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Slullitel PA, Holc F, Buljubasich M, Latorre M, Comba F, Zanotti G, Marquesini M, Grammatopoulos G, Buttaro MA. Anterior Center-Edge Angle Is Less Reliable Than Anterior Wall Index to Predict Anterior Coverage of the Femoral Head. Am J Sports Med 2023; 51:2151-2160. [PMID: 37227132 DOI: 10.1177/03635465231168902] [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: 05/26/2023]
Abstract
BACKGROUND No consensus is available regarding which radiographic measurement most accurately correlates with anterior coverage of the femoral head. PURPOSE (1) To determine the correlation between 2 measurements of anterior wall coverage: total anterior coverage (TAC) calculated from radiographs and equatorial anterior acetabular sector angle (eAASA) calculated from computed tomography (CT) scans; (2) to define the correlation between anterior center-edge angle (ACEA) and anterior wall index (AWI) with TAC and eAASA; and (3) to investigate what other radiographic metrics may help predict anterior coverage. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS The authors retrospectively reviewed 77 hips (48 patients) for which radiographs and CT scans were obtained for reasons other than hip-related pain. Mean age of the population was 62 ± 22 years; 48 (62%) hips were from female patients. Two observers measured lateral center-edge angle (LCEA), AWI, Tönnis angle, ACEA, CT-based pelvic tilt, and CT-based acetabular version, with all Bland-Altman plots within 95% agreement. Correlation between intermethod measurements was estimated with a Pearson coefficient. Linear regression was used to test the ability of baseline radiographic measurements to predict both TAC and eAASA. RESULTS Pearson coefficients were r = 0.164 (ACEA vs TAC; P = .155), r = 0.170 (ACEA vs eAASA; P = .140), r = 0.58 (AWI vs TAC; P = .0001), and r = 0.693 (AWI vs eAASA; P < .0001). Multiple linear regression model 1 showed that AWI (β = 17.8; 95% CI, 5.7 to 29.9; P = .004), CT acetabular version (β = -0.45; 95% CI, -0.71 to -0.22; P = .001), and LCEA (β = 0.33; 95% CI, 0.19 to 0.47; P = .001) were useful to predict TAC. Multiple linear regression model 2 revealed that AWI (β = 25; 95% CI, 15.67 to 34.4; P = .001), CT acetabular version (β = -0.48; 95% CI, -0.67 to -0.29; P = .001), CT pelvic tilt (β = 0.26; 95% CI, 0.12 to 0.4; P = .001), and LCEA (β = 0.21; 95% CI, 0.1 to 0.3; P = .001) accurately predicted eAASA. Model-based estimates and 95% CIs using 2000 bootstrap samples from the original data were 6.16 to 28.6 for AWI in model 1 and 15.1 to 34.26 for AWI in model 2. CONCLUSION There was a moderate to strong correlation between AWI and both TAC and eAASA, whereas ACEA correlated weakly with the former measurements, thus not being useful to quantify anterior acetabular coverage. Other variables such as LCEA, acetabular version, and pelvic tilt may also help predict anterior coverage in asymptomatic hips.
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Affiliation(s)
| | - Fernando Holc
- Hospital Italiano Buenos Aires, Buenos Aires, Argentina
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Kokubu Y, Kawahara S, Kitamura K, Hamai S, Motomura G, Ikemura S, Sato T, Yamaguchi R, Hara D, Fujii M, Nakashima Y. Evaluation of the anterior acetabular coverage with a false profile radiograph considering appropriate range of positioning. Sci Rep 2023; 13:8288. [PMID: 37217756 DOI: 10.1038/s41598-023-35514-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/19/2023] [Indexed: 05/24/2023] Open
Abstract
This study aimed to (1) set a reference value for anterior center edge angle (ACEA) for preoperative planning of periacetabular osteotomy (PAO), (2) investigate the effects of pelvic rotation and inclination from false profile (FP) radiographs on the measured ACEA, and (3) determine the "appropriate range of positioning" for FP radiograph. This single-centered, retrospective study analyzed 61 patients (61 hips) who underwent PAO from April 2018 and May 2021. ACEA was measured in each digitally reconstructed radiography (DRR) image of the FP radiograph reconstructed in different degrees of pelvic rotation. Detailed simulations were performed to determine the "appropriate range of positioning" (0.67 < ratio of the distance between the femoral heads to the diameter of the femoral head < 1.0). The vertical-center-anterior (VCA) angle was measured on the CT sagittal plane considering the patient-specific standing positions, and its correlation with the ACEA was investigated. The reference value of ACEA was determined by receiver operating characteristic (ROC) curve analysis. The ACEA measurement increased by 0.35° for every 1° pelvic rotation approaching the true lateral view. The pelvic rotation with the "appropriate range of positioning" was found at 5.0° (63.3-68.3°). The ACEA on the FP radiographs showed a good correlation with the VCA angle. The ROC curve revealed that an ACEA < 13.6° was associated with inadequate anterior coverage (VCA < 32°). Our findings suggest that during preoperative PAO planning, an ACEA < 13.6° on FP radiographs indicates insufficient anterior acetabular coverage. Images with the "appropriate positioning" can also have a measurement error of 1.7° due to the pelvic rotation.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- 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
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Medical-Engineering Collaboration for Healthy Longevity, 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
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taishi Sato
- 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
| | - Daisuke Hara
- 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
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Hong KB, Lee WS, Kang K, Kang KT, Cho BW. Evaluation of lateral and anterior center-edge angles according to sex and anterior pelvic plane tilt angle: a three-dimensional quantitative analysis. J Orthop Surg Res 2023; 18:280. [PMID: 37020213 PMCID: PMC10077611 DOI: 10.1186/s13018-023-03763-z] [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: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This study aimed to quantitatively evaluate lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) according to sex and the anterior pelvic plane (APP) tilt angle and analyze the correlation between these measurements and acetabular coverage. METHODS Computed tomography scans of 71 adults (38 men and 33 women) with normal hip joints were obtained. LCEA, anterior ACEA, and acetabular coverage were measured with APP tilt every 5° from - 30° to + 30° and were compared between the sexes. The correlation between acetabular coverage and LCEA/ACEA was also analyzed. RESULTS (1) LCEA, ACEA, and acetabular coverage were statistically larger in men than in women at all APP tilt angles (with the exception of acetabular coverage ≥ 25°). (2) LCEA, ACEA, and acetabular coverage differed according to APP tilt angle. LCEA and acetabular coverage showed maximum values at 10°. ACEA showed a tendency to increase by an average of 3.6° for every 5° increase in the APP tilt angle. LCEA demonstrated strong and very strong associations across all APP tilting angles, whereas ACEA showed a moderate association at angles ≥ 15° in men and ≥ 30° in women. CONCLUSIONS The LCEA and ACEA are adequate measurement methods that reflect actual acetabular coverage unless the pelvis is tilted excessively anteriorly. While pelvic tilting does not need to be considered for LCEA within the physiologic range, it should always be taken into account for ACEA, as it increases by an average of 3.6° for every 5° increase in APP tilt angle. LEVEL OF EVIDENCE Level III: retrospective cohort study.
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Affiliation(s)
- Kee-Bum Hong
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyutae Kang
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Byung Woo Cho
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Mozingo JD, Schuring LL, Mortensen AJ, Anderson AE, Aoki SK. Effect of Patient Positioning on Measurement of the Anterior Center-Edge Angle on False-Profile Radiographs and Its 3-Dimensional Mapping to the Acetabular Rim. Orthop J Sports Med 2022; 10:23259671211073834. [PMID: 35141341 PMCID: PMC8819774 DOI: 10.1177/23259671211073834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The anterior center-edge angle (ACEA) is used to quantify anterior coverage of the femoral head by the acetabulum. However, its measurement has not been evaluated in a manner consistent with routine use, and the precise 3-dimensional (3D) anatomic location where it measures coverage is not known. Purpose: To determine the effect of patient positioning on ACEA measurement reliability, magnitude, and 3D location. Study Design: Descriptive laboratory study. Methods: Included were 18 adults; 7 participants had cam morphology and femoroacetabular impingement syndrome, and 11 participants had no radiographic evidence of hip abnormalities and no history of hip pain or injuries. Ultimately, 3D femur and pelvis models were generated from computed tomography images. Radiographs were generated with the models in different degrees of pelvic rotation, tilt, and obliquity relative to the standard false-profile view. The ACEA was measured by 2 raters by selecting the location of the bone edge on each radiograph. Selections were projected onto the pelvis model and expressed as a clockface location on the acetabular rim. The clockface was mirrored on left hips to allow a direct comparison of locations between hips. Interrater and intrarater reliability were quantified via the intraclass correlation coefficient (ICC). The effect of position on ACEA measurements and clockface locations was determined via linear regression. Results: Intrarater and interrater reliability were excellent (ICC ≥0.97 for all). For every degree increase in rotation, tilt, and obliquity, the ACEA changed by +0.53°, +0.93°, and –0.04°, respectively. The mean clockface location (hour:minute:second) in the false-profile view was 2:09:32 ± 0:12:00 and changed by +0:02:08, –0:00:35, and –0:00:05 for every degree increase in rotation, tilt, and obliquity, respectively. Conclusion: ACEA measurements were reliable even with differences in patient positioning. Rotation and tilt were associated with notable changes in ACEA measurements. ACEA bone edge measurements mapped to the anterosuperior acetabular rim, typically in proximity to the anterior inferior iliac spine. Mapped location was most sensitive to rotation. Clinical Relevance: Pelvic rotation and tilt affected ACEA measurements, which could alter the clinical classification and treatment of borderline abnormalities. Rotation in particular must be well controlled during patient imaging to preserve measurement reliability and accuracy and to describe coverage from the intended 3D rim location.
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Affiliation(s)
- Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Lindsay L. Schuring
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Atilla HA, Raju S, Akdogan M, Ozturk A, Bilgetekin YG, Kose O. Rear drop: a new radiographic landmark for estimation of pelvic tilt on pelvis AP radiographs. J Hip Preserv Surg 2021; 8:58-66. [PMID: 34567601 PMCID: PMC8460171 DOI: 10.1093/jhps/hnab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/06/2021] [Indexed: 11/12/2022] Open
Abstract
Estimation of pelvic tilt on anteroposterior (AP) pelvis radiograph is often done by indirect methods based on the midline pelvic landmarks. The purpose of this cadaveric study is to describe a new radiographic landmark and reference measurements to estimate the coronal tilt of the pelvis, independent of the midline references. The new radiologic reference is called 'rear drop', and its anatomic location is described with the cadaveric pelvis AP radiographs in various pelvic inclination. The parameters derived from the new reference were used to assess the pelvic tilt, and the results were compared with the previously established method using 'sacrococcygeal joint to symphysis distance' (SCSD). The shape of the new figure is used to determine the position of the pelvis, and its relationship with the previously described acetabular retroversion indicators was statistically analyzed. The new reference figure corresponds to the posteroinferior edge of the horseshoe shape of the acetabular margin. The newly derived reference parameters, rear to tear distance and rear to tear angle, changes with pelvic tilt and are strongly correlated with SCSD. The shape of the rear drop changes with the changing pelvic tilt and correlates statistically with the previously described acetabular retroversion indicators. Rear drop and its derivative measurements can be used as a reliable and reproducible indicator to estimate the coronal pelvic tilt, free of midline reference points. This new reference will be a base for future clinical studies on pelvic tilt, rotation and their application in intraoperative hip fluoroscopy.
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Affiliation(s)
- Halis Atil Atilla
- Department of Orthopedics and Traumatology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Sht Omer Halisdemir Cad. No: 20 Altındag, Ankara 06110, Turkey
| | - Sivashanmugam Raju
- Department of Orthopedics, Saint Louis University School of Medicine, 1465 S Grand Blvd, St. Louis, MO 63104, USA
| | - Mutlu Akdogan
- Department of Orthopedics and Traumatology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Sht Omer Halisdemir Cad. No: 20 Altındag, Ankara 06110, Turkey
| | - Alper Ozturk
- Department of Orthopedics and Traumatology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Sht Omer Halisdemir Cad. No: 20 Altındag, Ankara 06110, Turkey
| | - Yenel Gurkan Bilgetekin
- Department of Orthopedics and Traumatology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ziraat Mah. Sht Omer Halisdemir Cad. No: 20 Altındag, Ankara 06110, Turkey
| | - Ozkan Kose
- Department of Orthopaedics and Traumatology, University of Health Sciences Antalya Training and Research Hospital, Varlık Mh. Kazim Karabekir Cd, Antalya 07100, Turkey
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Fowler LM, Nepple JJ, Devries C, Harris MD, Clohisy JC. Medialization of the Hip's Center with Periacetabular Osteotomy: Validation of Assessment with Plain Radiographs. Clin Orthop Relat Res 2021; 479:1040-1049. [PMID: 33861214 PMCID: PMC8052006 DOI: 10.1097/corr.0000000000001572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) increases acetabular coverage of the femoral head and medializes the hip's center, restoring normal joint biomechanics. Past studies have reported data regarding the degree of medialization achieved by PAO, but measurement of medialization has never been validated through a comparison of imaging modalities or measurement techniques. The ilioischial line appears to be altered by PAO and may be better visualized at the level of the inferior one-third of the femoral head, thus, an alternative method of measuring medialization that begins at the inferior one-third of the femoral head may be beneficial. QUESTIONS/PURPOSES (1) What is the true amount and variability of medialization of the hip's center that is achieved with PAO? (2) Which radiographic factors (such as lateral center-edge angle [LCEA] and acetabular inclination [AI]) correlate with the degree of medialization achieved? (3) Does measurement of medialization on plain radiographs at the center of the femoral head (traditional method) or inferior one-third of the femoral head (alternative method) better correlate with true medialization? (4) Are intraoperative fluoroscopy images different than postoperative radiographs for measuring hip medialization? METHODS We performed a retrospective study using a previously established cohort of patients who underwent low-dose CT after PAO. Inclusion criteria for this study included PAO as indicated for symptomatic acetabular dysplasia, preoperative CT scan, and follow-up between 9 months and 5 years. A total of 333 patients who underwent PAO from February 2009 to July 2018 met these criteria. Additionally, only patients who were between 16 and 50 years old at the time of surgery were included. Exclusion criteria included prior ipsilateral surgery, femoroacetabular impingement (FAI), pregnancy, neuromuscular disorder, Perthes-like deformity, inadequate preoperative CT, and inability to participate. Thirty-nine hips in 39 patients were included in the final study group; 87% (34 of 39) were in female patients and 13% (5 of 39 hips) were in male patients. The median (range) age at the time of surgery was 27 years (16 to 49). Low-dose CT images were obtained preoperatively and at the time of enrollment postoperatively; we also obtained preoperative and postoperative radiographs and intraoperative fluoroscopic images. The LCEA and AI were assessed on plain radiographs. Hip medialization was assessed on all imaging modalities by an independent, blinded assessor. On plain radiographs, the traditional and alternative methods of measuring hip medialization were used. Subgroups of good and fair radiographs, which were determined by the amount of pelvic rotation that was visible, were used for subgroup analyses. To answer our first question, medialization of all hips was assessed via measurements made on three-dimensional (3-D) CT hip reconstruction models. For our second question, Pearson correlation coefficients, one-way ANOVA, and the Student t-test were calculated to assess the correlation between radiographic parameters (such as LCEA and AI) and the amount of medialization achieved. For our third question, statistical analyses were performed that included a linear regression analysis to determine the correlation between the two radiographic methods of measuring medialization and the true medialization on CT using Pearson correlation coefficients, as well as 95% confidence intervals and standard error of the estimate. For our fourth question, Pearson correlation coefficients were calculated to determine whether using intraoperative fluoroscopy to make medialization measurements differs from measurements made on radiographs. RESULTS The true amount of medialization of the hip center achieved by PAO in our study as assessed by reference-standard CT measurements was 4 ± 3 mm; 46% (18 of 39 hips) were medialized 0 to 5 mm, 36% (14 hips) were medialized 5 to 10 mm, and 5% (2 hips) were medialized greater than 10 mm. Thirteen percent (5 hips) were lateralized (medialized < 0 mm). There were small differences in medialization between LCEA subgroups (6 ± 3 mm for an LCEA of ≤ 15°, 4 ± 4 mm for an LCEA between 15° and 20°, and 2 ± 3 mm for an LCEA of 20° to 25° [p = 0.04]). Hips with AI ≥ 15° (6 ± 3 mm) achieved greater amounts of medialization than did hips with AI of < 15° (2 ± 3 mm; p < 0.001). Measurement of medialization on plain radiographs at the center of the femoral head (traditional method) had a weaker correlation than using the inferior one-third of the femoral head (alternative method) when compared with CT scan measurements, which were used as the reference standard. The traditional method was not correlated across all radiographs or only good radiographs (r = 0.16 [95% CI -0.17 to 0.45]; p = 0.34 and r = 0.26 [95% CI -0.06 to 0.53]; p = 0.30), whereas the alternative method had strong and very strong correlations when assessed across all radiographs and only good radiographs, respectively (r = 0.71 [95% CI 0.51 to 0.84]; p < 0.001 and r = 0.80 [95% CI 0.64 to 0.89]; p < 0.001). Measurements of hip medialization made on intraoperative fluoroscopic images were not found to be different than measurements made on postoperative radiographs (r = 0.85; p < 0.001 across all hips and r = 0.90; p < 0.001 across only good radiographs). CONCLUSION Using measurements made on preoperative and postoperative CT, the current study demonstrates a mean true medialization achieved by PAO of 4 mm but with substantial variability. The traditional method of measuring medialization at the center of the femoral head may not be accurate; the alternate method of measuring medialization at the lower one-third of the femoral head is a superior way of assessing the hip center's location. We suggest transitioning to using this alternative method to obtain the best clinical and research data, with the realization that both methods using plain radiography appear to underestimate the true amount of medialization achieved with PAO. Lastly, this study provides evidence that the hip center's location and medialization can be accurately assessed intraoperatively using fluoroscopy. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Lucas M Fowler
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Jeffrey J Nepple
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Clarabelle Devries
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael D Harris
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - John C Clohisy
- L. M. Fowler, J. J. Nepple, C. Devries, J. C. Clohisy, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- M. D. Harris, Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
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Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Augmented reality (AR)-based surgical navigation may offer new possibilities for safe and accurate surgical execution of complex osteotomies. In this study we investigated the feasibility of navigating the periacetabular osteotomy of Ganz (PAO), known as one of the most complex orthopedic interventions, on two cadaveric pelves under realistic operating room conditions. Preoperative planning was conducted on computed tomography (CT)-reconstructed 3D models using an in-house developed software, which allowed creating cutting plane objects for planning of the osteotomies and reorientation of the acetabular fragment. An AR application was developed comprising point-based registration, motion compensation and guidance for osteotomies as well as fragment reorientation. Navigation accuracy was evaluated on CT-reconstructed 3D models, resulting in an error of 10.8 mm for osteotomy starting points and 5.4° for osteotomy directions. The reorientation errors were 6.7°, 7.0° and 0.9° for the x-, y- and z-axis, respectively. Average postoperative error of LCE angle was 4.5°. Our study demonstrated that the AR-based execution of complex osteotomies is feasible. Fragment realignment navigation needs further improvement, although it is more accurate than the state of the art in PAO surgery.
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Irie T, Espinoza OrÃas AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, Inoue N. Computed Tomography-Based Three-Dimensional Analyses Show Similarities in Anterosuperior Acetabular Coverage Between Acetabular Dysplasia and Borderline Dysplasia. Arthroscopy 2020; 36:2623-2632. [PMID: 32534004 DOI: 10.1016/j.arthro.2020.05.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To compare the acetabular coverage between dysplasia, borderline dysplasia, and control acetabulum in a quantitative 3-dimensional manner; and (2) to evaluate correlations between the radiologic parameters and the 3-dimensional zonal-acetabular coverage. METHODS We reviewed contralateral hip computed tomography images of patients 16 to 60 years of age who underwent 1 of 3 types of surgeries: eccentric rotational acetabular osteotomy, curved intertrochanteric varus osteotomy, and total hip replacement with minimum 1-year follow-up from January 2013 to April 2018. A point-cloud model of the acetabulum created from computed tomography was divided into 6 zones. Three-dimensional acetabular coverage was measured radially at intervals of 1°. Mean radial acetabular coverage for each zone was named ZAC (zonal acetabular coverage) and was compared among the 3 subgroups (control: 25° ≤lateral center-edge angle [LCEA] <40°; borderline: 20° ≤LCEA <25°; and dysplasia: LCEA ≤20°) statistically. Further, the correlations between the ZAC in each zone and the LCEA were analyzed using Pearson's correlation coefficient. RESULTS One-hundred fifteen hips were categorized as control (36 hips), borderline (32 hips), and dysplasia (47 hips). The mean anterocranial ZAC in the borderline (87.5 ± 5.7°) was smaller than that in the control (92.6 ± 5.9°, P = .005) but did not differ compared with the dysplasia (84.5 ± 7.6°, P = .131). In contrast, the anterocaudal (71.2 ± 5.0°), posterocranial (85.0 ± 6.4°), and posterocaudal (82.4 ± 4.5°) mean ZACs in the borderline were not different from those in the control (anterocaudal, 74.3 ± 4.6°, P = .090; posterocranial, 87.9 ± 4.3°, P = .082; posterocaudal, 85.1 ± 5.0°, P = .069) respectively. Although there was a very strong positive correlation with supra-anterior ZAC and LCEA (r = 0.750, P < .001), the correlation between the anterocranial ZAC and LCEA was relatively weak (r = 0.574, P < .001). CONCLUSIONS The anterosuperior acetabular coverage in the borderline dysplastic acetabulum is more similar to the dysplastic acetabulum than to the normal acetabulum. CLINICAL RELEVANCE This study emphasizes the importance of evaluating not only the lateral but also the anterior coverage in borderline dysplasia.
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Affiliation(s)
- Tohru Irie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; 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, U.S.A.; 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, U.S.A
| | - 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, U.S.A
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9
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Huang YF, Gao YH, Li YR, Ding L, Liu JG, Qi X. Assessment of pelvic morphology using 3D imaging and analysis in unilateral Crowe-IV developmental dysplasia of the hip. Bone Joint J 2020; 102-B:1311-1318. [PMID: 32993337 DOI: 10.1302/0301-620x.102b10.bjj-2020-0317.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with unilateral Crowe type IV DDH using 3D imaging and analysis. METHODS A total of 20 patients with unilateral Crowe-IV DDH were included in the study. The contralateral side was considered normal in all patients. A coordinate system based on the sacral base (SB) in a reconstructed pelvic model was established. The pelvic orientations (tilt, rotation, and obliquity) of the affected side were assessed by establishing a virtual anterior pelvic plane (APP). The bilateral coordinates of the anterior superior iliac spine (ASIS) and the centres of hip rotation were established, and parameters concerning size and volume were compared for both sides of the pelvis. RESULTS The ASIS on the dislocated side was located inferiorly and anteriorly compared to the healthy side (coordinates on the y-axis and z-axis; p = 0.001; p = 0.031). The centre of hip rotation on the dislocated side was located inferiorly and medially compared to the healthy side (coordinates on the x-axis and the y-axis; p < 0.001; p = 0.003). The affected hemipelvis tilted anteriorly in the sagittal plane (mean 8.05° (SD 3.57°)), anteriorly rotated in the transverse plane (mean 3.31° (SD 1.41°)), and tilted obliquely and caudally in the coronal plane (mean 2.04° (SD 0.81°)) relative to the healthy hemipelvis. The affected hemipelvis was significantly smaller in the length, width, height, and volume than the healthy counterpart. (p = 0.014; p = 0.009; p = 0.035; p = 0.002). CONCLUSION Asymmetric abnormalities were identified on the affected hemipelvis in patients with the unilateral Crowe-IV DDH using 3D imaging techniques. Improved understanding of the morphological changes may influence the positioning of the acetabular component at THA. Acetabular component malpositioning errors caused by anterior tilt of the affected hemi pelvis and the abnormal position of the affected side centre of rotation should be considered by orthopaedic surgeons when undertaking THA in patients with Crowe-IV DDH. Cite this article: Bone Joint J 2020;102-B(10):1311-1318.
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Affiliation(s)
- Yi-Fan Huang
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yu-Hang Gao
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ye-Ran Li
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Ding
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian-Guo Liu
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xin Qi
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
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10
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Wang R, Chen Z, Liu F. Modified False-Profile Radiographs: One Stone for Two Birds Should Be Based on Correct Pelvic Rotation. Arthroscopy 2020; 36:1792-1793. [PMID: 32624115 DOI: 10.1016/j.arthro.2020.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Rui Wang
- The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Zhefeng Chen
- The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Feng Liu
- The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
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11
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Aoki SK, Mortensen AJ. Author Reply to "Modified False-Profile Radiographs: One Stone for Two Birds Should be Based on Correct Pelvic Rotation". Arthroscopy 2020; 36:1793-1794. [PMID: 32624116 DOI: 10.1016/j.arthro.2020.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
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12
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Spiker AM, Fabricant PD, Wong AC, Suryavanshi JR, Sink EL. Radiographic and clinical characteristics associated with a positive PART (Prone Apprehension Relocation Test): a new provocative exam to elicit hip instability. J Hip Preserv Surg 2020; 7:288-297. [PMID: 33163214 PMCID: PMC7605765 DOI: 10.1093/jhps/hnaa021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/08/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
Hip instability due to mild dysplasia can be a diagnostic challenge. The physical exam is an important adjunct to radiographic evaluation for the clinical diagnosis of hip instability. Herein, we describe a new maneuver to replicate hip instability pain, called the PART (Prone Apprehension Relocation Test). We retrospectively identified patients in our institution’s hip preservation registry who presented for evaluation of hip pain. We divided patients into ‘positive’ or ‘negative’ PART and analyzed associated clinical and radiographic findings. Ninety patients (159 hips) were included, 83 female and 7 male, average age 27.3 ± 9.1 years. Thirty-four hips (21.4%) had a positive PART. There were no significant differences in hip range of motion, lateral center edge angle, or in acetabular depth. There was, however, a significant difference in acetabular version at 3 o’clock between the two test groups (18.5 ± 6.9° in negative, 21.2 ± 4.9° in positive, P = 0.045). There was no association between PART and previously described anterior apprehension testing. Historical methods of diagnosing hip dysplasia may not adequately identify patients with clinical hip instability. We describe a new provocative exam, the PART, which may be helpful in replicating hip instability symptoms in patients with anterior acetabular undercoverage. PART positive patients had significantly more acetabular anteversion at the 3 o’clock position, which is measured on computed tomography and is not visible on standard anteroposterior (AP) pelvis or false profile radiographs. We believe that the PART is a valuable supplement to clinical examination and radiographic measurements to identify patients with symptomatic hip instability.
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Affiliation(s)
- Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin - Madison, UW Health at The American Center, 4602 Eastpark Blvd, Madison, WI 53718, USA
| | - Peter D Fabricant
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Alexandra C Wong
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Joash R Suryavanshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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13
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Röling MA, Mathijssen NMC, Bloem RM. Diagnostic sensitivity and specificity of dynamic three-dimensional CT analysis in detection of cam and pincer type femoroacetabular impingement. BMC Musculoskelet Disord 2020; 21:37. [PMID: 31948418 PMCID: PMC6966890 DOI: 10.1186/s12891-020-3049-3] [Citation(s) in RCA: 4] [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: 05/15/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Cam and pincer-type morphologies can cause femoroacetabular impingement syndrome (FAI) and can be measured on plain radiographs using the alpha angle and the center edge angle. As an addition to plain radiographs and to assess femoroacetabular impingement, it is possible to visualize the interplay of the acetabular and femoral morphology by means of dynamic three-dimensional simulation of hip joint. Therefore, the objective of this study is to compare alpha angles and center edge angles on plain radiographs with the dynamic computerized tomography (CT) analysis in patients with complaints of femoroacetabular impingement. Methods All patients from our prospective cohort from 2012 to 2015 who underwent radiographs and a dynamic CT analysis for FAI were selected. Cam type morphologies were measured with the alpha angle and pincer type morphologies with lateral center-edge angle on radiographs and with CT analysis. The dynamic CT analysis also calculated position and size of impingement of femur and acetabulum. Intra-operative assessment was used to confirm impingement. Sensitivity, specificity and predictive values were calculated compared with respect to the intra-operative assessment. Results A total of 127 patients were included. 90 cam morphologies and 45 pincer morphologies were identified intra-operatively. The sensitivity and specificity for cam morphology measured with radiographs was 84 and 72% compared to 90 and 43% with three dimensional dynamic analyses. The sensitivity and specificity for pincer morphology measured with radiographs was 82 and 39% compared to 84 and 51% with three dimensional dynamic analyses. Conclusions Diagnostic accuracy is comparable in three-dimensional dynamic analysis of CT scans and radiographs representing FAI caused by cam or pincer type morphology. Level of evidence IV
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Affiliation(s)
- Maarten A Röling
- Department of Orthopaedic surgery, Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625, AD, Delft, the Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedic surgery, Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625, AD, Delft, the Netherlands
| | - Rolf M Bloem
- Department of Orthopaedic surgery, Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625, AD, Delft, the Netherlands
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14
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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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