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Fisk F, Oitment C, Taliaferro K, Pahuta MA. The Hip Center Rule Can be Used to Decide if Measured Pelvic Incidence is Accurate. Global Spine J 2023; 13:1787-1792. [PMID: 34658284 PMCID: PMC10556915 DOI: 10.1177/21925682211049734] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Simulation study. OBJECTIVE Pelvic incidence (PI) should be considered during surgical planning. The ideal patient position with both hip centers perfectly aligned for a lateral radiograph is rarely obtained. It has been suggested that a radiograph with axial and coronal rotation up to 20° is acceptable to obtain a measured PI within 6 degrees of the actual PI. We seek to: (1) evaluate the effect of variations in PI and patient malpositioning on measured vs true PI, and (2) determine whether the presence of one hip center within the bony acetabular rim of the contralateral hip can serve as a simple clinical decision rule on the accuracy of measured PI. METHODS Published anthropometric three-dimensional pelvic landmark coordinates were used in this study. Radiographic projections were generated using linear algebra for combinations of axial and coronal rotation from -20° to +20°. True and measured PIs were compared. RESULTS Rotation to 20° cannot be uniformly accepted as decision rule. Pelvises with higher PIs are more sensitive to malpositioning with greater PI deviation with smaller amounts of rotation. Diagnostic performance of the hip center rule demonstrated a sensitivity of 25.58% and a specificity of 100.00%. CONCLUSIONS Rather than assessing the quality of radiographs for PI measurement by magnitude of malpositioning, we recommend clinicians use the "hip center rule." As long as at least one hip center is contained within the bony acetabular rim of the contralateral hip, there is high confidence that measured PI will be within 6° of true PI.
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Affiliation(s)
- Felicity Fisk
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Colby Oitment
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Kevin Taliaferro
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Markian A. Pahuta
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Sha J, Yan YB, Xu HF, Li C, Dong H, Liu ZC, Fan ZZ, Huang LY. Quantification of femoral position on radiographic acetabular coverage in children. J Orthop Res 2022; 41:1248-1255. [PMID: 36222476 DOI: 10.1002/jor.25468] [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: 04/10/2022] [Revised: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
An accurate assessment of the radiographic acetabular coverage is essential for clinical diagnosis or surgical decision-making in hip disorders. This study aimed to evaluate the effect of femoral position on acetabular coverage and to predict the actual acetabular coverage from nonstandard radiographs. A total of 21 children (34 hips) with normative acetabular coverage were screened in this retrospective study. The Mimics-based local-rotation fluoroscopy simulation method was used to tilt, incline, and rotate the femur in 4° increments within the range of femoral motion. The acetabular coverage, namely acetabular-head index (AHI) and center-edge angle (CEA), increased with femoral abduction but decreased with other motions. Compared to the femoral neutral position, no significant differences were identified in AHI with the rotation (range: 0°-16°) and in CEA with the tilt (range: -20°-4°), inclination (range: 0°-4°), or rotation (range: -8°-40°). The linear regression analysis showed that the CEA increased by about 0.20° for each 1° increase in femoral inclination and decreased by about 0.01°, 0.07°, 0.06°, or 0.07° for each 1° increase in internal rotation, external rotation, flexion, or extension, respectively. And a more significant change in AHI was observed. All femoral malpositions, especially the inclination, affected radiographic acetabular coverage in children. Therefore, each pelvic radiograph should assess potential femoral malpositioning before diagnosing hip disorders. This study will assist surgeons in predicting the acetabular coverage on nonstandard radiographs.
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Affiliation(s)
- Jia Sha
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Ya-Bo Yan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hui-Fa Xu
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Chao Li
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hui Dong
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Zhi-Chen Liu
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Zong-Zhi Fan
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Lu-Yu Huang
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
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Lee KY, Lee JH, Im SK, Lee WY. Analysis of measurement changes in pelvic incidence according to pelvic rotation using a three-dimensional model. BMC Musculoskelet Disord 2022; 23:110. [PMID: 35109846 PMCID: PMC8808983 DOI: 10.1186/s12891-022-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background Pelvic incidence (PI) is used as a key parameter in surgical correction of adult spinal deformity (ASD). However, reflecting the exact center or inclination of the three-dimensional anatomical structures on the two-dimensional (2D) sagittal radiographs is limited, resulting in measurement errors. Therefore, we evaluated whether there is a change in PI measurement according to the actual rotation of the pelvis, and conducted a study on a more accurate method for PI measurement using 2D sagittal radiographs. Methods From 2014 to 2015, the data of 30 patients who visited our outpatient clinic were analyzed retrospectively. CT scans including those of the lower lumbar spine, pelvis, and both femurs in the DICOM format were imported to Mimics Research 17.0 (Materialise NV, Belgium), SolidWorks (Dassault systems, France), and AutoCAD 2014 (AUTODESK, US). The changes in PI according to vertical and horizontal pelvic rotations were evaluated. Results The average PIs according to the horizontal pelvic rotations measured on AutoCAD with 0°, 5°, 10°, 15°, 20°, 25°, 30°, 35°, and 40° were 48.8°, 48.7°, 48.3°, 47.8°, 46.9°, 45.6°, 44.0°, 42.2°, and 39.9°, respectively. The PI with an acceptable error of 6° on radiographs was 35° in the horizontal pelvic rotation. The average PIs according to the vertical pelvic rotations measured on AutoCAD with 0°, 5°, 10°, 15°, 20°, 25°, 30°, 35°, and 40° were 48.8°, 49.0°, 49.5°, 50.2°, 51.3°, 52.7°, 54.4°, 56.6°, and 59.4°, respectively. The PI with an acceptable error of 6° on radiographs was 30° in the vertical pelvic rotation. Conclusions This study revealed that the PI value could differ from the actual anatomical value due to the horizontal and vertical rotation of the pelvis while acquiring the radiograph. Regarding whole-spine lateral radiographs, errors in PI measurement may occur due to pelvic rotation or nonvertical projection of X-rays. In the standing pelvic lateral radiographs, ensuring superposition of the femoral heads at the center and obtaining the straight sacral endplate by referring to CT or magnetic resonance imaging would be a more accurate measurement method to define PI.
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Affiliation(s)
- Ki Young Lee
- Department of Orthopaedic Surgery, Graduate School, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
| | - Jung-Hee Lee
- Department of Orthopaedic Surgery, Graduate School, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea.
| | - Sang-Kyu Im
- Department of Orthopaedic Surgery, Graduate School, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
| | - Won Young Lee
- Department of Orthopaedic Surgery, Graduate School, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, South Korea
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Hamano D, Yoshida K, Higuchi C, Otsuki D, Yoshikawa H, Sugamoto K. Evaluation of errors in measurements of infantile hip radiograph using digitally reconstructed radiograph from three-dimensional MRI. J Orthop 2019; 16:302-306. [PMID: 31193248 DOI: 10.1016/j.jor.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/05/2019] [Indexed: 02/08/2023] Open
Abstract
Purpose Plain hip radiograph is commonly used for the diagnosis of infantile acetabular dysplasia. Many infants are unable to maintain adequate position during radiography. Besides, the infantile hip is much smaller and has a higher cartilage component in the acetabulum and proximal femur compared with the adult hip. In this study, we developed a digitally reconstructed radiograph synthesized from magnetic resonance imaging (MRI) and investigated errors of hip radiographic measurements in different pelvic positions. Patients and methods MRI of both hips was performed in 10 patients (mean age 3.9 years). Three-dimensional (3D) bone models were created from MRI data. We tilted 3D pelvic bone models between 10° anteversion and retroversion and through 10° rotation on the affected and contralateral sides using 3D axes. Following this, we created digitally reconstructed radiographs in each pelvic position and calculated the acetabular index (AI), center-edge angle (CEA), migration percentage (MP), and teardrop distance (TDD). Results AI tended to increase with pelvic retroversion and did not change with pelvic rotation. CEA tended to decrease with pelvic retroversion and rotation on the contralateral side. MP increased with pelvic retroversion and rotation on the contralateral side. TDD did not change significantly with pelvic tilt and rotation. Conclusions Radiographic measurements of hip in infants were highly influenced by pelvic movement. AI was influenced by pelvic tilt; CEA and MP were influenced by both pelvic tilt and rotation. We need to keep in mind that infantile hip radiographs could have about ±5° errors in AI and CEA.
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Affiliation(s)
- Daisuke Hamano
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Kiyoshi Yoshida
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Chikahisa Higuchi
- Department of Orthopaedic Surgery, Osaka Women's and Children's Hospital, Japan
| | - Dai Otsuki
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan
| | - Kazuomi Sugamoto
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Japan
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Imai N, Suzuki H, Nozaki A, Miyasaka D, Tsuchiya K, Ito T, Minato I, Endo N. Evaluation of anatomical pelvic parameters between normal, healthy men and women using three-dimensional computed tomography: a cross-sectional study of sex-specific and age-specific differences. J Orthop Surg Res 2019; 14:126. [PMID: 31072379 PMCID: PMC6506943 DOI: 10.1186/s13018-019-1165-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Background Sagittal spinal balance and standing posture are affected by pelvic morphology, especially pelvic incidence (PI). However, it is not difficult to identify the hip center because of overlap of the pelvis, image contrast, and soft tissue artifacts. Measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is nonspherical, subluxed, or dislocated. We measured PI, pelvic tilt (PT), and sacral slope (SS) as anatomical parameters using a novel three-dimensional measurement in order to compare the pelvic morphology between normal, healthy men and women. Methods In this cross-sectional study, we evaluated 108 Japanese subjects (55 men, 53 women) without low back or knee pain. We used the three-dimensional pelvis model adjusted to the anterior pelvic plane and measured the pelvic parameters. The subjects were stratified by age (< 50 versus ≥ 50 years) and sex. Intraobserver and interobserver reliabilities were calculated with intraclass correlation coefficients. Results There was no significant difference in PI, anatomical-PT, and anatomical-SS between sexes. There was a strong correlation between PI and anatomical-SS in men and women (R = 0.790 and 0.715, respectively). Values of anatomical-PT were lower, and values of anatomical-SS were greater among older subjects than among younger subjects; the value of PI was similar between younger and older subjects. Intraobserver and interobserver mean absolute differences were about 2 mm and 2°, respectively; the intraclass correlation coefficient was > 0.87. Conclusions We found a strong correlation between PI and anatomical-SS in men and women. This novel measurement concept may be useful to estimate PI from anatomical-SS because the measurements of PI are not always suitable in all patients, especially those with osteoarthritis of the hip joint whose femoral head is not spherical or whose femoral head is subluxed or dislocated. This is the first report to describe the relationship between PI, anatomical-PT, and anatomical-SS as morphologic parameters with a high interclass correlation coefficient for intraobserver and interobserver reliabilities.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-do-ri, Chuou ku, Niigata City, Niigata Prefecture, 951-8167, Japan. .,Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Asami Nozaki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Dai Miyasaka
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuki Tsuchiya
- Division of Advanced Materials Science and Technology, Niigata University Graduate School of Science and Technology, Niigata, Japan
| | - Tomoyuki Ito
- Division of Orthopedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, Japan
| | - Izumi Minato
- Division of Orthopedic Surgery, Niigata Riko Hospital, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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