Orthop Surg 2021; 13:1818-1827. [PMID: 34435459 PMCID: PMC8523773 DOI: 10.1111/os.13119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To explore factors affecting the efficacy of Bernese periacetabular osteotomy for the treatment of hip dysplasia. METHODS A retrospective study was conducted on 44 patients with hip dysplasia who underwent Bernese periacetabular osteotomy with a modified Smith-Peterson approach between January 2017 and November 2019. Among them, 40 were women and four were men. The average age was 31.2 ± 9.4. Preoperative and postoperative imaging parameters were measured. The acetabular top tilt angle, lateral central edge angle, acetabular abduction angle, femoral head extrusion index, sphericity index of femoral head, Shenton line, Tonnis grade of osteoarthritis, joint congruency, p/a ratio, acetabular anteversion angle, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale scores, and modified Harris hip score (MHHS) were observed. MHHS were divided into three clinically relevant categories: poor (<70 points), good (70-85 points), and excellent (86-91 points). Patient demographic data, as well as preoperative and postoperative radiographic parameters, were subjected to univariate logistic regression analysis. Multiple regression analysis was used to determine factors influencing postoperative MHHS. RESULTS The follow-up time was 1.0-3.9 years after surgery, with an average of 1.6 years. By the last follow-up, MHHS increased from 70 points before surgery to 91 points after surgery (P < 0.001), WOMAC pain score decreased from 4 points before surgery to 0 points after surgery (P < 0.001). WOMAC functional score decreased (Preoperative: 18.0 [4.0]; Postoperative: 4.0 [0], P = 0.004). Six patients had sensory disturbance of the lateral femoral cutaneous nerve, four of which recovered completely during follow-up. No other complications related to surgical approach, osteotomy, acetabular displacement, acetabular fixation, and postoperative stage were found. There was no significant vascular, nerve, or visceral injuries in any of the patients. On multiple regression analysis, the probability of the postoperative modified Harris hip score of a hip joint with a preoperative lateral center edge angle ≥4.5° being classified as excellent was six times that of angles <4.5° (Exp[β]: 6.249, 95% CI: 1.03-37.85, P = 0.046). Regression analysis of other factors found no significant correlation with postoperative functional scores. CONCLUSION Overall functional scores post-PAO significantly improved, and pain symptoms were significantly reduced. Patients with a preoperative lateral center edge angle ≥4.5° had better joint function after surgery.
Collapse
Affiliation(s)
- Yan-Ge Gu
- School of Medicine, Shandong University, Jinan, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Zhi-Wei Shi
- School of Medicine, Shandong University, Jinan, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Yao-Hui Yue
- School of Medicine, Shandong University, Jinan, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Zhao-Long Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Lu-Xu Yin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Ye-Yong Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Hua-Qiang Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Shu-Feng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Xin-Feng Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| |
Collapse
|
8
|
Chinzei N, Hashimoto S, Hayashi S, Nakano N, Haneda M, Kuroda Y, Matsumoto T, Kuroda R. Patients' Characteristics Can Predict Clinical Outcomes Following Hip Arthroscopy by Reflecting the Patterns of Labral Tears: A Retrospective Observational Study. Indian J Orthop 2021; 56:295-302. [PMID: 35140861 PMCID: PMC8789971 DOI: 10.1007/s43465-021-00481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/06/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the relationship between morphological differences in labral tears and clinical features of the hip joint in patients who underwent hip arthroscopy. MATERIALS AND METHODS We retrospectively analyzed data from patients who underwent arthroscopic surgery for the treatment of labral tears. Hip labral tears were morphologically classified as longitudinal peripheral tears (group L), radial fibrillated tears (group FI), radial flaps (group FL), and an unstable labrum (group U). Radiographically, the center-edge angle, acetabular roof obliquity, vertical-center-anterior angle, alpha angle, femoral head-neck offset ratio, and crossover sign were evaluated and compared among the groups. The relationship between labral morphology and these radiographic findings, as well as clinical findings, such as age, gender, preoperative range of hip motion, and the clinical outcomes using modified Harris Hip Score (mHHS) were also examined. RESULTS This study included fifty patients. Groups L and FI were often observed in late middle-aged patients with relatively shallow acetabular coverage. Group FL tears were frequently observed in young males with radiographic features, such as femoroacetabular impingement (FAI), compared to the other groups. Group U comprised mostly young females with relatively shallow acetabular coverage compared to the other groups. For the postoperative mHHS, group FL showed the best score among all groups, with a significant difference between groups FL and FI (p = 0.034). CONCLUSIONS Our study revealed that morphologically, different labral tears were associated with different clinical features and radiological findings. Especially, our study can provide predictive findings for hip arthroscopists that younger males with FAI show better clinical outcomes when compared to middle-aged females with shallow acetabulum, which is indicative of degenerative hip labral tears. LEVEL OF EVIDENCE IV case series.
Collapse
Affiliation(s)
- Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Masahiko Haneda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan ,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| |
Collapse
|
9
|
Kitamura K, Fujii M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Does Patient-specific Functional Pelvic Tilt Affect Joint Contact Pressure in Hip Dysplasia? A Finite-element Analysis Study. Clin Orthop Relat Res 2021; 479:1712-1724. [PMID: 33787527 PMCID: PMC8277263 DOI: 10.1097/corr.0000000000001737] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although individual and postural variations in the physiologic pelvic tilt affect the acetabular orientation and coverage in patients with hip dysplasia, their effect on the mechanical environment in the hip has not been fully understood. Individual-specific, finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the contact mechanics of dysplastic hips, which can lead to further understanding of the pathogenesis and improved treatment of this patient population. QUESTION/PURPOSE We used finite-element analysis to ask whether there are differences between patients with hip dysplasia and patients without dysplasia in terms of (1) physiologic pelvic tilt, (2) the pelvic position and joint contact pressure, and (3) the morphologic factors associated with joint contact pressure. METHODS Between 2016 and 2019, 82 patients underwent pelvic osteotomy to treat hip dysplasia. Seventy patients with hip dysplasia (lateral center-edge angle ≥ 0° and < 20° on supine AP pelvic radiographs) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or supine surgery, or poor-quality imaging were excluded. Thirty-two patients (32 hips) were eligible to this finite-element analysis study. For control groups, we reviewed 33 female volunteers without a history of hip disease. Individuals with frank or borderline hip dysplasia (lateral center-edge angle < 25°) or poor-quality imaging were excluded. Sixteen individuals (16 hips) were eligible as controls. Two board-certified orthopaedic surgeons measured sagittal pelvic tilt (the angle between the anterior pelvic plane and vertical axis: anterior pelvic plane [APP] angle) and acetabular version and coverage using pelvic radiographs and CT images. Intra- and interobserver reliabilities, evaluated using the kappa value and intraclass correlation coefficient, were good or excellent. We developed individual-specific, finite-element models using pelvic CT images, and performed nonlinear contact analysis to calculate the joint contact pressure on the acetabular cartilage during the single-leg stance with respect to three pelvic positions: standardized (anterior pelvic plane), supine, and standing. We compared physiologic pelvic tilt between patients with and without dysplasia using a t-test or the Wilcoxon rank sum test. A paired t-test or the Wilcoxon signed rank test with a Bonferroni correction was used to compare joint contact pressure between the three pelvic positions. We correlated joint contact pressure with morphologic parameters and pelvic tilt using the Pearson or the Spearman correlation coefficients. RESULTS The APP angle in the supine and standing positions varied widely among individuals. It was greater in patients with hip dysplasia than in patients in the control group when in the standing position (3° ± 6° versus -2° ± 8°; mean difference 5° [95% CI 1° to 9°]; p = 0.02) but did not differ between the two groups when supine (8° ± 5° versus 5° ± 7°; mean difference 3° [95% CI 0° to 7°]; p = 0.06). The mean pelvic tilt was 6° ± 5° posteriorly when shifting from the supine to the standing position in patients with hip dysplasia. The median (range) maximum contact pressure was higher in dysplastic hips than in control individuals (in standing position; 7.3 megapascals [MPa] [4.1 to 14] versus 3.5 MPa [2.2 to 4.4]; difference of medians 3.8 MPa; p < 0.001). The median maximum contact pressure in the standing pelvic position was greater than that in the supine position in patients with hip dysplasia (7.3 MPa [4.1to 14] versus 5.8 MPa [3.5 to 12]; difference of medians 1.5 MPa; p < 0.001). Although the median maximum joint contact pressure in the standardized pelvic position did not differ from that in the standing position (7.4 MPa [4.3 to 15] versus 7.3 MPa [4.1 to 14]; difference of medians -0.1 MPa; p > 0.99), the difference in the maximum contact pressure varied from -3.3 MPa to 2.9 MPa, reflecting the wide range of APP angles (mean 3° ± 6° [-11° to 14°]) when standing. The maximum joint contact pressure in the standing position was negatively correlated with the standing APP angle (r = -0.46; p = 0.008) in patients with hip dysplasia. CONCLUSION Based on our findings that individual and postural variations in the physiologic pelvic tilt affect joint contact pressure in the hip, future studies on the pathogenesis of hip dysplasia and joint preservation surgery should not only include the supine or standard pelvic position, but also they need to incorporate the effect of the patient-specific pelvic tilt in the standing position on the biomechanical environment of the hip. CLINICAL RELEVANCE We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning preservation hip surgery because assessment in a supine or standard pelvic position may overlook alterations in the hip's contact mechanics in the weightbearing positions. Further studies are needed to elucidate the effect of patient-specific functional pelvic tilt on the degeneration process of dysplastic hips, the acetabular reorientation maneuver, and the clinical result of joint preservation surgery.
Collapse
Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
10
|
Fujii M, Nakashima Y, Kitamura K, Motomura G, Hamai S, Ikemura S, Noguchi Y. Preoperative Rather Than Postoperative Intra-Articular Cartilage Degeneration Affects Long-Term Survivorship of Periacetabular Osteotomy. Arthroscopy 2021; 37:2112-2122. [PMID: 33581297 DOI: 10.1016/j.arthro.2021.01.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether intra-articular lesions changed in short-term follow-up after periacetabular osteotomy (PAO) and whether the intra-articular lesion changes impacted the long-term survivorship of PAO. METHODS We reviewed patients with hip dysplasia who underwent PAO with arthroscopic observation between 1990 and 2001. Patients who underwent second-look arthroscopy were included. The correlations between the intra-articular lesion changes and the long-term outcome of PAO were analyzed for patients with >10 years of follow-up. The possible risk factors included demographic factors (age, sex, and body mass index), radiographic factors (Tönnis grade, lateral center-edge angle, Tönnis angle, acetabular head index, crossover sign, posterior wall sign, and joint congruity), and arthroscopic findings (full-thickness lesions at the time of PAO and lesions changes at the time of second-look arthroscopy). RESULTS A total of 64 patients (72 hips) were studied. Second-look arthroscopy was performed at a median of 1.4 years after PAO. Intra-articular lesions were observed in 93% in the acetabulum, 81% in the femoral head, and 97% in the labrum, respectively. These lesions unchanged in 74% in the acetabulum, 76% in the femoral head, and 79% in the labrum, respectively. Cartilage repair was observed in the acetabulum and the femoral head in 24% and 17% of hips, respectively. Labral repair occurred in 10%. Intra-articular lesion changes were not a predictor of failure. Multivariate analysis identified International Cartilage Repair Society grade 4 lesion in the femoral head as an independent risk factor for failure. CONCLUSIONS Our results suggest that PAO prevents further deterioration in mild cartilage lesions and results in cartilage repair in some cases with advanced cartilage degenerations in the short term. However, these postoperative changes were not associated with long-term survivorship. Thus, appropriate surgical indications based on the preoperative intra-articular cartilage degeneration is paramount to achieving long-term success in PAO. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University.
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Yasuo Noguchi
- Department of Orthopaedic Surgery, Fukuoka Hoeikai Hospital, Fukuoka, Japan
| |
Collapse
|
11
|
Nakashima Y. CORR Insights®: What Mid-term Patient-reported Outcome Measure Scores, Reoperations, and Complications Are Associated with Concurrent Hip Arthroscopy and Periacetabular Osteotomy to Treat Dysplasia with Associated Intraarticular Abnormalities? Clin Orthop Relat Res 2021; 479:1078-1080. [PMID: 33617157 PMCID: PMC8052021 DOI: 10.1097/corr.0000000000001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Yasuharu Nakashima
- Y. Nakashima, Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| |
Collapse
|
12
|
Lara J, Garín A, Herrera C, Abara S, Besomi J, Villegas D, Neumann H, Tobar C. Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg 2020; 7:256-261. [PMID: 33163210 PMCID: PMC7605770 DOI: 10.1093/jhps/hnaa014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19–31), 96% females. Mean follow-up 7 years (range: 3–16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.
Collapse
Affiliation(s)
- Joaquín Lara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Alan Garín
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Cristhián Herrera
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Selim Abara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Javier Besomi
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Diego Villegas
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Hassan Neumann
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Carlos Tobar
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| |
Collapse
|
13
|
Iwamoto M, Fujii M, Komiyama K, Sakemi Y, Shiomoto K, Kitamura K, Yamaguchi R, Nakashima Y. Is lateral acetabular rotation sufficient to correct anterolateral deficiency in periacetabular reorientation osteotomy? A CT-Based simulation study. J Orthop Sci 2020; 25:1008-1014. [PMID: 32035753 DOI: 10.1016/j.jos.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. METHODS We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. RESULTS After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). CONCLUSIONS Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°-15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.
Collapse
Affiliation(s)
- Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuta Sakemi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
14
|
Kamenaga T, Hashimoto S, Hayashi S, Takayama K, Niikura T, Kuroda R, Matsumoto T. Larger Acetabular Labrum Is Associated With Hip Dysplasia, Joint Incongruence, and Clinical Symptoms. Arthroscopy 2020; 36:2446-2453. [PMID: 32461021 DOI: 10.1016/j.arthro.2020.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the association of labral length with acetabular morphology and clinical symptoms. METHODS Patients treated at our hip joint clinic between January 2015 and December 2018 were retrospectively enrolled in the study. Our sample included patients who received a diagnosis of one or more of the following: hip labral tear, femoroacetabular impingement (FAI), and developmental dysplasia of the hip. Patients with osteoarthritis and/or osteonecrosis were excluded. Bilateral labral length was measured as the distance from the acetabular rim to the edge of the labrum at the level of the central coronal T1-weighted magnetic resonance imaging scan cross-referenced to the axial plane (3- to 9-o'clock position). The lateral center-edge angle (LCEA) and acetabular roof obliquity (ARO) were evaluated with plain radiographs. An LCEA of 25° or less was defined as developmental dysplasia of the hip, whereas a positive crossover sign in the presence of an LCEA of 30° or greater, an LCEA greater than 40°, or acetabular inclination lower 0° was defined as pincer FAI. An alpha angle greater than 50° or head-neck offset lower 8 mm was considered cam FAI. The severity of hip symptoms was evaluated bilaterally using the Japanese Orthopaedic Association pain scale, on which hips scoring full points (i.e., a perfect score) were defined as asymptomatic whereas hips with all other scores were considered symptomatic. We used simple linear regression to examine the correlations of labral length with the LCEA and ARO. Labral length was also compared according to patient hip symptom status using the Mann-Whitney U test. RESULTS The study included 102 patients (14 with bilateral symptoms and 88 with unilateral symptoms). Labral length was strongly correlated with the LCEA (r = -0.612, P < .001) and ARO (r = 0.635, P < .001). Additionally, patients with symptomatic hips had significantly larger labra (9.5 ± 3.0 mm) than those with asymptomatic hips (7.9 ± 2.1 mm, P = .004). CONCLUSIONS Acetabular labral length is significantly greater in dysplastic, irregularly congruent, symptomatic hips. LEVEL OF EVIDENCE Level Ⅳ, retrospective cross-sectional study.
Collapse
Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
15
|
Petrie JR, Novais EN, An TW, Clohisy J. What Is the Impact of Periacetabular Osteotomy Surgery on Patient Function and Activity Levels? J Arthroplasty 2020; 35:S113-S118. [PMID: 32241651 DOI: 10.1016/j.arth.2020.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periacetabular osteotomy (PAO) is a hip preserving procedure performed often in younger, highly active patients. However, counseling patients is difficult, as there are limited data regarding activity level after PAO. The purpose of this study is to analyze the physical activity levels after PAO in a large, prospective multicenter cohort. METHODS Prospectively collected data from a multicenter study group included 359 hips treated by PAO for hip dysplasia at a mean age of 25.1 years. Patient demographics, radiographic measures, operative data, and clinical outcomes were evaluated preoperatively, at 1 year, and at minimum 2 years postoperatively. Activity level was assessed with the University of California Los Angeles (UCLA) activity score, and patients were stratified into low activity, moderate activity, and high activity groups based on preoperative function. RESULTS Compared to preoperative scores across the complete cohort, postoperative UCLA scores were improved on average 0.6 points at final follow-up (P = .001). The low activity and moderate activity groups had significant improvement in UCLA scores (P < .001 and P = .0007, respectively), while the high activity groups saw a significant decrease in UCLA activity scores (P < .0001). Modified Harris Hip Score, Hip Disability and Osteoarthritis Score Pain, and Hip Disability and Osteoarthritis Score Sports and Recreation scores were significantly improved across all preoperative activity levels. Multivariable linear regression (r2 = 0.45) confirmed prior ipsilateral surgery as a predictor for change in UCLA score (P = .002). CONCLUSION Overall, these data suggest that consistent improvements in activity level and function can be expected following PAO surgery, with greater gains experienced by patients with lower preoperative levels of activity.
Collapse
Affiliation(s)
- Jeff R Petrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MI
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Tonya W An
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MI
| | -
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MI
| | - John Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MI
| |
Collapse
|
16
|
Modified lateralized head sign: An accurate marker in diagnosing adult hip dysplasia. J Orthop Sci 2020; 25:460-465. [PMID: 31202493 DOI: 10.1016/j.jos.2019.05.015] [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: 04/16/2019] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although lateralized head sign (LHS) is considered indicative of structural instability, it lacks reproducibility, and its usefulness in diagnosing adult hip dysplasia is unknown. In this study, we proposed a modified LHS and aimed to determine its reliability and accuracy in diagnosing adult hip dysplasia. METHODS We reviewed anteroposterior pelvic radiographs of 94 patients (134 hips) with hip dysplasia. As controls, 133 normal hips were evaluated. We defined the modified lateralization distance (LD) as the horizontal distance between the medial aspect of the femoral head to the acetabular fossa. The sensitivity, specificity, and cutoff value of modified LD in diagnosing hip dysplasia were calculated using receiver operating characteristic curve analysis. RESULTS The sensitivity and specificity of the modified LD (79% and 87%, respectively) were higher than those of the conventional LD (63% and 80%, respectively). Diagnostic accuracy was further improved when patients were divided on the basis of sex. The sensitivity and specificity of the modified LD in men were 89% and 97%, respectively, with a cutoff value of 12 mm, while in women, they were 80% and 96%, respectively, with a cutoff value of 9.7 mm. Therefore, we defined the modified LHS as presentation with a modified LD ≥ 12 mm in men and ≥10 mm in women. Between three observers, the kappa value for intraobserver reliability was ≥0.9, while that for interobserver reliability was >0.8. The mean sensitivity and specificity of the modified LHS in diagnosing hip dysplasia were 85% and 99%, respectively. CONCLUSIONS Modified LHS-a horizontal distance between the medial aspect of the femoral head and the acetabular fossa ≥12 mm in men and ≥10 mm in women-is a clinically useful marker in detecting lateral femoral head subluxation indicative of hip dysplasia or structural hip instability.
Collapse
|
17
|
Kitamura K, Fujii M, Utsunomiya T, Iwamoto M, Ikemura S, Hamai S, Motomura G, Todo M, Nakashima Y. Effect of sagittal pelvic tilt on joint stress distribution in hip dysplasia: A finite element analysis. Clin Biomech (Bristol, Avon) 2020; 74:34-41. [PMID: 32114278 DOI: 10.1016/j.clinbiomech.2020.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/24/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physiologic pelvic tilt can change acetabular orientation and coverage in patients with hip dysplasia. In this study, we aimed to clarify the impact of change in sagittal pelvic tilt on joint stress distribution in dysplastic hips. METHODS We developed patient-specific finite element models of 21 dysplastic hips and 21 normal hips. The joint contact area, contact pressure, and equivalent stress of the acetabular cartilage were assessed at three pelvic tilt positions relative to the functional pelvic plane: 10° anterior tilt, no tilt, and 10° posterior tilt. FINDINGS The mean contact area was 0.6-0.7 times smaller, the mean maximum contact pressure was 1.8-1.9 times higher, and the mean maximum equivalent stress was 1.3-2.8 times higher in dysplastic hips than in normal hips at all three pelvic positions. As the pelvis tilted from 10° anterior to 10° posterior, the mean contact area decreased, and the mean maximum contact pressure and median maximum equivalent stress increased. The latter two changes were more significant in dysplastic hips than in normal hips (total increment was 1.3 MPa vs. 0.4 MPa, P = 0.001, and 3.6 MPa vs. 0.4 MPa, P < 0.001, respectively). The mean equivalent stress increased in the anterosuperior acetabulum during posterior pelvic tilt in dysplastic and normal hips, while the change was not significant in the superior and posterosuperior acetabulum in both groups. INTERPRETATION Sagittal pelvic tilt alters the loading environment and joint stress distribution of the hip joint and may impact the degeneration process in dysplastic hips.
Collapse
Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Mitsugu Todo
- Research Institute for Applied Mechanics, Kyushu University, 6-1 Kasuga-koen, Kasuga 816-8580, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
18
|
Does Acetabular Coverage Vary Between the Supine and Standing Positions in Patients with Hip Dysplasia? Clin Orthop Relat Res 2019; 477:2455-2466. [PMID: 31389893 PMCID: PMC6903855 DOI: 10.1097/corr.0000000000000898] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although variation in physiologic pelvic tilt may affect acetabular version and coverage, postural change in pelvic tilt in patients with hip dysplasia who are candidates for hip preservation surgery has not been well characterized, and its clinical importance is unknown. QUESTIONS/PURPOSES The aim of this study was to determine (1) postural changes in sagittal pelvic tilt between the supine and standing positions; (2) postural changes in the acetabular orientation and coverage of the femoral head between the supine and standing positions; and (3) patient demographic and morphologic factors associated with sagittal pelvic tilt. METHODS Between 2009 and 2016, 102 patients underwent pelvic osteotomy to treat hip dysplasia. All patients had supine and standing AP pelvic radiographs and pelvic CT images taken during their preoperative examination. Ninety-five patients with hip dysplasia (lateral center-edge angle < 20°) younger than 60 years old were included. Patients with advanced osteoarthritis, other hip disease, prior hip or spine surgery, femoral head deformity, or inadequate imaging were excluded. Sixty-five patients (64%) were eligible for participation in this retrospective study. Two board-certified orthopaedic surgeons (TT and MF) investigated sagittal pelvic tilt, spinopelvic parameters, and acetabular version and coverage using pelvic radiographs and CT images. Intra- and interobserver reliabilities, evaluated using the intraclass correlation coefficient (0.90 to 0.98, 0.93 to 0.99, and 0.87 to 0.96, respectively), were excellent. Demographic data (age, gender, and BMI) were collected by medical record review. Sagittal pelvic tilt was quantified as the angle formed by the anterior pelvic plane and a z-axis (anterior pelvic plane angle). Using a 2D-3D matching technique, we measured the change in sagittal pelvic tilt, acetabular version, and three-dimensional coverage between the supine and standing positions. We correlated sagittal pelvic tilt with demographic and CT measurement parameters using Pearson's or Spearman's correlation coefficients. RESULTS Although functional pelvic tilt varied widely among individuals, the pelvis of patients with hip dysplasia tilted posteriorly from the supine to the standing position (mean APP angle 8° ± 6° versus 2° ± 7°; mean difference -6°; 95% CI, -7° to -5°; range -17° to 4.1°; p < 0.001; paired t-test).The pelvis tilted more than 5° posteriorly from the supine to the standing position in 39 patients (60%), and the change was greater than 10° in 12 (18%). In the latter subgroup of patients, the mean acetabular anteversion angle increased (22° ± 5° versus 27° ±5°; mean difference 5°; 95% CI, 4°-6°; p < 0.001) and the mean anterosuperior acetabular sector angle notably deceased from the supine to the standing position (91° ± 11° versus 77° ± 14°; mean difference -14°; 95% CI, -17° to -11°; p < 0.001; paired t-test). Postural change in pelvic tilt was not associated with any of the studied demographic or morphologic parameters, including patient age, gender, BMI, and acetabular version and coverage. CONCLUSIONS On average, the pelvis tilted posteriorly from the supine to the standing position in patients with hip dysplasia, resulting in increased acetabular version and decreased anterosuperior acetabular coverage in the standing position. Thus, assessment with a supine AP pelvic radiograph may overlook changes in acetabular version and coverage in weightbearing positions. We recommend assessing postural change in sagittal pelvic tilt when diagnosing hip dysplasia and planning hip preservation surgery. Further studies are needed to determine how postural changes in sagittal pelvic tilt affect the biomechanical environment of the hip and the clinical results of acetabular reorientation osteotomy. LEVEL OF EVIDENCE Level IV, diagnostic study.
Collapse
|
19
|
Sun Y, You Y, Jiang W, Zhai Z, Dai K. 3D-bioprinting a genetically inspired cartilage scaffold with GDF5-conjugated BMSC-laden hydrogel and polymer for cartilage repair. Theranostics 2019; 9:6949-6961. [PMID: 31660079 PMCID: PMC6815949 DOI: 10.7150/thno.38061] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Rationale: Articular cartilage injury is extremely common in congenital joint dysplasia patients. Genetic studies have identified Growth differentiation factor 5 (GDF5) as a shared gene in joint dysplasia and OA progression across different populations. However, few studies have employed GDF5 in biological regeneration for articular cartilage repair. Methods & Results: In the present study, we report identified genetic association between GDF5 loci and hip joint dysplasia with genome-wide association study (GWAS). GWAS and replication studies in separate populations achieved significant signals for GDF5 loci. GDF5 expression was dysregulated with allelic differences in hip cartilage of DDH and upregulated in the repaired cartilage in a rabbit cartilage defect model. GDF5 in vitro enhanced chondrogenesis and migration of bone marrow stem cells (BMSCs), GDF5 was tested in ectopic cartilage generation with BMSCs by GDF5 in nude mice in vivo. Genetically inspired, we further generated functional knee articular cartilage construct for cartilage repair by 3d-bioprinting a GDF5-conjugated BMSC-laden scaffold. GDF5-conjugated scaffold showed better cartilage repairing effects compared to control. Meanwhile, transplantation of the 3D-bioprinted GDF5-conjugated BMSC-laden scaffold in rabbit knees conferred long-term chondroprotection. Conclusions: In conclusion, we report identified genetic association between GDF5 and DDH with combined GWAS and replications, which further inspired us to generate a ready-to-implant GDF5-conjugated BMSC-laden scaffold with one-step 3d-bioprinting for cartilage repair.
Collapse
|
20
|
Utsunomiya H, Briggs KK, Dornan GJ, Bolia IK, Locks R, Philippon MJ. Predicting Severe Cartilage Damage in the Hip: A Model Using Patient-Specific Data From 2,396 Hip Arthroscopies. Arthroscopy 2019; 35:2051-2060.e13. [PMID: 31208918 DOI: 10.1016/j.arthro.2019.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine patient-specific factors that can be used to predict the presence of severe articular cartilage damage in the hip in patients without osteoarthritis. METHODS The prevalence of severe (Outerbridge grade III or IV) cartilage damage to the acetabulum and femoral head was prospectively recorded at hip arthroscopy. Patients who underwent primary hip arthroscopic surgery between 2006 and 2016 performed by a single surgeon were included. Patients were excluded if they underwent previous hip surgery, had poor-quality radiographs, were younger than 16 years at the time of surgery, or had a minimal joint space of 2 mm or less. The relation between severe cartilage damage and preoperative patient characteristics was examined using multivariable logistic regression analysis with restricted cubic splines. RESULTS Of the 2,396 hips presenting for hip arthroscopy, 995 (41%) had severe cartilage damage to the acetabulum and 257 (11%) had severe cartilage damage to the femoral head. Older age was a significant risk factor for severe cartilage damage both to the acetabulum (χ2 = 69.5, P < .001) and to the femoral head (χ2 = 53.9, P < .001). An age of 45 years was associated with a 1.96 (95% confidence interval, 1.54-2.49) increase in the odds of severe acetabular cartilage damage and a 3.94 (95% confidence interval, 2.61-5.94) increase in the odds of severe femoral head cartilage damage relative to an age of 20 years. Male sex was associated with severe cartilage damage to the acetabulum (χ2 = 66.7, P < .001), and a lower center-edge angle was a significant risk factor for severe cartilage damage to the femoral head (χ2 = 78.5, P < .001). Predictive nomograms were established for severe cartilage lesions. CONCLUSIONS The primary risk factors for severe hip cartilage damage were older age for both the femoral head and acetabulum; a lower center-edge angle and larger Tönnis angle for the femoral head; and male sex, body mass index, alpha angle, and joint space for the acetabulum. The likelihood of cartilage damage to the hip can be estimated clinically using a prediction nomogram. LEVEL OF EVIDENCE Level III, cross-sectional study.
Collapse
Affiliation(s)
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Ioanna K Bolia
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Renato Locks
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
| |
Collapse
|
21
|
Nwachukwu BU, Gaudiani MA, Marsh NA, Ranawat AS. Labral hypertrophy correlates with borderline hip dysplasia and microinstability in femoroacetabular impingement: a matched case-control analysis. Hip Int 2019; 29:198-203. [PMID: 30354686 DOI: 10.1177/1120700018807860] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE: The goal of this study was to: (1) investigate the association between labral hypertrophy and radiographic and computed tomography (CT) imaging measurements of dysplasia in a femoroacetabular impingement (FAI) cohort; (2) evaluate the association between physical examination parameters suggestive of microinstability and labral hypertrophy. METHODS: A retrospective case-control study was performed. Labral hypertrophy was defined as intraoperative labral width measuring greater >4 mm. A control cohort (NL) was matched to the cases. Physical examination parameters and preoperative radiographic and CT imaging studies were reviewed. RESULTS: 231 hip arthroscopies for FAI were reviewed from which 42 cases of labral hypertrophy were identified (LH). In the LH group there was significantly increased hip internal rotation at 90° hip flexion compared to normal controls (13.6° ± 1 0.7° LH vs. 9.3° ± 6.2° NL; p = 0.04). On plain radiographs, the mean lateral centre-edge angle was smaller in the LH group compared to the NL group (27.6° ± 6.00° LH vs. 31.6° ± 6.59° NL; p < 0.001) and the acetabular index was larger in the LH group compared to the NL group (6.61 ± 4.18 LH vs. 4.14 ± 6.13 NL; p = 0.04). On CT imaging coronal sagittal CEA was significantly lower in LH cases compared to NL control (31.8° ± 5.30° LH vs. 35.1° ± 7.67° NL; p = 0.01). CONCLUSIONS: We found that patients with labral hypertrophy have radiographic and CT measurements consistent with subtle but not absolute dysplasia and physical examination findings suggestive of microinstability. We propose that labral hypertrophy can be a useful clinical tool for identifying FAI patients on the dysplasia spectrum.
Collapse
Affiliation(s)
- Benedict U Nwachukwu
- 1 Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| | - Michael A Gaudiani
- 1 Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| | - Nathan A Marsh
- 2 West Point Department of Sports Medicine, New York, USA
| | - Anil S Ranawat
- 1 Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, USA
| |
Collapse
|
22
|
Sutton R, Azboy I, Restrepo C, Parvizi J. Ptosis of the hip: a new radiographic finding in patients undergoing femoroacetabular osteoplasty. J Hip Preserv Surg 2019; 5:425-434. [PMID: 30647934 PMCID: PMC6328752 DOI: 10.1093/jhps/hny039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/22/2018] [Accepted: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
Ptosis is a newly described phenomenon appearing on AP radiographs of patients undergoing femoroacetabular osteoplasty (FAO), and refers to a reverse break down in Shenton’s Line. Thorough characterization of this phenomenon is needed to better understand the hip morphology and pathologic ramifications. Our goal was to define the radiographic hip parameters accompanying a break down in Shenton’s Line and to determine how these values compare with standard values in normal hips. Using two independent readers, we retrospectively reviewed the medical records and preoperative supine radiographs of 630 patients (1260 hips) who underwent FAO by a single surgeon between 2003 and 2016. Prevalence of hip pathology and 28 radiographic parameters in ptosis hips was measured, as well as a comparison between unilateral ptosis hips and contralateral normal hips. Of the 53 patients (106 hips) who fulfilled the criteria for the study, 94 hips had a Shenton’s Line break down of at least 5 mm. Sixty-nine percent of ptosis hips had femoroacetabular impingement (FAI), 70.2% had coxa profunda, and 52.1% had partial joint space narrowing. Ptosis hips had 1.05 mm less lateral subluxation (P = 0.012), 2.28° larger Center-edge angle (P = 0.046), 2.59° smaller Sharp angle (P = 0.011) and 2.49% smaller extrusion index (P = 0.016) compared with contralateral normal hips. FAI is prevalent in patients with a positive ptosis sign. The high prevalence of partial joint space narrowing could suggest eventual osteoarthritis. We believe our results demonstrate the importance of further investigation of a positive ptosis sign on AP pelvic radiographs.
Collapse
Affiliation(s)
- Ryan Sutton
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Ibrahim Azboy
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Camilo Restrepo
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA, USA
| |
Collapse
|
23
|
Risk Factors for Bilateral Femoroacetabular Impingement Syndrome Requiring Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e070. [PMID: 30656260 PMCID: PMC6324903 DOI: 10.5435/jaaosglobal-d-18-00070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To identify the risk factors for contralateral surgery in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients who underwent unilateral surgery were compared with those who underwent staged bilateral surgery to identify risk factors associated with bilateral surgery. Variables examined included demographics, comorbidities, and radiographic features. Binary logistic regression was used to identify predictors of bilateral FAIS. Results: A total of 694 patients with an average age of 34.0 ± 13.1 years met were included in the analysis. Overall, 109 patients (15.3%) had staged bilateral hip arthroscopy for FAIS. Risk factors associated for bilateral FAIS requiring surgery were decreased age and lower Charlson Comorbidity Index (CCI). Compared with patients aged <25 years, those aged 25 to 34 years (odds ratio [OR], 0.5; P = 0.031), 35 to 44 years (OR, 0.5; P = 0.034), and ≥45 years (OR, 0.3; P = 0.002) had lower odds of bilateral labral tear. In addition, patients with a CCI <2 were three times more likely to require bilateral FAIS surgery (OR, 3.4; P = 0.044). None of the radiographic parameters predicted bilateral labral tears. Conclusion: Patients younger than 25 years and those with a CCI <2 had markedly increased rates of bilateral FAIS necessitating surgery compared with older patients. This study may be of value in preoperative counseling.
Collapse
|
24
|
Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study. Arch Orthop Trauma Surg 2018; 138:1495-1499. [PMID: 29971509 DOI: 10.1007/s00402-018-2992-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The significance of the relationship between the spine and hip joints has been frequently discussed. However, the relationship between acetabular coverage and spinal sagittal alignment has not been fully elucidated as previous studies did not adequately control for factors that might affect the spinopelvic alignment. The aim of this study was to elucidate the impact of acetabular coverage on spinal sagittal alignment by comparing patient groups matched on sex, age, and the presence of hip and anterior impingement pain. MATERIALS AND METHODS We prospectively enrolled 30 women undergoing periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) and 30 women undergoing hip arthroscopic surgery (HAS) for labral tears. The lateral centre edge angle was measured on hip radiographs. In addition, the sagittal vertical axis, pelvic tilt, pelvic incidence, sacral slope (SS), and lumbar lordosis (LL) were measured on preoperative plain radiographs of the whole spine to assess the sagittal spinal alignment. Clinical and radiologic data were compared between the two groups (PAO vs. HAS). RESULTS The patient groups did not differ in age and body mass index. The mean SS was significantly greater in the PAO group (41.6° ± 1.6°) than in the HAS group (35.3° ± 1.5°; P = 0.0039). Additionally, the mean LL was significantly greater in the PAO group (54.5° ± 2.0°) than in the HAS group (45.1° ± 1.9°; P = 0.0015). CONCLUSIONS The SS and LL were greater in patients with DDH than in patients with hip pain, but without DDH. Patients with DDH might show lumbar hyperlordosis to rotate the pelvis anteriorly, increasing the anterosuperior acetabular coverage.
Collapse
|
25
|
Maldonado DR, LaReau JM, Lall AC, Battaglia MR, Mohr MR, Domb BG. Concomitant Arthroscopy With Labral Reconstruction and Periacetabular Osteotomy for Hip Dysplasia. Arthrosc Tech 2018; 7:e1141-e1147. [PMID: 30533361 PMCID: PMC6262138 DOI: 10.1016/j.eats.2018.07.012] [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: 04/11/2018] [Accepted: 07/30/2018] [Indexed: 02/03/2023] Open
Abstract
In the setting of true hip dysplasia, the high prevalence of intra-articular pathology may lead to recurrent symptoms and failure after periacetabular osteotomy (PAO). Femoral neck osteochondroplasty, microfracture, removal of loose bodies, and labral repair are examples of procedures that are performed with concomitant arthroscopy. When damage to the labrum is too severe to repair, reconstruction instead of extensive debridement before PAO can be more effective in restoring the labral seal to maintain joint lubrication and chondral protection. This Technical Note describes a method for concomitant hip arthroscopy with circumferential labral reconstruction with allograft and PAO.
Collapse
Affiliation(s)
| | - Justin M. LaReau
- American Hip Institute, Westmont, Illinois, U.S.A
- Hinsdale Orthopaedics, Westmont, Illinois, 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
- Address correspondence to Benjamin G. Domb, M.D., American Hip Institute, 1010 Executive Ct, Ste 250, Westmont, IL 60559, U.S.A.
| |
Collapse
|
26
|
Pascual-Garrido C, Guilak F, Rai MF, Harris MD, Lopez MJ, Todhunter RJ, Clohisy JC. Canine hip dysplasia: A natural animal model for human developmental dysplasia of the hip. J Orthop Res 2018; 36:1807-1817. [PMID: 29227567 DOI: 10.1002/jor.23828] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/29/2017] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) in humans is a common condition that is associated with hip pain, functional limitations, and secondary osteoarthritis (OA). Surgical treatment of DDH has improved in the last decade, allowing excellent outcomes at short- and mid-term follow-up. Still, the etiology, mechanobiology, and pathology underlying this disease are not well understood. A pre-clinical animal model of DDH could help advance the field with a deeper understanding of specific pathways that initiate hip joint degeneration secondary to abnormal biomechanics. An animal model would also facilitate different interventional treatments that could be tested in a rigorous and controlled environment. The dog model exhibits several important characteristics that make it valuable as a pre-clinical animal model for human DDH. Dogs are naturally prone to develop canine hip dysplasia (CHD), which is treated in a similar manner as in humans. Comparable to human DDH, CHD is considered a pre-OA disease; if left untreated it will progress to OA. However, progression to OA is significantly faster in dogs than humans, with progression to OA within 1-2 years of age, associated with their shorter life span compared to humans. Animal studies could potentially reveal the underlying biochemical pathway(s), which can inform refined treatment modalities and provide opportunities for new treatment and prevention targets. Herein, we review the similarities and differences between the two species and outline the argument supporting CHD as an appropriate pre-clinical model of human DDH. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1807-1817, 2018.
Collapse
Affiliation(s)
- Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, School of Medicine, Musculoskeletal Research Center, Washington University, 660 S. Euclid, Campus Box 8233, Saint Louis, Missouri, 63110
| | - Farshid Guilak
- Department of Orthopaedic Surgery, School of Medicine, Musculoskeletal Research Center, Washington University, 660 S. Euclid, Campus Box 8233, Saint Louis, Missouri, 63110.,Shriners Hospitals for Children-St. Louis, St. Louis, Missouri
| | - M Farooq Rai
- Department of Orthopaedic Surgery, School of Medicine, Musculoskeletal Research Center, Washington University, 660 S. Euclid, Campus Box 8233, Saint Louis, Missouri, 63110.,Department of Cell Biology & Physiology, School of Medicine, Washington University, Saint Louis, Missouri
| | - Michael D Harris
- Program in Physical Therapy, School of Medicine, Washington University, Saint Louis, Missouri
| | - Mandi J Lopez
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Rory J Todhunter
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - John C Clohisy
- Department of Orthopaedic Surgery, School of Medicine, Musculoskeletal Research Center, Washington University, 660 S. Euclid, Campus Box 8233, Saint Louis, Missouri, 63110
| |
Collapse
|
27
|
Mittal A, Bomar JD, Jeffords ME, Huang MT, Wenger DR, Upasani VV. Defining the lateral edge of the femoroacetabular articulation: correlation analysis between radiographs and computed tomography. J Child Orthop 2016; 10:365-70. [PMID: 27541022 PMCID: PMC5033787 DOI: 10.1007/s11832-016-0768-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/10/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the variation in measuring the lateral center edge angle of Wiberg (LCEA) using the lateral edge of the sourcil (LCEA-S) compared to the lateral edge of the acetabulum (LCEA-E), and to correlate these measurements with three-dimensional computed tomography (3D-CT)-based analysis of the femoroacetabular articulation. METHODS A retrospective analysis was performed on 24 patients (45 hips) treated for hip dysplasia at a single institution. All patients were required to have an anteroposterior (AP) pelvis radiograph and pelvic CT. LCEA-S and LCEA-E measurements were calculated from radiographs. Axial CT images were processed to standardize pelvic orientation and calculate the LCEA at three points (posterior, central, anterior) along the acetabular edge. Correlation analysis was used to evaluate radiographic and CT measures. RESULTS Eight males and 16 females with an average age of 14.6 years were included. The LCEA-S (16.5° ± 2.0°) was found to be significantly less than the LCEA-E (26.0° ± 2.0°) (p < 0.001). The LCEA-S had the greatest correlation with the central measurement on the 3D-CT (r s = 0.893; p < 0.001). The LCEA-E had the greatest correlation with the anterior measurement on the 3D-CT (r = 0.834; p < 0.001). CONCLUSIONS The LCEA can change significantly depending on the bony landmark used to define the lateral edge of the femoroacetabular articulation. The edge of the sourcil most closely correlates with the central weight-bearing portion of the articular surface on the 3D-CT and should be used to define the LCEA when treating patients with hip dysplasia. LEVEL OF EVIDENCE Level III, retrospective comparison study.
Collapse
Affiliation(s)
- Ashish Mittal
- Department of Orthopedics, University of California, San Diego, San Diego, CA USA
| | - James D. Bomar
- Department of Orthopedics, Rady Children’s Hospital, San Diego, 3030 Children’s Way, Suite 410, San Diego, CA 92123 USA
| | - Megan E. Jeffords
- Department of Orthopedics, Rady Children’s Hospital, San Diego, 3030 Children’s Way, Suite 410, San Diego, CA 92123 USA
| | - Ming-Tung Huang
- National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Dennis R. Wenger
- Department of Orthopedics, University of California, San Diego, San Diego, CA USA ,Department of Orthopedics, Rady Children’s Hospital, San Diego, 3030 Children’s Way, Suite 410, San Diego, CA 92123 USA
| | - Vidyadhar V. Upasani
- Department of Orthopedics, University of California, San Diego, San Diego, CA USA ,Department of Orthopedics, Rady Children’s Hospital, San Diego, 3030 Children’s Way, Suite 410, San Diego, CA 92123 USA
| |
Collapse
|
28
|
Hohmann E. Editorial Commentary: Risk Factors for Chondral Lesions in the Hip-There Is More to It Than Cam and Pincer. Arthroscopy 2016; 32:1590-1. [PMID: 27495863 DOI: 10.1016/j.arthro.2016.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 02/02/2023]
Abstract
Age has been cited in a recent article as the largest predictor of both chondral and labral lesions in patients with hip dysplasia. But it was not surprising that there is also a direct relation between a small lateral center-edge angle, acetabular head index, and cartilage degeneration and an increased acetabular index and labral tears in patients with hip dysplasia. The severity of the congenital disease determines the severity of the intra-articular lesions.
Collapse
|