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Funahashi H, Osawa Y, Takegami Y, Iida H, Ozawa Y, Ido H, Imagama S. What Are the Sex-Based Differences of Acetabular Coverage Features in Hip Dysplasia? Clin Orthop Relat Res 2024:00003086-990000000-01675. [PMID: 38996383 DOI: 10.1097/corr.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/24/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Eccentric rotational acetabular osteotomy is performed to prevent osteoarthritis caused by developmental dysplasia of the hip (DDH). To achieve sufficient acetabular coverage, understanding the characteristics of acetabular coverage in DDH is necessary. However, the features of acetabular coverage in males with DDH remain unclear. We thought that the differences in acetabular coverage between females and males might be associated with the differences in pelvic morphology between the sexes. QUESTIONS/PURPOSES (1) What are the differences in the acetabular coverage between females and males with DDH? (2) What are the differences in the rotations of the ilium and ischium between females and males with DDH? (3) What is the relationship between the rotation of the ilium and ischium and the acetabular coverage at each height in females and males with DDH? METHODS Between 2016 and 2023, 114 patients (138 hips) underwent eccentric rotational acetabular osteotomy at our hospital. We excluded patients with Tönnis Grade 2 or higher, a lateral center-edge angle of 25º or more, and deformities of the pelvis or femur, resulting in 100 patients (122 hips) being included. For female patients (98 hips), the median (range) age was 40 years (10 to 58), and for the male patients (24 hips), it was 31 years (14 to 53). We used all patients' preoperative AP radiographs and CT data. The crossover sign, posterior wall sign, and pelvic width index were evaluated in AP radiographs. The rotation of the innominate bone in the axial plane was evaluated at two different heights, specifically at the slice passing through the anterior superior iliac spine and the slice through the pubic symphysis and ischial spine in CT data. Furthermore, we evaluated the anterior and posterior acetabular sector angles. Comparisons of variables related to innominate bone measurements and acetabular coverage measurements between females and males in each patient were performed. The correlations between pelvic morphology measurements and acetabular coverage were evaluated separately for females and males, and the results were subsequently compared to identify any sex-specific differences. For continuous variables, we used the Student t-test; for binary variables, we used the Fisher exact test. A p value less than 0.05 was considered statistically significant. RESULTS In the evaluation of AP radiographs, an indicator of acetabular retroversion-the crossover sign-showed no differences between the sexes, whereas the posterior wall sign (females 46% [45 of 98] hips versus males 75% [18 of 24] hips, OR 3.50 [95% confidence interval (CI) 1.20 to 11.71]; p = 0.01) and pelvic width index less than 56% (females 1% [1 of 98] versus males 17% [4 of 24], OR 18.71 [95% CI 1.74 to 958.90]; p = 0.005) occurred more frequently in males than in females. There were no differences in the iliac rotation parameters, but the ischium showed more external rotation in males (females 30° ± 2° versus males 24° ± 1°; p < 0.001). Regarding acetabular coverage, no differences between females and males were observed in the anterior acetabular sector angles. In contrast, males showed smaller values than females for the posterior acetabular sector angles (85° ± 9° versus 91° ± 7°; p = 0.002). In females, a correlation was observed between iliac rotation and acetabular sector angles (anterior acetabular sector angles: r = -0.35 [95% CI -0.05 to 0.16]; p < 0.001, posterior acetabular sector angles: r = 0.42 [95% CI 0.24 to 0.57]; p < 0.001). Similarly, ischial rotation showed a correlation with both acetabular sector angles (anterior acetabular sector angles: r = -0.34 [95% CI -0.51 to -0.15]; p < 0.001 and posterior acetabular sector angles: r = 0.45 [95% CI 0.27 to 0.59]; p < 0.001). Thus, in females, we observed that external iliac rotation and ischial internal rotation correlated with increased anterior acetabular coverage and reduced posterior coverage. In contrast, although acetabular coverage in males showed a correlation with iliac rotation (anterior acetabular sector angles: r = -0.55 [95% CI -0.78 to -0.18]; p = 0.006 and posterior acetabular sector angles: r = 0.74 [95% CI 0.48 to 0.88]; p < 0.001), no correlation was observed with ischial rotation. CONCLUSION In males, acetabular retroversion occurs more commonly than in females and is attributed to their reduced posterior acetabular coverage. In females, an increase in the posterior acetabular coverage was correlated with the external rotation angle of the ischium, whereas in males, no correlation was found between ischial rotation and posterior acetabular coverage. In treating males with DDH via eccentric rotational acetabular osteotomy, it is essential to adjust bone fragments to prevent inadequate posterior acetabular coverage. Future studies might need to investigate the differences in acetabular coverage between males and females in various limb positions and consider the direction of bone fragment rotation. CLINICAL RELEVANCE Our findings suggest that males with DDH exhibit acetabular retroversion more frequently than females, which is attributed to the reduced posterior acetabular coverage observed in males. The smaller posterior acetabular coverage in males might be related to differences in ischial morphology between sexes. During eccentric rotational acetabular osteotomy for males with DDH, adequately rotating acetabular bone fragments might be beneficial to compensate for deficient posterior acetabular coverage.
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Affiliation(s)
- Hiroto Funahashi
- Department of Orthopaedic Surgery, Nagoya University Graduates School of Medicine, Nagoya, Japan
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Beaulé PE, Verhaegen JCF, Clohisy JC, Zaltz I, Stover MD, Belzile EL, Sink EL, Carsen S, Nepple JJ, Smit KM, Wilkin GP, Poitras S. The Otto Aufranc Award: Does Hip Arthroscopy at the Time of Periacetabular Osteotomy Improve the Clinical Outcome for the Treatment of Hip Dysplasia? A Multicenter Randomized Clinical Trial. J Arthroplasty 2024:S0883-5403(24)00482-0. [PMID: 38768770 DOI: 10.1016/j.arth.2024.05.035] [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: 02/23/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND A periacetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage and labral pathologies are very commonly present, and there is a lack of evidence examining the benefits of adjunct arthroscopy to treat these. The goal of this study was to compare the clinical outcome of patients undergoing PAO with and without arthroscopy, with the primary end point being the International Hip Outcome Tool-33 at 1 year. METHODS In a multicenter study, 203 patients who had symptomatic hip dysplasia were randomized: 97 patients undergoing an isolated PAO (mean age 27 years [range, 16 to 44]; mean body mass index of 25.1 [range, 18.3 to 37.2]; 86% women) and 91 patients undergoing PAO who had an arthroscopy (mean age 27 years [range, 16 to 49]; mean body mass index of 25.1 [17.5 to 25.1]; 90% women). RESULTS At a mean follow-up of 2.3 years (range, 1 to 5), all patients exhibited improvements in their functional score, with no significant differences between PAO plus arthroscopy versus PAO alone at 12 months postsurgery on all scores: preoperative International Hip Outcome Tool-33 score of 31.2 (standard deviation [SD] 16.0) versus 36.4 (SD 15.9), and 12 months postoperative score of 72.4 (SD 23.4) versus 73.7 (SD 22.6). The preoperative Hip disability and Osteoarthritis Outcome pain score was 60.3 (SD 19.6) versus 66.1 (SD 20.0) and 12 months postoperative 88.2 (SD 15.8) versus 88.4 (SD 18.3). The mean preoperative physical health Patient-Reported Outcomes Measurement Information System score was 42.5 (SD 8.0) versus 44.2 (SD 8.8) and 12 months postoperative 48.7 (SD 8.5) versus 52.0 (SD 10.6). There were 4 patients with PAO without arthroscopy who required an arthroscopy later to resolve persistent symptoms, and 1 patient from the PAO plus arthroscopy group required an additional arthroscopy. CONCLUSIONS This randomized controlled trial has failed to show any significant clinical benefit in performing hip arthroscopy at the time of the PAO at 1-year follow-up. Longer follow-up will be required to determine if hip arthroscopy provides added value to a PAO for symptomatic hip dysplasia.
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Affiliation(s)
- Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | | | - Ira Zaltz
- Beaumont Hospital, Royal Oak, Michigan
| | | | | | | | - Sasha Carsen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey J Nepple
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kevin M Smit
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Geoffrey P Wilkin
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Faculty of Health Sciences, University Ottawa, Ottawa, Ontario, Canada
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Verhaegen JCF, DeVries Z, Rakhra K, Speirs A, Beaule PE, Grammatopoulos G. Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study. Clin Orthop Relat Res 2024; 482:259-274. [PMID: 37498285 PMCID: PMC10776167 DOI: 10.1097/corr.0000000000002768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studies have used patients with unknown physical status to define morphological thresholds to guide management. QUESTIONS/PURPOSES (1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management. METHODS Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [ 28 ]), if they had a PROMIS less than 50 (1% [ 18 ]), or their Tönnis score was higher than 1 (0.4% [ 6 ]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls. RESULTS Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm 2 , covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface. CONCLUSION An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes.Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jeroen C. F. Verhaegen
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
- Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Zach DeVries
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Kawan Rakhra
- Department of Radiology, the Ottawa Hospital, Ottawa, ON, Canada
| | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, ON, Canada
| | - Paul E. Beaule
- Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Verhaegen JCF, Dedeoğulları ES, Horton IS, Beaulé PE, Grammatopoulos G. Does pelvic tilt change with a peri-acetabular osteotomy? J Hip Preserv Surg 2023; 10:204-213. [PMID: 38162263 PMCID: PMC10757406 DOI: 10.1093/jhps/hnad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/14/2023] [Accepted: 08/18/2023] [Indexed: 01/03/2024] Open
Abstract
Change in pelvic tilt (PT) during and after peri-acetabular osteotomy (PAO) is important for surgical planning. The aims of this study were to (i) determine how PT varies throughout the course of treatment in patients undergoing PAO, (ii) test what factors influence the change in PT and (iii) assess whether changes in PT influenced achieved correction. This is an retrospective, single-centre, consecutive case series of 111 patients treated with PAO for global (n = 79), posterior (n = 49) or anterior dysplasia (n = 6) (mean age: 27.3 ± 7.7 years; 85% females). PT was determined on supine, anteroposterior pelvic radiographs pre-, intra-, 1 day, 6 weeks and 1 year post-operatively, using the sacro-femoral-pubic (SFP) angle, a validated, surrogate marker of PT. An optimal acetabular correction was based on the lateral centre-edge angle (25°-40°), acetabular index (-5° to 10°) and cross-over ratio (<20%). There was a significant difference across pre- (70.1° ± 4.8°), 1-day (71.7° ± 4.3°; P < 0.001) and early post-operative SFP (70.6° ± 4.7°; P = 0.004). The difference in SPF between pre-operative and 1-year post-operative was -0.5° ± 3.1° (P = 0.043), with 9% of cases having a difference of >5°. The difference in SFP did not correlate with age, sex, body mass index, type of dysplasia or achievement of optimal acetabular correction (P = 0.1-0.9). In the early post-operative period, PT is reduced, leading to a relative appearance of acetabular retroversion, which gradually corrects and is restored by annual follow-up. The degree of change in PT during PAO did not adversely affect fragment orientation. PT does not significantly change in most patients undergoing PAO and therefore does not appear to be a compensatory mechanism.
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Affiliation(s)
- Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
- Department of Orthopaedics, University Hospital Antwerp, Drie Eikenstraat 655, Edegem 2650, Belgium
- Orthopedic Center Antwerp, AZ Monica, Stevenslei 20, Deurne 2100, Belgium
| | - Emin Süha Dedeoğulları
- Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, Sıhhiye, Ankara 06230, Turkey
| | - Isabel S Horton
- Department of Orthopaedic Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Paul E Beaulé
- Department of Orthopaedic Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - George Grammatopoulos
- Department of Orthopaedic Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
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Tanaka S, Fujii M, Kawano S, Ueno M, Sonohata M, Kitajima M, Mawatari D, Mawatari M. Joint awareness following periacetabular osteotomy in patients with hip dysplasia. Bone Joint J 2023; 105-B:760-767. [PMID: 37399111 DOI: 10.1302/0301-620x.105b7.bjj-2022-1441.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Aims The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS). Methods Data from 686 patients (882 hips) with hip dysplasia who underwent transposition osteotomy of the acetabulum, a type of PAO, between 1998 and 2019 were reviewed. After screening the study included 442 patients (582 hips; response rate, 78%). Patients who completed a study questionnaire consisting of the visual analogue scale (VAS) for pain and satisfaction, FJS-12, and Hip disability and Osteoarthritis Outcome Score (HOOS) were included. The ceiling effects, internal consistency, convergent validity, and PASS thresholds of FJS-12 were investigated. Results The median follow-up was 12 years (interquartile range 7 to 16). The ceiling effect of FJS-12 was 7.2%, the lowest of all the measures examined. FJS-12 correlated with all HOOS subscales (ρ = 0.72 to 0.77, p < 0.001) and pain and satisfaction-VAS (ρ = -0.63 and 0.56, p < 0.001), suggesting good convergent validity. Cronbach's α was 0.95 for the FJS-12, which indicated excellent internal consistency. The median FJS-12 score for preoperative Tönnis grade 0 hips (60 points) was higher than that for grade 1 (51 points) or 2 (46 points). When PASS was defined as pain-VAS < 21 and satisfaction-VAS ≥ 77, the FJS-12 threshold that maximized the sensitivity and specificity for detecting PASS was 50 points (area under the curve (AUC) = 0.85). Conclusion Our results suggest that FJS-12 is a valid and reliable assessment tool for patients undergoing PAO, and the threshold of 50 points may be useful to determine patient satisfaction following PAO in clinical settings. Further investigation of the factors influencing postoperative joint awareness may enable improved prediction of treatment efficacy and informed decision-making regarding the indication of PAO.
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Affiliation(s)
- Shiori Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shunsuke Kawano
- Research Center for Arthroplasty, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopedic Surgery, JCHO Saga Central Hospital, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopedic Surgery, Shiroishi Kyouritsu Hospital, Saga, Japan
| | - Daisuke Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Cheng H, Zhang Z, Sun W, Ren N, Luo D, Li Y, Zhang J, Zhang H. Can we determine anterior hip coverage from pelvic anteroposterior radiographs? A study of patients with hip dysplasia. BMC Musculoskelet Disord 2023; 24:522. [PMID: 37355606 DOI: 10.1186/s12891-023-06624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE Insufficient coverage causes hip joint instability and results in hip pain. Anterior hip coverage can be determined on both pelvic anteroposterior (AP) radiographs and false profile (FP) radiographs. Four parameters are commonly used to determine the anterior coverage on pelvic AP radiographs: the crossover index, crossover sign, anterior wall index (AWI), and rule of thirds. This study aims to clarify the relationship between these 4 parameters on AP radiographs and the anterior center edge angle (ACEA) on FP radiographs. METHODS In this study, 53 patients who underwent periacetabular osteotomy for hip dysplasia at our center between July 2020 and October 2020 were retrospectively reviewed. Four parameters on AP radiographs and the ACEA on FP radiographs before surgery and 6 months after surgery were measured and compared for each hip. RESULTS Upon examining the 53 hips in this study, there was no correlation between either the crossover index and the ACEA (P = 0.66) or the crossover sign before surgery. The postoperative correlation between the crossover index and the ACEA was weak (r = 0.36, P = 0.007), and that between the crossover sign and the ACEA was moderate (r = 0.41, P = 0.003). There was a weak correlation between the AWI and ACEA both before (r = 0.288, P = 0.036) and after (r = 0.349, P = 0.011) the operation. Evaluation of the anterior coverage by the rule of thirds was also not consistent when determining the anterior coverage with the ACEA. CONCLUSION Anterior coverage on AP radiographs is largely inconsistent with ACEA on FP radiographs, especially before the surgery. It is recommended to take FP radiographs routinely for determining anterior hip coverage.
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Affiliation(s)
- Hui Cheng
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Zhendong Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Wei Sun
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Ningtao Ren
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Dianzhong Luo
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China.
| | - Yong Li
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Jianli Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
| | - Hong Zhang
- Senior Department of Orthopaedics, the, Fourth Medical Center , PLA General Hospital, Beijing, 100048, China
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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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9
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Shirogane Y, Homma Y, Yanagisawa N, Higano M, Hirasawa Y, Nakamura S, Baba T, Kaneko K, Taneda H, Ishijima M. Relationship between labral length and symptoms in patients with acetabular dysplasia before rotational acetabular osteotomy. J Hip Preserv Surg 2022; 9:240-251. [PMID: 36908550 PMCID: PMC9993447 DOI: 10.1093/jhps/hnac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/03/2022] [Accepted: 09/06/2022] [Indexed: 03/14/2023] Open
Abstract
The aim of this study was to investigate the relationship between acetabular labral length and symptoms in patients with acetabular dysplasia. In a retrospective medical record review, 218 patients with acetabular dysplasia who had undergone rotational acetabular osteotomy were identified. After implementing the inclusion and exclusion criteria, 53 patients were analyzed for preoperative symptoms measured by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), acetabular bone morphology parameters by anteroposterior pelvic radiographs and labral parameters by radial magnetic resonance imaging. Spearman's correlation coefficients were calculated among JHEQ scores, bone morphologic parameters and labral parameters. Multiple linear regression models to determine the predictive variables of JHEQ score and labral length were obtained. There was no correlation between bone morphologic parameters and JHEQ scores. Labral length measured anteriorly correlated with JHEQ pain {r [95% confidence interval (CI)] = -0.335 (-0.555, -0.071), P = 0.014}, movement subscale [r (95% CI) = -0.398 (-0.603, -0.143), P = 0.003], mental subscale [r (95% CI) = -0.436 (-0.632, -0.188), P = 0.001] and total JHEQ score [r (95% CI) = -0.451 (-0.642, -0.204), P = 0.001]. The multiple linear regression results showed that anterior labral length was independently associated with JHEQ subscales in some models. Meanwhile, age, acetabular head index and total JHEQ score were independently associated with anterior labral length in all models. Labral length, notably in anterosuperior area, in patients with symptomatic acetabular dysplasia was related to patient's symptom. Labral length may be an important objective image finding that can be used to assess the severity of cumulative hip instability.
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Affiliation(s)
- Yuichi Shirogane
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Naotake Yanagisawa
- Clinical Research and Trial Center, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Masanori Higano
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Yoichiro Hirasawa
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Shigeru Nakamura
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Hitoshi Taneda
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
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10
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Laboudie P, Fischman D, Speirs AD, Salih S, Holc F, Beaule PE, Witt JD, Grammatopoulos G. Comparison of Acetabular Measurements Between 2 Validated Software Programs Used in Hip Preservation Surgery. Am J Sports Med 2022; 50:2637-2646. [PMID: 35867779 DOI: 10.1177/03635465221109240] [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: 01/31/2023]
Abstract
BACKGROUND Validated software tools (Clinical Graphics [CG] and Hip2Norm) permit measurement of the percentage of femoral head coverage (%FHC), which aids in morphological classification and prediction of outcome after hip preservation surgery. PURPOSE (1) To assess whether acetabular parameter measurements determined from 2 commonly used software systems are comparable. (2) To determine which parameters influence the correlation or differences between software outputs and measurements. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The study included 69 patients (90 hips) who underwent periacetabular osteotomy and had comprehensive preoperative imaging available. Lateral center-edge angle (LCEA), acetabular index (AI), and %FHC were determined using 3-dimensional computed tomography (CT) measurements by CG and Hip2Norm software. Images of 18 pelvises were segmented to determine spinopelvic parameters and subtended acetabular angles. Between-group measurements were compared using correlation coefficients and Bland-Altman analyses. The difference in the outputs of the 2 programs was defined as delta (Δ). Radiographic parameters were tested to assess whether they were responsible for differences in %FHC between software programs. RESULTS Strong correlations between LCEA (ρ = 0.862) and AI (ρ = 0.825) measurements were seen between the Hip2Norm and CG programs. However, weak correlation was seen in the estimate of %FHC (ρ = 0.358), with the presence of a systematic error. Hip2Norm consistently produced lower anterior, posterior, and total %FHC values than CG. The %FHC determined by CG, but not Hip2Norm, correlated with acetabular subtended angles (P < .05). Pelvic tilt measured on CT did not correlate with pelvic tilt estimated by Hip2Norm (P = .56), and ΔPelvicTilt strongly correlated with the difference in %FHC by the 2 software programs (ρ = 0.63; P = .005), pelvic incidence (ρ = 0.73; P < .001), and pelvic tilt (ρ = -0.91; P < .001) as per CT. CONCLUSION The correlation of %FHC between Hip2Norm and CG was weak (ρ = 0.358). The difference in measurements of %FHC correlated with ΔPelvicTilt. The %FHC determined by CG strongly correlated with the segmented acetabular subtended angles and thus more likely reflected true values. Hip preservation surgeons should be aware of these measurement differences because %FHC is important in the diagnosis and prognosis of acetabular dysplasia.
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Affiliation(s)
- Pierre Laboudie
- Orthopaedic Surgery Department, Cochin Hospital, Paris, France.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel Fischman
- Division of Orthopaedic Surgery, Hospital Militar Santiago, Chile
| | - Andrew D Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Saif Salih
- Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, UK
| | - Fernando Holc
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul E Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Johan D Witt
- Reconstruction Service, University College London Hospitals, London, UK
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Laboudie P, Dymond T, Kreviazuk C, Grammatopoulos G, Beaulé PE. Hip arthroscopy after periacetabular osteotomy for acetabular dysplasia - incidence and clinical outcome. BMC Musculoskelet Disord 2022; 23:659. [PMID: 35820874 PMCID: PMC9275150 DOI: 10.1186/s12891-022-05625-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background The periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia and has demonstrated improvement in patient reported outcomes measures (PROMs) as well as acceptable long-term survival. However, acetabular dysplasia is also associated with intra-articular lesions that can negatively impact clinical outcome. This study aimed to analyse the incidence, operative findings, and outcomes of hip arthroscopy after PAO. Methods This is a single center retrospective study by querying our hip preservation prospectively collected database from 2006 to 2020. All patients having undergone hip arthroscopy after a PAO, with a minimal follow-up of one year, were identified. 202 PAOs were done with a mean age of 28.3 years (12.7 – 53.6) including 39 males and 167 females. Failure was defined as conversion to hip replacement. Demographics, surgical findings, reoperations, and PROMs (pre and post operatively at the last follow-up point only for hips not converted to hip replacement). Results Fifteen hips in 15 patients (7.4%) out of 202 PAOs underwent a hip arthroscopy at a mean time of 3.9 years (0.3–10.3) after PAO. There were 2 males, 13 females and the mean age was 29.8 years (18.5–45). 12 hips had no radiological osteoarthritis (Tönnis 0) and 3 hips had early osteoarthritis (Tönnis 1). At time of arthroscopy, all hips had a labral tear, 9 had a chondral damage ≥ Beck 4. Eight hips had labral debridement, 7 had labral repair, 2 had resection of adhesions and 4 underwent a femoral osteochondroplasty. Four hips (27%) were converted to a hip replacement at a mean time of 1.8 years(0.5–3.2) after hip arthroscopy. Patients converted to hip replacement were significantly older (p = 0.01), had a lower post-PAO LCEA (p = 0.01) and a higher post-PAO Tönnis angle (p = 0.02). There were no significant improvements in PROMs. Conclusion This study reports a hip arthroscopy reoperation rate after PAO of 7.4%. All three types of dysplasia (uncovered anteriorly, posteriorly, or globally) were present in this cohort. Twenty seven percent of patients were converted to hip replacement and PROMs were not significantly improved by hip arthroscopy. Therefore, this procedure should be approached with some caution.
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Affiliation(s)
- Pierre Laboudie
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada.,Orthopaedic surgery department, Cochin hospital, Paris, France
| | - Thomas Dymond
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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12
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A computational approach to determine key anatomic landmarks on pelvis and its application to acetabular orientation assessment and hip computational biomechanics. Med Eng Phys 2022; 105:103824. [DOI: 10.1016/j.medengphy.2022.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/07/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
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