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Chen K, Wu J, Zhang X, Han X, Li T, Xia J, Shen C, Chen X. A Modified Approach to Measuring Femoro-Epiphyseal Acetabular Roof Index Has Better Intraobserver and Interobserver Reliability Compared With the Original Femoro-Epiphyseal Acetabular Roof Index. Arthroscopy 2024; 40:1807-1815. [PMID: 38056725 DOI: 10.1016/j.arthro.2023.11.024] [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: 03/04/2023] [Revised: 10/29/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To propose a modified approach to measuring the femoro-epiphyseal acetabular roof (FEAR) index while still abiding by its definition and biomechanical basis, and to compare the intra- and interobserver reliabilities of the original and the modified FEAR index. To propose a classification for medial sourcil edges. METHODS We retrospectively reviewed a consecutive series of patients treated with periacetabular osteotomy and/or hip arthroscopy at a single institute. Patients with unilateral or bilateral symptomatic borderline hip(s) were included. Hips with remarkable osteoarthritis, deformities, history of previous surgery, or without symptoms were excluded. A modified FEAR index was defined using a best-fit circle to determine the sourcil line and 2 ancillary lines connecting femoral head and sourcil edges to determine epiphyseal line. Lateral center-edge angle, Sharp angle, Tönnis angle on all hips, as well as FEAR index with original and modified approaches, were measured. Intra- and interobserver reliability were calculated as intraclass correlation coefficients (ICCs) for the FEAR index with both approaches and other alignments. A classification was proposed to categorize medial sourcil edges. ICCs for the 2 approaches across different sourcil groups also were calculated. RESULTS After we reviewed 411 patients, 49 were finally included. Thirty-two patients (40 hips) were identified as having borderline dysplasia defined by a lateral center-edge angle of 18 to 25°. Intraobserver ICCs for the modified method were good to excellent for borderline hips; poor to excellent for developmental dysplasia of the hip; and moderate to excellent for normal hips. As for interobserver reliability, the modified approach outperformed original approach with moderate-to-good interobserver reliability (developmental dysplasia of the hip group, ICC = 0.650; borderline dysplasia group, ICC = 0.813; normal hip group, ICC = 0.709). The medial sourcil edge was classified to 3 groups upon its morphology. Type II (39.0%) and III (43.9%) sourcil were the dominant patterns. The sourcil classification had substantial intraobserver agreement (observer 4, kappa = 0.68; observer 1, kappa = 0.799) and moderate interobserver agreement (kappa = 0.465). The modified approach to FEAR index possessed greater interobserver reliability in all medial sourcil edge patterns. CONCLUSIONS The modified FEAR index has better intra- and interobserver reliability compared with the original approach in all hip groups and sourcil groups. Type II and III sourcil types account for the majority, to which the modified approach is better. LEVEL OF EVIDENCE Level II, development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding).
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Affiliation(s)
- Kangming Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jinyan Wu
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xinhai Zhang
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xiuguo Han
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Tao Li
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Jun Xia
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
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Girardi NG, Lee JH, Genuario JW, Vogel LA, Kraeutler MJ, Keeter C, Mei-Dan O. The Everted Acetabular Labrum: Outcomes of Surgical Management. Am J Sports Med 2024; 52:1563-1571. [PMID: 38544383 DOI: 10.1177/03635465241237252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND An everted acetabular labrum (EL) is a pathologic variant in which the labrum is flipped to the capsular side of the acetabular rim. An iatrogenic EL is a known complication of a poorly executed labral repair, and a recent study described the native acetabular EL. PURPOSE To analyze surgical outcomes after advancement or reconstruction of an EL in a native hip. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This was a multicenter retrospective review of prospectively collected data on primary hip arthroscopic surgeries performed between 2013 and 2023. An EL was identified arthroscopically as a labrum-femoral head gap while off traction in the native hip. All patients with EL who were analyzed in this study underwent arthroscopic labral repair and advancement or labral augmentation or reconstruction. Patients with hip dysplasia also underwent periacetabular osteotomy with or without a derotational femoral osteotomy. Patient-reported outcomes (PROs) were assessed using the 12-item International Hip Outcome Tool (iHOT-12) and the Nonarthritic Hip Score. PROs were obtained preoperatively and up to 24 months after surgery. PROs were compared with those of a case-matched control cohort in a 1:2 ratio. Only patients with PROs available at ≥1 year postoperatively were included in the outcome analysis. RESULTS A total of 111 patients (129 hips) with EL during the study period were identified, with PROs available in 96 hips. The mean age of patients with EL was 30.5 years, and women made up 87% of the cohort. Of the 129 hips with an EL, an isolated diagnosis of an EL was present in 11.6% of hips. Deficient acetabular coverage (lateral center-edge angle <25°) was seen in 40.6% of EL hips. No difference was seen in iHOT-12 scores between EL and control groups at 12- or 24-month follow-up (P = .18 and .94, respectively). Patients with EL reported a significant improvement of PROs at latest follow-up (P < .001 for iHOT-12 and Nonarthritic Hip Score). CONCLUSION Surgical management of a native EL with restoration of the labral seal on the femoral head and correction of concomitant pathologies resulted in significant clinical improvement, with postoperative outcome scores comparable to those of patients without an EL. These findings provide evidence supporting surgical intervention for a native EL.
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Affiliation(s)
- Nicholas G Girardi
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Jessica H Lee
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - James W Genuario
- UC Health Steadman Hawkins Clinic-Denver, Englewood, Colorado, USA
| | - Laura A Vogel
- The Orthopedic Clinic Association at Banner Health, Phoenix, Arizona, USA
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carson Keeter
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Omer Mei-Dan
- The Orthopedic Clinic Association at Banner Health, Phoenix, Arizona, USA
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Kraeutler MJ, Garabekyan T, Mei-Dan O. We Need Better Classification of Patients With Borderline Hip Dysplasia: Shifting the Focus From Dysplasia to Instability. Arthroscopy 2024; 40:653-654. [PMID: 38206250 DOI: 10.1016/j.arthro.2023.10.023] [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: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, U.S.A
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Kraeutler MJ. Editorial Commentary: Most Patients With Borderline Hip Dysplasia Do Well After Hip Arthroscopy: Could Instability Be the Problem for Those Who Do Poorly? Arthroscopy 2023; 39:283-284. [PMID: 36603997 DOI: 10.1016/j.arthro.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023]
Abstract
Borderline hip dysplasia (BHD) is often defined based on the lateral center edge angle. While patients with frank hip dysplasia often require bony realignment with periacetabular osteotomy and/or derotational femoral osteotomy, patients with BHD represent an "in-between" group of patients. While many, perhaps even most, patients with BHD will have successful outcomes after hip arthroscopy alone, some will be unresponsive to an arthroscopic-only approach and require the same surgical treatments as those with frank dysplasia. A variety of radiographic and arthroscopic parameters can be used to assess the degree of instability in patients with BHD. It may be that patients with "borderline" hip dysplasia combined with hip instability are more likely to fail an arthroscopic-only approach but to date we still do not have a great algorithm for determining which patients with BHD should undergo bony treatment with periacetabular osteotomy. It is important for future studies to continue to seek out characteristics of BHD patients that predict failure of an arthroscopic-only approach. This will not only allow for optimal initial surgical treatment in "at-risk" patients with BHD but will also improve success rates in BHD patients selected for hip arthroscopy as initial surgical treatment.
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Welton KL, Kraeutler MJ, Garabekyan T, Mei-Dan O. Radiographic Parameters of Adult Hip Dysplasia. Orthop J Sports Med 2023; 11:23259671231152868. [PMID: 36874050 PMCID: PMC9983115 DOI: 10.1177/23259671231152868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/08/2022] [Indexed: 03/04/2023] Open
Abstract
As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician's ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others. The purpose of this narrative review was to detail various established criteria and parameters on anteroposterior pelvis plain radiographs, MRI/MRA, and CT that assist in defining the nature and severity of instability present in a dysplastic hip, thereby aiding in the development of patient-specific surgical treatment plans.
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Affiliation(s)
- K Linnea Welton
- MultiCare Orthopedics & Sports Medicine, Auburn, Washington, USA
| | - Matthew J Kraeutler
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | | | - Omer Mei-Dan
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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Sonoda K, Hara T. "Anterior-shift sign": a novel MRI finding of adult hip dysplasia. Arch Orthop Trauma Surg 2022; 142:1763-1768. [PMID: 33576848 DOI: 10.1007/s00402-021-03808-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In adult hip dysplasia, methods for direct evaluation of hip instability have not been established. The present study aimed to determine findings suggestive of hip instability on magnetic resonance imaging (MRI) and to evaluate their correlations with clinical and radiological factors. MATERIALS AND METHODS We retrospectively reviewed 72 hips in 50 patients with hip dysplasia (45 females, 5 males; mean age: 40.0 years; age range: 15-59 years; Kellgren-Lawrence grade: ≤ 2). Hip dysplasia was defined as a lateral center-edge angle < 25°. Among the hips, 50 had pain (symptomatic dysplasia group) and 22 were asymptomatic (asymptomatic dysplasia group). As controls, 12 normal hips in 12 patients who underwent screening for asymptomatic osteonecrosis of the femoral head by MRI were evaluated. Using an oblique axial view on fat-suppressed T2-weighted images, we evaluated the presence of a gap between the posterior part of the femoral head and the corresponding acetabular surface, indicating hip instability (anterior-shift sign). The correlations of anterior-shift sign with clinical and radiographical factors were examined. RESULTS Anterior-shift sign was observed in 92.0% in the symptomatic dysplasia group, 9.1% in the asymptomatic dysplasia group, and 0% in the control group. In adult hip dysplasia, cases with anterior-shift sign had significantly more pain and labrum tear occurrence than cases without anterior-shift sign. Anterior-shift sign was correlated with Kellgren-Lawrence grade and degree of acetabular coverage. CONCLUSIONS This study suggested that hip instability can be observed as the anterior-shift sign on MRI. This sign is useful when considering indications for periacetabular osteotomy in adult hip dysplasia.
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Affiliation(s)
- Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, 820-8505, Japan.
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, 820-8505, Japan
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Ng KCG, Bankes MJK, El Daou H, Beaulé PE, Cobb JP, Jeffers JRT. Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia. J Bone Joint Surg Am 2022; 104:1015-1023. [PMID: 35133990 DOI: 10.2106/jbjs.21.00405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips. METHODS Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested. RESULTS The PAO reduced internal rotation in flexion of 90° (∆IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (∆ER = +7°; p = 0.001) and flexion of 90° (∆ER = +11°; p = 0.001). The PAO also reduced abduction in extension (∆ABD = -10°; p = 0.002), neutral 0° (∆ABD = -7°; p = 0.001), and flexion of 30° (∆ABD = -8°; p = 0.001), but increased adduction in neutral 0° (∆ADD = +9°; p = 0.001), flexion of 30° (∆ADD = +11°; p = 0.002), and flexion of 60° (∆ADD = +11°; p = 0.003). CONCLUSIONS PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
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Affiliation(s)
- K C Geoffrey Ng
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Medical Imaging, Western University, London, Ontario, Canada.,Department of Surgery, Western University, London, Ontario, Canada.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Marcus J K Bankes
- Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Fortius Clinic, London, United Kingdom
| | - Hadi El Daou
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Gebhardt S, Lerch S, Sobau C, Miehlke W, Wassilew GI, Zimmerer A. Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip. J Hip Preserv Surg 2022; 9:78-83. [PMID: 35854807 PMCID: PMC9291363 DOI: 10.1093/jhps/hnac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/26/2022] [Accepted: 03/27/2022] [Indexed: 11/12/2022] Open
Abstract
Recently, there was a debate about whether borderline dysplastic hips should be treated surgically with hip arthroscopy or periacetabular osteotomy (PAO). Current studies recommend a classification into stable and unstable hips. Therefore, radiological scores have been described in recent years. Likewise, a new clinical stability test with the Prone Apprehension Relocation Test (PART) has been described. However, there has been no correlation between the modern radiological scores and the PART. We prospectively studied a consecutive group of patients who presented to our clinic. The PART and radiological scores were assessed in these patients. We divided the patients into a PART-positive and a PART-negative group and analyzed the associated clinical and radiological findings. Out of 126 patients (126 hips) included, 36 hips (29%) were evaluated as PART positive. There were significantly more females in the PART positive group (P = 0.005). Comparing the PART groups, significant differences (P < 0.0001) were found for the lateral center edge angle (LCEA), Femoro-Epiphyseal Acetabular Roof (FEAR) index, Gothic arch angle (GAA), anterior wall index (AWI), the occurrence of the upsloping lateral sourcil (ULS) and signs of acetabular retroversion. The correlation analysis showed an association between LCEA, FEAR index, GAA, AWI, ULS and the PART. A chi-square automatic interaction detection algorithm revealed that the strongest predictor of positive PART was the GAA. In conclusion, a high correlation between the PART and known radiological instability parameters was found. Consequently, a combination of clinical instability testing and radiological instability parameters should be applied to detect unstable hips.
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Affiliation(s)
- Sebastian Gebhardt
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany
| | - Solveig Lerch
- Department of Orthopaedic Surgery, Klinikum Agnes Karll Laatzen, Laatzen, Germany
| | | | | | - Georgi I Wassilew
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
- ARCUS Sportklinik Pforzheim, Pforzheim, Germany
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Vogel LA, Kraeutler MJ, Jesse MK, Ho CK, Houck DA, Garabekyan T, Mei-Dan O. The Everted Acetabular Labrum: Patho-anatomy, Magnetic Resonance Imaging and Arthroscopic Findings of a Native Variant. Arthroscopy 2022; 38:72-79. [PMID: 33957213 DOI: 10.1016/j.arthro.2021.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to introduce a native labral variant, the everted acetabular labrum, and to describe the patho-anatomy, magnetic resonance imaging and magnetic resonance arthrogram (MRI/MRA) characteristics and the arthroscopic findings in this condition. METHODS All primary hip arthroscopy procedures performed by the senior author between June 2013 and January 2020 were reviewed retrospectively. An everted acetabular labrum was identified as a segment of labrum that lacked apposition to the femoral head with the hip off traction. All everted labra were treated with labral advancement and repair with or without augmentation or reconstruction. The labrum-to-femoral head distance was measured in 3T MRI/MRA at the 1-2 o'clock position. A random selection of 38 hips without an everted labrum served as controls to compare radiographic parameters. RESULTS A total of 68 hips were identified as having an everted labrum during the study period (mean age, 29.1 years), and 55 hips had advanced imaging available for review. MRI/MRA scans revealed the everted labrum to have a triangular shape in 17 hips (31%) and a blunted/round shape in 38 hips (69%), which differed significantly from controls (triangular 25/38 [66%], blunted 13/38 [34%], P < 0.001). The average labrum-to-femoral head distance was 1.4 mm for everted labra versus 0.0 mm for controls (P < 0.0001) and the mean labral lengths and widths were significantly shorter than those of controls (both P < 0.01). Of the hips, 8 underwent labral reconstruction or augmentation, and 61 underwent labral advancement/repair. CONCLUSION The everted acetabular labrum is a native variant that is identifiable during hip arthroscopy by assessing the labral seal off traction. Preoperative MRI/MRA findings can be highly predictive of an everted labrum. Surgical treatment includes labral advancement and repair or reconstruction to restore contact between the labrum and the femoral head. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Laura A Vogel
- The Orthopedic Clinic Association at Banner Health, Phoenix, Arizona, U.S.A
| | - Matthew J Kraeutler
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, U.S.A
| | - Mary K Jesse
- University of Colorado School of Medicine, Department of Radiology, Aurora, Colorado, U.S.A
| | - Corey K Ho
- University of Colorado School of Medicine, Department of Radiology, Aurora, Colorado, U.S.A
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, U.S.A
| | | | - Omer Mei-Dan
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, U.S.A..
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Wu J, Chen X. [Recent research progress of hip-preserving treatment for adolescents and adults with developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1513-1518. [PMID: 34913305 DOI: 10.7507/1002-1892.202108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. Methods The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. Results DDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. Conclusion Cartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.
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Affiliation(s)
- Jinyan Wu
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China.,Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P.R.China
| | - Xiaodong Chen
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China.,Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P.R.China
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11
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Zimmerer A, Löchel J, Schoon J, Janz V, Wassilew GI. Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia. Sci Rep 2021; 11:19531. [PMID: 34593957 PMCID: PMC8484561 DOI: 10.1038/s41598-021-99011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/15/2021] [Indexed: 01/20/2023] Open
Abstract
In recent years, there has been a controversial discussion about whether borderline dysplastic hips should be treated with an arthroscopic procedure or rather with an acetabular reorientation. New research suggests that a classification into stable and unstable hips may be helpful. The aim of the study was to validate (1) the intra- and interobserver reliability of a newly defined radiographic parameter named the Gothic Arch Angle, (2) the association between the GAA and previously existing measurements used to define severity of acetabular dysplasia, and (3) the correlation between radiographic measurements of acetabular dysplasia with MRI findings previously suggestive of hip instability. We defined and validated the GAA in 10 standardized radiographs of asymptomatic hips by two observers and calculated intra- and interobserver coefficients at two individual dates. Subsequently, a consecutive series of 100 patients with dysplastic hips (LCEA < 25°, Toennis grade ≤ 1) were evaluated for signs of instability on anteroposterior (a.p.) pelvic radiographs and direct MR arthrography and were divided in two groups: stable and unstable. In these patients the LCEA, the AI, the FEAR index and the GAA were radiographically evaluated. Correlation analyses and a logistic regression analysis was performed to identify the predictive value of instability for each radiographic parameter. Cutoff probabilities analysis was performed using standard receiver operating characteristic (ROC) curves to rate the predictive efficiency value of the GAA. The GAA showed excellent inter- and intraobserver reliability. A correlation was found between GAA and FEAR index. A logistic regression analysis showed that LCEA, FEAR index and GAA are distinct predictors of instability in hip dysplasia. The GAA showed the largest area under the curve (AUC 0.96), indicating it to be the best predictor of instability with an optimal cutoff value of 90° (sensitivity, 0.95; specificity, 0.93). The GAA is a new available indicator for instability and is thus suggested to be used as a future radiographic parameter for the stability of dysplastic hips. Further studies are needed to understand how this parameter might additionally predict clinical outcome in the treatment of hip dysplasia. Level of evidence: Level III, diagnostic study.
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Affiliation(s)
- A Zimmerer
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,ARCUS Sportklinik Pforzheim, Rastatterstr. 17-19, 75179, Pforzheim, Germany.
| | - J Löchel
- Orthopedic Department, Center for Musculoskeletal Surgery, Charité-University Medicine, Berlin, Germany
| | - J Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - V Janz
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - G I Wassilew
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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12
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Zurmühle CA, Kuner V, McInnes J, Pfluger DH, Beck M. The crescent sign—a predictor of hip instability in magnetic resonance arthrography. J Hip Preserv Surg 2021; 8:164-171. [PMID: 35145713 PMCID: PMC8826156 DOI: 10.1093/jhps/hnab067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Currently, much is debated on the optimal treatment of borderline hips, being in the continuum between stable and unstable hips. The diagnosis of stability is often difficult but is a prerequisite for further treatment. Analysis includes a variety of radiographic parameters. We observed that unstable hips often had a crescent-like gadolinium collection in the postero-inferior joint space. We therefore questioned if the ‘crescent sign’ could be an indicator for hip instability? A retrospective comparative study was conducted including 56 hips in the instability group (treated with PAO) and 70 hips with femoroacetabular impingement (FAI) as control group. Based on standard radiographic parameters and magnetic resonance imaging (MRI), the association between hip instability and the ‘crescent sign’ was analyzed. For univariate group comparisons, the non-parametric Wilcoxon two sample test was used. Association between discrete variables was examined by means of chi-square tests. To examine predictive variables, logistic regression models were carried out. Most hips with a crescent sign belong to the instability group. A crescent sign has a sensitivity of 73.3% and specificity of 93% for instability. Based on our results, the crescent sign is a factor that is more prevalent in unstable hips. However, its absence does not exclude instability of the hip. If present, the specificity speaks strongly in favor for instability of the hip.
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Affiliation(s)
- Corinne A Zurmühle
- Department of Orthopaedic Surgery and Traumatology, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Valerie Kuner
- Department of Orthopaedic Surgery and Traumatology, Luzerner Kantonsspital, Luzern, Switzerland
| | - James McInnes
- Department of Orthopaedic Surgery, ReBalanceMD, Victoria, British Columbia, Canada
| | | | - Martin Beck
- Department of Orthopaedic Surgery and Traumatology, Luzerner Kantonsspital, Luzern, Switzerland
- Orthopaedic Clinic Lucerne, Hirslanden St. Anna Hospital, Luzern, Switzerland
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13
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Abstract
Acetabular dysplasia represents a structural pathomorphology associated with hip pain, instability, and osteoarthritis. The wide spectrum of dysplasia anatomically refers to a 3-dimensional volumetric- and surface area-based insufficiency in coverage and is classified based on the magnitude and location of undercoverage. Borderline dysplasia has been variably defined and leads to management challenges. In symptomatic dysplasia, treatment addresses coverage with periacetabular osteotomy. Concomitant simultaneous or staged hip arthroscopy has significant advantages to address intra-articular pathology. In nonarthritic individuals, there is evidence PAO alters the natural history of dysplasia and decreases the risk of hip arthritis and total hip arthroplasty.
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Affiliation(s)
- Joshua D Harris
- The Houston Methodist Hip Preservation Program, Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX 77030, USA; Houston Methodist Academic Institute; Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA; Weill Cornell Medical College, New York, NY, USA; Texas A&M University, College Station, TX, USA.
| | - Brian D Lewis
- Department of Orthopedics, Duke University Medical Center, Box 3389, Durham, NC 27710, USA
| | - Kwan J Park
- The Houston Methodist Hip Preservation Program, Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX 77030, USA
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14
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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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15
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Kraeutler MJ, Safran MR, Scillia AJ, Ayeni OR, Garabekyan T, Mei-Dan O. A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia. Am J Sports Med 2020; 48:2314-2323. [PMID: 31725329 DOI: 10.1177/0363546519881411] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challenging treatment dilemma, as it remains unknown when they should be treated with hip arthroscopy and/or a PAO. PURPOSE To perform a narrative review to report the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. STUDY DESIGN Narrative review. METHODS A systematic search of the literature was conducted through the Medline, EMBASE, and Cochrane databases with the search phrase borderline hip dysplasia. RESULTS The search identified 305 articles, of which 48 were considered relevant to this study after screening of titles and abstracts. Four articles discussed new radiographic means of evaluating adult hip dysplasia, 16 articles analyzed morphology of dysplastic hips, and 28 articles described the clinical outcomes of patients with frank hip dysplasia or BHD treated with hip arthroscopy and/or PAO. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the diagnosis, hip morphology, and clinical outcomes of patients with frank hip dysplasia or BHD is presented. CONCLUSION Adult hip dysplasia is most commonly diagnosed based on the LCEA; however, the LCEA is an unreliable sole marker for dysplasia, and additional radiographic parameters should be utilized. Furthermore, specific pathology identified on imaging and/or during hip arthroscopy can provide clues to a surgeon when the diagnosis is inconclusive according to history and physical examination alone. While the data support that patients with frank dysplasia are best treated with PAO, there is no such preferred treatment for patients with BHD, who have a wide spectrum of instability. Selective use of arthroscopic labral and capsular treatment alone may provide good results in carefully chosen patients with BHD, while some may end up requiring a bony realignment procedure.
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Affiliation(s)
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, USA
| | - Anthony J Scillia
- St Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Omer Mei-Dan
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, Colorado, USA
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16
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Rosinsky PJ, Mayo BC, Kyin C, Shapira J, Maldonado DR, Meghpara MB, Lall AC, Domb BG. The Femoral Head "Divot" Sign: A Useful Arthroscopic Sign of Hip Microinstability. Orthop J Sports Med 2020; 8:2325967120917919. [PMID: 32490025 PMCID: PMC7238801 DOI: 10.1177/2325967120917919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background: A femoral head “divot” is a rare finding during hip arthroscopy. A linear
chondral indentation can be observed on the femoral head, just lateral and
parallel to the acetabular labrum. Purpose/Hypothesis: The purpose of this study was to describe a novel arthroscopic sign and
retrospectively review patients with this finding. We hypothesized that this
sign would be found in patients with characteristics consistent with hip
microinstability. Study Design: Case series; Level of evidence, 4. Methods: Intraoperative images of patients undergoing primary hip arthroscopy between
July 2017 and July 2019 were reviewed for evidence of a femoral head divot.
Preoperative characteristics, physical examination findings, radiographic
measurements, and magnetic resonance imaging (MRI) findings were
described. Results: Of 690 available cases, 14 cases (13 patients; 2.0%) had evidence of a
femoral head divot. The mean patient age was 29.1 years, and all but 1
patient (92.3%) were female. Ligamentous laxity was present in 81.8% of
patients, anterior apprehension test was positive in 78.6%, and painful
internal snapping was present in 50.0%. The mean lateral center-edge angle,
anterior center-edge angle, and Tönnis angle were 19.2°, 20.3°, and 12.4°,
respectively. The divot was identified in 5 of 12 available MRI scans, most
commonly on axial proton density sequence. Intraoperatively, all hips had
labral tears, iliopsoas bursitis was demonstrated in 78.6%, and the
ligamentum teres was damaged in 42.9%. Labral repair was performed in 12 of
the 14 hips, with 2 patients undergoing labral reconstruction. Iliopsoas
fractional lengthening was performed in 50.0%, capsular plication was
performed in 78.6%, and capsular repair was performed in the remainder. Conclusion: The femoral head divot sign is a rare arthroscopic finding during hip
arthroscopy. The results of this study demonstrated that patients who have a
divot also present with characteristic radiographic or physical examination
findings of hip microinstability due to either acetabular dysplasia or
ligamentous laxity. Recognition of a femoral head divot may be valuable for
the diagnosis of microinstability during hip arthroscopy and may help guide
appropriate management, such as capsular plication. Further studies are
needed to determine the exact prevalence of the femoral head divot in
patients with microinstability and to evaluate the effect of this finding on
patient outcomes.
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Affiliation(s)
- Philip J Rosinsky
- American Hip Institute Research Institute, Des Plaines, Illinois, USA
| | - Ben C Mayo
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cynthia Kyin
- American Hip Institute Research Institute, Des Plaines, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Institute, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Institute, Des Plaines, Illinois, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Institute, Des Plaines, Illinois, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Institute, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Institute, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
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17
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Hosseinzadeh P, Baldwin K, Minaie A, Miller F. Management of Hip Disorders in Patients with Cerebral Palsy. JBJS Rev 2020; 8:e0148. [PMID: 32224639 DOI: 10.2106/jbjs.rvw.19.00148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hip disorders are the second most common musculoskeletal abnormality seen in children with cerebral palsy, affecting nearly 1 in 3.
The goal of surgical intervention is to provide a mobile, located, and painless hip. Reconstructive procedures are indicated for children with migration percentages of >40%. Reconstructive procedures typically result in a long-term satisfactory outcome, although recurrence is seen particularly in nonambulatory children and when the reconstruction is performed earlier than 6 years of age. Salvage procedures are performed when reconstructive procedures are no longer an option and degenerative changes have occurred. They include proximal femoral valgus osteotomy, proximal femoral resection, and hip arthroplasty.
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Affiliation(s)
- Pooya Hosseinzadeh
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Keith Baldwin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arya Minaie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Freeman Miller
- Motion Analysis Laboratory, Alfred I. DuPont Institute, Wilmington, Delaware
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18
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Maranho DA, Ferrer M, Kalish LA, Hovater W, Novais EN. The acetabulum in healed Legg-Calvé-Perthes disease is cranially retroverted and associated with global reduction of femoral head coverage: a matched-cohort study. J Hip Preserv Surg 2020; 7:49-56. [PMID: 32382429 PMCID: PMC7195929 DOI: 10.1093/jhps/hnaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/29/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022] Open
Abstract
To evaluate the acetabular morphology in healed Legg–Calvé–Perthes disease after skeletal maturity using computed tomography (CT) scan and to compare with matched controls. We identified 33 (37 hips) patients with healed Legg–Calvé–Perthes disease and closed triradiate cartilage who underwent pelvic CT scan. Each patient was matched based on sex, age and side to a subject with no history of hip disease who had undergone pelvic CT evaluation because of abdominal pain. Both cohorts had 23 (70%) males and mean age of 16.4–16.5 ± 3.6 years. Two independent readers assessed lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version 10 mm below the dome (cranial) and at the acetabular center and anterior (AASA) and posterior acetabular sector angles (PASA). All measurements had good to excellent interobserver agreement (intraclass coefficients ≥ 0.87). The hips in the Legg–Calvé–Perthes disease cohort had a smaller mean ± standard deviation (SD) superior, anterior and posterior acetabular coverage as assessed by LCEA (13.2° ± 10.7° versus 28.2° ± 3.4°; P < 0.0001), IA (11.6° ± 6.7° versus 3.5° ± 2.8°; P < 0.0001), AASA (52.4° ± 9.5° versus 59.3° ± 5.0°; P = 0.001) and PASA (79.3° ± 5.9° versus 92.3° ± 5.5°; P < 0.0001) compared with controls. The acetabulum was shallower (ADR 287 ± 45 versus 323 ± 28; P = 0.0002) and the acetabular version was decreased cranially (0.4°±9.2° versus 8.2°±6.8°; P = 0.0002) and at the acetabular center (13.7°±5.1° versus 17.2° ±3.8°; P = 0.004) in Legg–Calvé–Perthes disease hips. After skeletal maturity, hips with healed Legg–Calvé–Perthes disease have shallower and more cranially retroverted acetabula, with globally reduced coverage of the femoral head compared with age-, sex- and side-matched control hips.
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Affiliation(s)
- Daniel A Maranho
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes 3900, 11° Floor, Ribeirao Preto, Sao Paulo 14049-900, Brazil
| | - Mariana Ferrer
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Leslie A Kalish
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Whitney Hovater
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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19
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Bixby SD, Millis MB. The borderline dysplastic hip: when and how is it abnormal? Pediatr Radiol 2019; 49:1669-1677. [PMID: 31686172 DOI: 10.1007/s00247-019-04468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Borderline acetabular dysplasia refers to mildly sub-normal patterns of acetabular shape and coverage that might predispose children to mechanical dysfunction and instability. Borderline dysplasia generally includes children with a lateral center edge angle (CEA) of 18-24°. Some children with borderline radiographic measurements have normal joint mechanics and function while others benefit from acetabular reorienting surgery. Although radiographic findings of borderline dysplasia might suggest instability, the ultimate diagnosis is based on history and physical exam in addition to imaging. Children with borderline acetabular dysplasia sometimes benefit from other cross-sectional imaging studies such as MR imaging to evaluate for secondary evidence of instability, including damage along the acetabular rim, or labral degeneration and hypertrophy. CT is also helpful for depiction of 3-D acetabular morphology for preoperative assessment and planning. Pediatric radiologists are often the first to identify borderline or mild dysplasia on radiographs. It is imperative that pediatric radiologists serve as effective consultants and offer appropriate recommendations as part of a cohesive multidisciplinary approach to this complex patient population.
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Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Main 2, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Michael B Millis
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
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20
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Kraeutler MJ, Goodrich JA, Fioravanti MJ, Garabekyan T, Mei-Dan O. The "Outside-In" Lesion of Hip Impingement and the "Inside-Out" Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury. Am J Sports Med 2019; 47:2978-2984. [PMID: 31490700 DOI: 10.1177/0363546519871065] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) and acetabular dysplasia lead to acetabular cartilage damage that commonly results in the chondral flaps seen during hip arthroscopy. PURPOSE To compare the acetabular chondral flap morphology seen during hip arthroscopy ("outside-in" vs "inside-out") with clinical and radiographic parameters underlying FAI and hip dysplasia. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent hip arthroscopy by the senior author between 2013 and 2017 with a finding of Outerbridge grade IV acetabular chondral flap were included. Each procedure was retrospectively reviewed on video and chondral flaps were categorized as inside-out or outside-in. An inside-out designation was made for flaps exhibiting an intact chondrolabral junction with a detached sleeve of chondrolabral tissue from the central acetabulum, and an outside-in designation was made for centrally anchored flaps exhibiting a break in the chondrolabral junction. Radiographic markers of hip impingement/dysplasia were noted for each patient during assignment into 1 of 2 radiographic groups: group 1, lateral center edge angle (LCEA) >20 with FAI, and group 2, LCEA ≤20 with or without cam FAI. Associations between chondral flap morphology and clinical diagnosis were tested using a chi-square test. RESULTS Overall, 95 patients (103 hips) were included (group 1, 78 hips; group 2, 25 hips). Among hips in group 2, 24 had concurrent cam FAI. There was a significant relationship between chondral flap type and radiographic diagnosis (P < .001). Among group 1 hips, 78% exhibited outside-in type chondral flaps, 12% exhibited combined outside-in and inside-out flaps, and 10% exhibited inside-out flaps. Group 2 hips showed 72% inside-out type chondral flaps, 16% combined, and 12% outside-in. Hips exhibiting outside-in type flaps were significantly more likely to be in group 1 (positive predictive value [PPV], 91%; negative predictive value [NPV], 69%). Similarly, hips exhibiting inside-out type flaps were significantly more likely to be in group 2 (PPV, 56%; NPV, 95%). Altogether, 90% of group 1 hips exhibited an outside-in lesion and 88% of group 2 hips exhibited an inside-out lesion. CONCLUSION Acetabular chondral flap type visualized during hip arthroscopy correlates with radiographic markers of hip impingement and hip instability. Outside-in flaps are highly predictive of FAI, whereas inside-out flaps are highly predictive of acetabular dysplasia.
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Affiliation(s)
| | - Jesse A Goodrich
- University of Colorado Boulder, Department of Integrative Physiology, Boulder, Colorado, USA
| | - Matthew J Fioravanti
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
| | | | - Omer Mei-Dan
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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