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Zhao C, Kong K, Ding X, Zhu Z, Li H, Zhang J. A novel intraoperative acetabular reaming center locating method in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1733-1742. [PMID: 38563992 DOI: 10.1007/s00264-024-06164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Although the principles of hip reconstruction are consistent, due to lack of reliable anatomical landmarks, how to decide the acetabular cup reaming centre intraoperatively in Crowe IV patients with developmental dysplasia of the hip (DDH) remains unclear. This study aims to address this question. METHODS Fifty-eight Crowe IV patients were enrolled from 2017 to 2019. By examining our previous clinical data, we analyzed the anatomical morphology of Crowe IV acetabulum and proposed a method of locating intraoperative reaming centering for implantation of a standard-sized acetabular cup, which is the upper two thirds of the posterior border of the true acetabulum. All patients included in this study were reamed according to this method. The average postoperative follow-up was 4.1 years (3-5 years). The position of the centre of rotation (COR), cup coverage (CC), and optimal range of joint motion (ROM) were examined by 3D computer simulation measurement. Postoperative complications and hip Harris score were collected and analyzed. RESULTS The morphology of the type IV DDH true acetabulum was mostly triangular. The intraoperative reaming centre were centered on the upper two thirds of the posterior border of the true acetabulum. The postoperative 3D CC was 80.20% ± 7.63% (64.68-90.24%, 44-48-mm cup size). The patients' mean Harris score improved from 39.7 ± 20.4 preoperatively to 91.5 ± 8.12 at the last follow-up. CONCLUSION Our study demonstrated that satisfactory CC and clinical results could be achieved by implanting a standard-sized cup with the reaming centre on the upper two thirds of the posterior border of the true acetabulum.
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Affiliation(s)
- Chen Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Keyu Kong
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xiaohui Ding
- Joint and Sports Medicine Department, Zhu Cheng People's Hospital, No. 59, South Ring Road, Zhucheng City, Weifang City, Shandong Province, China
| | - Zhenan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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Tschurl J, Shadi M, Kotwicki T. Hip Joint Stability during and after Femoral Lengthening in Congenital Femoral Deficiency. CHILDREN (BASEL, SWITZERLAND) 2024; 11:500. [PMID: 38671717 PMCID: PMC11049063 DOI: 10.3390/children11040500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Hip stability remains a major preoccupation during femoral lengthening in Congenital Femoral Deficiency (CFD). We aimed to review hip stability in Paley type 1a CFD patients undergoing femoral lengthening. METHODS A total of 33 patients with unilateral CFD, who were treated between 2014 and 2023, were retrospectively reviewed. In 20/33 cases (60.6%) the SUPERhip preparatory surgery was performed at a mean age of 4.3 years (range 2.7-8.1). The femoral lengthening using an external fixator was performed at a mean age of 7.8 years (range 4.3-14.3). RESULTS All patients presented with a stable hip joint after preparatory surgery and during femoral lengthening. Six cases of hip instability at a mean of 637 days after the external fixator removal were observed (range 127 to 1447 days). No significant differences between stable and unstable hips were noted for (1) Center-Edge Angle: 23.7 vs. 26.1 deg; (2) Acetabular Inclination: 12.8 vs. 11.7 deg; and (3) Ex-Fix Index: 35.6 days/cm vs. 42.4 days/cm; p > 0.05. Late hip instability was related to Coxa Vara and decreased femoral antetorsion before lengthening. CONCLUSIONS Late hip joint instability in Paley type 1a CFD patients may occur long after femoral lengthening despite hip morphology appearing to be normal on radiograms before and at the end of femoral lengthening. Coxa Vara, femoral torsional deformity, and posterior acetabular deficiency might be risk factors for hip instability.
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Affiliation(s)
| | | | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, Poznań University of Medical Sciences, 61-701 Poznań, Poland
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Fracka AB, Zindl C, Allen MJ. Three-Dimensional Morphometry of the Canine Pelvis: Implications for Total Hip Replacement Surgery. Vet Comp Orthop Traumatol 2023. [PMID: 36796430 DOI: 10.1055/s-0043-1761243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Two-dimensional measurements of acetabular geometry are widely used for the assessment of acetabular component orientation following total hip replacement (THR). With the increasing availability of computed tomography scans, there is an opportunity to develop three-dimensional (3D) planning to improve surgical accuracy. The aim of this study was to validate a 3D workflow for measuring angles of lateral opening (ALO) and version, and to establish reference values for dogs. METHODS Pelvic computed tomography scans were obtained from 27 skeletally mature dogs with no radiographic evidence of hip joint pathology. Patient-specific 3D models were built, and ALO and version angles were measured for both acetabula. The validity of the technique was determined by calculating intra-observer coefficient of variation (CV, %). Reference ranges were calculated and data from left and right hemipelves were compared using a paired t-test and symmetry index. RESULTS Measurements of acetabular geometry were highly repeatable (intra-observer CV 3.5-5.2%, inter-observer CV 3.3-5.2%). Mean (± standard deviation) values for ALO and version angle were 42.9 degrees (± 4.0 degrees) and 27.2 degrees (± 5.3 degrees) respectively. Left-right measurements from the same dog were symmetrical (symmetry index 6.8 to 11.1%) and not significantly different. CONCLUSIONS Mean values of acetabular alignment were broadly similar to clinical THR guidelines (ALO of 45 degrees, version angle of 15-25 degrees), but the wide variation in angle measurements highlights the potential need for patient-specific planning to reduce the risk of complications such as luxation.
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Affiliation(s)
- Agnieszka B Fracka
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Claudia Zindl
- Veterinary Specialists Ireland, Summerhill, County Meath, Ireland
| | - Matthew J Allen
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Vayalapra S, Wang X, Qureshi A, Vepa A, Rahman U, Palit A, Williams MA, King R, Elliott MT. Repeatability of Inertial Measurement Units for Measuring Pelvic Mobility in Patients Undergoing Total Hip Arthroplasty. SENSORS (BASEL, SWITZERLAND) 2022; 23:s23010377. [PMID: 36616975 PMCID: PMC9823306 DOI: 10.3390/s23010377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/12/2023]
Abstract
Consideration of pelvic mobility when positioning implants for total hip arthroplasty (THA) has been shown to reduce the risk of complications such as dislocation, squeaking and excessive wear. We aim to test the repeatability of pelvic tilt measurements taken between three positions (standing, flexed-seated and step-up) by an inertial measurement unit (IMU) and hence, evaluate their reliability in screening for high pelvic mobility in patients undergoing THA. The repeated IMU measurements of pelvic tilt were analysed for consistency and compared with measures taken by x-ray analysis. Our study showed greater variation in measures taken by the IMU particularly in the flexed-seated position. The patient's pelvic tilt in this position negatively correlated with their mid-back angle, suggesting the posture of the patient is a source of variation in the flexed-seated position if not kept consistent during assessments. IMUs were overall able to produce accurate and reliable measurements of pelvic tilt; however, protocols will need to be adjusted to factor in a patient's mid-back angle when taking future readings.
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Affiliation(s)
- Sushanth Vayalapra
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Xueyang Wang
- WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Arham Qureshi
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Abhinav Vepa
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Usama Rahman
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Arnab Palit
- WMG, University of Warwick, Coventry CV4 7AL, UK
| | | | - Richard King
- Department of Trauma and Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Tu LA, Weinberg DS, Liu RW. The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model. Hip Int 2022; 32:634-640. [PMID: 33934619 DOI: 10.1177/11207000211013029] [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: 02/04/2023]
Abstract
BACKGROUND While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. METHODS 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. RESULTS The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta -0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. CONCLUSIONS With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. CLINICAL RELEVANCE An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.
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Affiliation(s)
- Leigh-Anne Tu
- Division of Paediatric Orthopaedics, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, OH, USA
| | - Douglas S Weinberg
- Division of Paediatric Orthopaedics, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, OH, USA
| | - Raymond W Liu
- Division of Paediatric Orthopaedics, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, OH, USA
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Smith AH, Brassett C, Gooding C, Abood A, Norrish A. Vastus lateralis vs rectus femoris muscle flaps for recalcitrant hip joint infection: an anatomical study comparing the effectiveness of acetabular dead space control. Clin Anat 2022; 35:961-973. [PMID: 35736665 PMCID: PMC9544425 DOI: 10.1002/ca.23925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/08/2022] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
Eliminating recalcitrant prosthetic hip joint infections remains one of the greatest challenges in orthopedic surgery. In such cases, the salvage procedure of femoral head excision (the Girdlestone procedure) is often performed. There has been emerging surgical interest in filling the resulting acetabular dead space with a pedicled muscle flap, to enable antibiotic delivery. Both vastus lateralis (VL) and rectus femoris (RF) muscle flaps have been described for this purpose with good success. This study is the first anatomical investigation comparing VL and RF as candidates for interposition myoplasty following hip joint excision. Following standard surgical technique, the Girdlestone procedure and interposition myoplasty of both RF and VL were performed on 10 cadavers. The primary aim was to determine which muscle flap eliminated a greater volume of acetabular dead space. Secondary aims were to characterize the blood supply to RF and assess additional metrics indicative of the likelihood of flap success. The VL flap eliminated more dead space than RF. However, the use of the RF flap was feasible in all cases and has several benefits, including ease of harvest, mobility, and aesthetics. The location of the inferior vascular pedicle into RF was relatively consistent and the most effective predictor of flap success. Both VL and RF are effective in reducing acetabular dead space. While VL can fill a greater volume, the RF flap has technical advantages, related to the predictability of the blood supply.
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Affiliation(s)
- Alexandria H Smith
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge
| | | | - Ahid Abood
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
| | - Alan Norrish
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queen's Medical Centre, Nottingham
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Bekkouch IEI, Maksudov B, Kiselev S, Mustafaev T, Vrtovec T, Ibragimov B. Multi-landmark environment analysis with reinforcement learning for pelvic abnormality detection and quantification. Med Image Anal 2022; 78:102417. [PMID: 35325712 DOI: 10.1016/j.media.2022.102417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/14/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022]
Abstract
Morphological abnormalities of the femoroacetabular (hip) joint are among the most common human musculoskeletal disorders and often develop asymptomatically at early easily treatable stages. In this paper, we propose an automated framework for landmark-based detection and quantification of hip abnormalities from magnetic resonance (MR) images. The framework relies on a novel idea of multi-landmark environment analysis with reinforcement learning. In particular, we merge the concepts of the graphical lasso and Morris sensitivity analysis with deep neural networks to quantitatively estimate the contribution of individual landmark and landmark subgroup locations to the other landmark locations. Convolutional neural networks for image segmentation are utilized to propose the initial landmark locations, and landmark detection is then formulated as a reinforcement learning (RL) problem, where each landmark-agent can adjust its position by observing the local MR image neighborhood and the locations of the most-contributive landmarks. The framework was validated on T1-, T2- and proton density-weighted MR images of 260 patients with the aim to measure the lateral center-edge angle (LCEA), femoral neck-shaft angle (NSA), and the anterior and posterior acetabular sector angles (AASA and PASA) of the hip, and derive the quantitative abnormality metrics from these angles. The framework was successfully tested using the UNet and feature pyramid network (FPN) segmentation architectures for landmark proposal generation, and the deep Q-network (DeepQN), deep deterministic policy gradient (DDPG), twin delayed deep deterministic policy gradient (TD3), and actor-critic policy gradient (A2C) RL networks for landmark position optimization. The resulting overall landmark detection error of 1.5 mm and angle measurement error of 1.4° indicates a superior performance in comparison to existing methods. Moreover, the automatically estimated abnormality labels were in 95% agreement with those generated by an expert radiologist.
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Affiliation(s)
- Imad Eddine Ibrahim Bekkouch
- Sorbonne Center for Artificial Intelligence, Sorbonne University, Paris, France; Institute of Data Science and Artificial Intelligence, Innopolis University, Innopolis, Russia
| | - Bulat Maksudov
- Institute of Data Science and Artificial Intelligence, Innopolis University, Innopolis, Russia; Department of Computer Science, University College Dublin, Dublin, Ireland
| | - Semen Kiselev
- Institute of Data Science and Artificial Intelligence, Innopolis University, Innopolis, Russia
| | - Tamerlan Mustafaev
- Institute of Data Science and Artificial Intelligence, Innopolis University, Innopolis, Russia; Public Hospital #2, Department of Radiology, Kazan, Russia
| | - Tomaž Vrtovec
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Bulat Ibragimov
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia; Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.
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EREN MB. Volume-based dysplasia severity index with the spheric cup method in the evaluation of adult and adolescent acetabular dysplasia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.910775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jóźwiak M, Rychlik M, Szymczak W, Grzegorzewski A, Musielak B. Acetabular shape and orientation of the spastic hip in children with cerebral palsy. Dev Med Child Neurol 2021; 63:608-613. [PMID: 33415726 DOI: 10.1111/dmcn.14793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
AIM To see if three-dimensional (3D) methods could bring new understanding to acetabular changes in shape and orientation in the spastic hip and in which direction(s) acetabular orientation might change, which is crucial for planning appropriate hip correction surgery. METHOD We performed a retrospective study of pelvic computed tomography (CT) examinations in 20 consecutive patients (10 females, 10 males). The mean age of patients was 12 years 9 months (SD 2y; range: 9-16y) at the time of the CT examination. The control group consisted of 18 consecutive pelvic CT examinations (36 acetabula) of deceased individuals (six females, 12 males) aged 4 to 17 years (mean age: 10y 6mo; SD 5y 2mo) whose whole-body CT scans were taken shortly after their death. We compared 3D CT reconstructions of 28 unstable and dislocated hips in children with bilateral cerebral palsy (Gross Motor Function Classification System levels IV and V) with the unaffected side and typically developing controls to assess spatial orientation (inclination, anteversion, and tilt), acetabular volume, and surface area. Additionally, we analysed the multiple factors that may lead to structural and spatial changes of the acetabulum. RESULTS Patients with dislocated and spastic hips had significantly lower anteversion (-3.2° and -1.4° respectively, p<0.001), increased inclination (85.2° and 85.3° respectively, p<0.001), and decreased tilt (24.6° [p=0.014] and 20.7° [p=0.013] respectively) compared with typically developing individuals. Regarding acetabular volume and surface area, dislocated and unstable hips had significantly lower volume (17.6ml vs 31.5ml respectively, p<0.001) and surface area (28.9cm2 vs 36.2cm2 respectively, p<0.001) than unaffected hips. Among several factors, only Reimer's migration index had an influence on acetabular orientation (i.e. anteversion, p=0.01), volume (p<0.001), and surface (p=0.004). INTERPRETATION Acetabula in patients with spastic hip disease were severely retroverted with increased steepness; acetabular orientation was distorted superoposteriorly. In rare cases, acetabular orientation was distorted only superiorly or superoanteriorly. WHAT THIS PAPER ADDS Acetabular orientation was distorted superoposteriorly in most patients with severe bilateral cerebral palsy. More pronounced acetabular changes were found in hips with a higher Reimer's migration index.
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Affiliation(s)
- Marek Jóźwiak
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Rychlik
- Division of Virtual Engineering, Poznan University of Technology, Poznan, Poland
| | | | - Andrzej Grzegorzewski
- Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Łódź, Łódź, Poland
| | - Bartosz Musielak
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
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Park JY, Kwon HM, Lee WS, Yang IH, Park KK. Anthropometric Measurement About the Safe Zone for Transacetabular Screw Placement in Total Hip Arthroplasty in Asian Middle-Aged Women: In Vivo Three-Dimensional Model Analysis. J Arthroplasty 2021; 36:744-751. [PMID: 32950340 DOI: 10.1016/j.arth.2020.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the pelvic vascular injury caused by a transacetabular screw is rare, it is a major local complication of total hip arthroplasty. We aimed to obtain anthropometric data about the safe zone for the placement of transacetabular screws by analyzing the three-dimensional (3D) reconstruction model and determine the safe length of transacetabular screws by performing the 3D simulated surgery. METHODS We reviewed 50 hips of 25 patients who underwent lower extremity angiographic computed tomography scans retrospectively. We reconstructed the 3D models of 50 hips with normal pelvic bone and vascular status using the customized computer software. We measured the central angle and safe depth of the safe zone of the transacetabular screws on the 3D models. We also performed the 3D simulated surgery to confirm the safe length of screws in each hole of the customized cup implant. RESULTS The measured central angle of the posterior-superior area was 79.5°. And we determined a mean safe depth of 49.8 mm in the safe zone, with a central angle of 47.7°. During the 3D simulated surgery, we determined a mean safe length of the transacetabular screw of 43.3 mm when applied to a lateral hole on a line bisecting the posterior-superior area. CONCLUSION Although our study was limited by the use of a virtual computer program, the quantitative measurements obtained can help reduce the incidence of pelvic vascular injury during transacetabular screw fixation in total hip arthroplasty.
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Affiliation(s)
- Jun Young Park
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ick Hwan Yang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Wang X, Qureshi A, Vepa A, Rahman U, Palit A, Williams MA, King R, Elliott MT. A Sensor-Based Screening Tool for Identifying High Pelvic Mobility in Patients Due to Undergo Total Hip Arthroplasty. SENSORS 2020; 20:s20216182. [PMID: 33143034 PMCID: PMC7663251 DOI: 10.3390/s20216182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that pelvic mobility is a critical factor to consider in implant alignment during total hip arthroplasty (THA). Here, we test the feasibility of using an inertial sensor fitted across the sacrum to measure change in pelvic tilt, and hence screen for patients with high pelvic mobility. Patients (n = 32, mean age: 57.4 years) due to receive THA surgery participated in the study. Measures of pelvic tilt were captured simultaneously using the device and radiograph in three functional positions: Standing, flexed-seated, and step-up. We found a strong correlation between the device and radiograph measures for the change in pelvic tilt measure from standing to flexed-seated position (R2 = 0.911); 75% of absolute errors were under 5 degrees. We demonstrated that the device can be used as a screening tool to rapidly identify patients who would benefit from more detailed surgical planning of implant positioning to reduce future risks of impingement and dislocation.
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Affiliation(s)
- Xueyang Wang
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Arham Qureshi
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Abhinav Vepa
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Usama Rahman
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Arnab Palit
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Mark A. Williams
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
| | - Richard King
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK; (A.Q.); (A.V.); (U.R.); (R.K.)
| | - Mark T. Elliott
- WMG, University of Warwick, Coventry CV4 7AL, UK; (X.W.); (A.P.); (M.A.W.)
- Correspondence:
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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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Musielak BJ, Shadi M, Kubicka AM, Koczewski P, Rychlik M, Premakumaran P, Jóźwiak M. Is acetabular dysplasia and pelvic deformity properly interpreted in patients with congenital femoral deficiency? A 3D analysis of pelvic computed tomography. J Child Orthop 2020; 14:364-371. [PMID: 33204343 PMCID: PMC7666788 DOI: 10.1302/1863-2548.14.200065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study is to assess the pelvis's morphology and spatial orientation of the acetabulum, and their relation to the severity of Congenital Femoral Deficiency (CFD) using 3D imaging. Defining these pathologies is crucial for adequate surgical correction. METHODS The shape and structure of the acetabulum and pelvis were evaluated in 14 children with unilateral CFD via 3D computed tomography (CT) scans, and then analysed with geometric morphometrics (Procrustes ANOVA). The association between pelvic directional asymmetry and CFD classifications (Aitken, Paley) was assessed. The affected acetabulum's orientation was compared to the non-affected side, and the variability of orientation in different CFD types was evaluated (bivariate correlation). RESULTS The hemipelvis with CFD is characterized by a smaller acetabulum, a laterally curved ischium and a less upright ilium (p < 0.001). Multivariate regressions revealed a greater level of pelvis asymmetry in more severe types of CFD (p < 0.001). The acetabulum orientation assessment showed a significant decrease in mean anteversion (1.3°) and inclination (9.6°) angle, when compared to the non-affected side (26°and 17.1° respectively; p < 0.001). CONCLUSIONS The affected side of the pelvis is considerably smaller and more deformed, and this should be considered during limb lengthening. The acetabulum presents with significant dysplasia due to its severe retroversion and steepness (superoposterior distortion). This should not be interpreted as a simple wall deficit, but as a complete acetabular misalignment (often misinterpreted in 2D imagery). Using transiliac osteotomies (e.g. Dega, Salter) is debatable due to abnormal acetabular orientation (superoposterior malalignment). Therefore, alternative options, e.g. San Diego or triple pelvic osteotomy, should be considered.
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Affiliation(s)
- Bartosz Jan Musielak
- Department of Paediatric Orthopaedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland,Correspondence should be sent to Bartosz Jan Musielak, 28 Czerwca 1956 r. 135/147, 61-545 Poznań, Poland. E-mail:
| | - Milud Shadi
- Department of Spine Disorders and Paediatric Orthopaedics, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Maria Kubicka
- Department of Zoology, Poznań University of Life Sciences, Poznań, Poland
| | - Paweł Koczewski
- Department of Paediatric Orthopaedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Michał Rychlik
- Division of Virtual Engineering, Poznań University of Technology, Poznań, Poland,Faculty of Medicine, Carl Gustav Carus: Dresden, Sachsen, Germany
| | | | - Marek Jóźwiak
- Department of Paediatric Orthopaedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
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14
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Aprato A, Sacco R, Boero S, Marrè G, Andreacchio A, Massè A. Teenagers' sub-acute acetabular dysplasia. MINERVA ORTHOPEDICS 2020; 71. [DOI: 10.23736/s0394-3410.20.03964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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15
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Morandi MM, Daily D, Kee C, Barton RS, Solitro GF. Safe Supra-Acetabular Pin Insertion in Relation to Intraosseous Depth. J Orthop Res 2019; 37:1790-1797. [PMID: 31042305 DOI: 10.1002/jor.24323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45° cranial to 45° caudal in 5° increments. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45° medial to 45° lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9° ± 6.9°) and transverse range (27.5° ± 4.1°) at 30° caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20° cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20° cranial to 30° caudal with an average of 27.9° ± 1.2° (p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1790-1797, 2019.
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Affiliation(s)
- Massimo Max Morandi
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Clarence Kee
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - R Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
| | - Giovanni F Solitro
- Department of Orthopaedic Surgery, Louisiana State University Health Science Center, Shreveport, Louisiana
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16
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Mechlenburg I, Stilling M, Rømer L, de Bruijne M, Søballe K, de Raedt S. Reference values and variation of acetabular angles measured by computed tomography in 170 asymptomatic hips. Acta Radiol 2019; 60:895-901. [PMID: 30818980 DOI: 10.1177/0284185119831688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sepp de Raedt
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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17
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Musielak B, Kubicka AM, Rychlik M, Czubak J, Czwojdziński A, Grzegorzewski A, Jóźwiak M. Variation in pelvic shape and size in Eastern European males: a computed tomography comparative study. PeerJ 2019; 7:e6433. [PMID: 30809442 PMCID: PMC6387581 DOI: 10.7717/peerj.6433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background The significantly accelerated development of human society in the last millennium has brought about changes in human behavior and body mass that may have influenced human bone morphology. Our objective was to analyze the variation in pelvic shape and size in males from modern and medieval populations. Methods We obtained 22 pelvic girdles of adult males from a medieval cemetery located in Cedynia, Poland. The control group comprised 31 contemporary male pelves from individuals inhabiting the same region. The analyzed parameters were: interspinous distance (ISD), intercristal distance (ICD), intertuberous distance (ITD), anatomic conjugate of the pelvis, height of the pelvis (HP), iliac opening angle (IOA), iliac tilt angle (ITA), and ISD/ITD/HP ratio. Geometric morphometrics was used to analyze differences in shape in the pelves. All analyses were carried out on three-dimensional CT reconstructions of pelves. Results ISD, ICD, and IOA were significantly greater in modern pelves than in those from Cedynia, but no significant differences were seen between the two groups in ITD, anatomical conjugate, HP, or ITA. ISD/ITD/HP ratios were significantly lower in the Cedynia group. Geometric morphometrics revealed significant differences in pelvic shape between the analyzed groups. Discussion The pelves of modern males are larger, wider, and flatter than those of medieval males. Changes in the set of daily activities that produce mechanical loading and estimated body mass may constitute the main factors explaining pelvic variability. However, differences in ontogenesis should also be taken into consideration, especially since growth in past populations is often found to be reduced relative to modern populations.
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Affiliation(s)
- Bartosz Musielak
- Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Maria Kubicka
- Department of Zoology, Poznań University of Life Sciences, Poznań, Poland
| | - Michał Rychlik
- Division of Virtual Engineering, Poznań University of Technology, Poznań, Poland
| | - Jarosław Czubak
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Adam Czwojdziński
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Andrzej Grzegorzewski
- Department of Orthopedics and Pediatric Orthopedics, Medical University of Lódź, Łódź, Poland
| | - Marek Jóźwiak
- Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
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18
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Lee C, Jang J, Kim HW, Kim YS, Kim Y. Three-dimensional analysis of acetabular orientation using a semi-automated algorithm. Comput Assist Surg (Abingdon) 2019; 24:18-25. [DOI: 10.1080/24699322.2018.1545872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Changhwan Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Jongseong Jang
- Center for Integration of Advanced Medicine Life Science Innovative Technologies (CAMIT), Department of Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan
| | - Hyung Wook Kim
- Institute of Innovative Surgical Technology, Hanyang University, Seoul, Korea
| | - Young Soo Kim
- Institute of Innovative Surgical Technology, Hanyang University, Seoul, Korea
| | - Yeesuk Kim
- Department of Orthopedic Surgery, Hanyang University, Seoul, Korea
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19
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Dunlap AE, Mathews KG, Walters BL, Bruner KA, Ru H, Marcellin-Little DJ. Three-dimensional assessment of the influence of juvenile pubic symphysiodesis on the pelvic geometry of dogs. Am J Vet Res 2018; 79:1217-1225. [PMID: 30372155 DOI: 10.2460/ajvr.79.11.1217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the 3-D geometry of canine pelves and to characterize the long-term effects of juvenile pubic symphysiodesis (JPS) on pelvic geometry by comparing the pelvic configuration between littermates that did and did not undergo the procedure. ANIMALS 24 Labrador Retriever, Golden Retriever, or Labrador Retriever-Golden Retriever crossbred service dogs from 13 litters. PROCEDURES At 16 weeks old, puppies with a hip joint distraction index ≥ 0.5 were randomly assigned to undergo thermal JPS (n = 9), mechanical JPS (7), or a sham (control) surgical procedure (8). Ten years later, each dog underwent a CT scan of the pelvic region. Modeling software was used to create 3-D reconstructions from the CT scans, and various pelvic measurements were made and compared among the 3 treatments. RESULTS Compared with the control treatment, thermal and mechanical JPS increased the hemipelvis acetabular angle by 4°, the acetabular angle of lateral opening by 5°, and the orientation of the medial acetabular wall in a transverse plane by 6°, which indicated that JPS increased dorsal femoral head coverage by the acetabulum. Both JPS procedures decreased the pelvic canal area by approximately 20% and acetabular inclination by 6° but did not alter acetabular retroversion. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that thermal and mechanical JPS were equally effective in altering the 3-D pelvic geometry of dogs. These findings may help guide future studies of alternatives for optimizing canine pelvic anatomy to minimize the risk of hip dysplasia and associated osteoarthritis.
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20
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Morosato F, Traina F, Cristofolini L. Standardization of hemipelvis alignment for in vitro biomechanical testing. J Orthop Res 2018; 36:1645-1652. [PMID: 29194747 DOI: 10.1002/jor.23825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023]
Abstract
Although in vitro biomechanical tests are regularly performed, the definition of a suitable reference frame for hemipelvic specimens is still a challenge. The aims of the present study were to: (i) define a reference frame for the human hemipelvis suitable for in vitro applications, based on robust anatomical landmarks; (ii) identify the alignment of a hemipelvis based on the alignment of a whole pelvis (including right/left and male/female differences); (iii) identify the relative alignment of the proposed in vitro reference frame with respect to a reference frame commonly used in gait analysis; (iv) create an in vitro alignment procedure easy, robust and inexpensive; (v) quantify the intra-operator repeatability and inter-operator reproducibility of the procedure. A procedure to univocally identify the anatomical landmarks was created, exploiting the in vitro accessibility of the specimen's surface. Through the analysis on 53 CT scans (106 hemipelvises), the alignment of the hemipelvis based on the alignment of a whole pelvis was analyzed: differences between male/female and right/left hemipelvises were not statistically significant To overcome the uncertainty in the identification of the acetabular rim, a standard acetabular plane was defined. An alignment procedure was developed to implement such anatomical reference frame. The intra-operator repeatability and the inter-operator reproducibility were quantified with four operators, on male and female hemipelvises. The intra-operator repeatability was better than 1.5°. The inter-operator reproducibility was better than 2.0°. Alignment in the transverse plane was the most repeatable. The presented procedure to align hemipelvic specimens is sufficiently robust, standardized, and accessible. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1645-1652, 2018.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Via Umberto Terracini 24/26, Bologna, 40131, Italy
| | | | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, Via Umberto Terracini 24/26, Bologna, 40131, Italy
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21
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Cai Z, Zhao Q, Li L, Zhang L, Ji S. Can Computed Tomography Accurately Measure Acetabular Anterversion in Developmental Dysplasia of the Hip? Verification and Characterization Using 3D Printing Technology. J Pediatr Orthop 2018; 38:e180-e185. [PMID: 29356794 DOI: 10.1097/bpo.0000000000001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the important pathologic changes in developmental dysplasia of the hip (DDH) is increased acetabular version angle (AA). Reasonable correction for excessive AA is an important step in the treatment of DDH, making accurate AA measurement very crucial. However, the results of different AA measurement methods vary. Thus, this study aimed to compare the difference in AA measurements between 2-dimensional computed tomography (2D-CT) and 3-dimensional computed tomography (3D-CT) in children with DDH and to identify the AA degree in children with DDH to guide treatment. METHODS AA was measured by 2D-CT and 3D-CT in 186 children with DDH, and the measurement results were compared with the physical measurement result in the 3D-printed pelvis (3D-PP) model. The 3D-PP was a 1:1 model identical to the human pelvis. All patients were unilaterally affected. RESULTS The results of AA measurement through 2D-CT, 3D-CT, and 3D-PP of normal hips were 14.0±6.6, 11.9±5.3, and 11.9±3.4 degrees, respectively, whereas those of the dislocated hips were 24.9±8.9, 19.8±5.2, and 19.5±4.3 degrees, respectively. In both the normal and dislocated hip groups, the results between 2D-CT and 3D-CT was significantly different (P<0.05), but there was no difference between the results of 3D-CT and 3D-PP (P>0.05). The AA of the normal and dislocated hips as measured by 3D-PP was 11.9±3.6 and 19.6±4.3 degrees, respectively, with statistically significant difference (P<0.05). In the dislocated hips, a significant positive correlation was found between age and AA (r=0.756, P<0.05) and between AA and degree of dislocation (r=0.837, P<0.05). CONCLUSIONS 3D-CT is more accurate than 2D-CT for AA measurement, and compared with normal hips, AA in dislocated hips increased by ∼7.7 degrees on average. AA increases as age and degree of dislocation increase. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Zhencun Cai
- Department of Orthopaedics, Central Hospital of Shenyang Medical College
| | - Qun Zhao
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Lijun Zhang
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Shijun Ji
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, P.R. China
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A surface-based approach to determine key spatial parameters of the acetabulum in a standardized pelvic coordinate system. Med Eng Phys 2017; 52:22-30. [PMID: 29269225 DOI: 10.1016/j.medengphy.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/20/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022]
Abstract
Accurately determining the spatial relationship between the pelvis and acetabulum is challenging due to their inherently complex three-dimensional (3D) anatomy. A standardized 3D pelvic coordinate system (PCS) and the precise assessment of acetabular orientation would enable the relationship to be determined. We present a surface-based method to establish a reliable PCS and develop software for semi-automatic measurement of acetabular spatial parameters. Vertices on the acetabular rim were manually extracted as an eigenpoint set after 3D models were imported into the software. A reliable PCS consisting of the anterior pelvic plane, midsagittal pelvic plane, and transverse pelvic plane was then computed by iteration on mesh data. A spatial circle was fitted as a succinct description of the acetabular rim. Finally, a series of mutual spatial parameters between the pelvis and acetabulum were determined semi-automatically, including the center of rotation, radius, and acetabular orientation. Pelvic models were reconstructed based on high-resolution computed tomography images. Inter- and intra-rater correlations for measurements of mutual spatial parameters were almost perfect, showing our method affords very reproducible measurements. The approach will thus be useful for analyzing anatomic data and has potential applications for preoperative planning in individuals receiving total hip arthroplasty.
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23
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Wang RY, Xu WH, Kong XC, Yang L, Yang SH. Measurement of acetabular inclination and anteversion via CT generated 3D pelvic model. BMC Musculoskelet Disord 2017; 18:373. [PMID: 28851328 PMCID: PMC5576350 DOI: 10.1186/s12891-017-1714-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Inclination and anteversion were the main factors that determined the reliability of the acetabulum. Inclination and anteversion measurements included anatomical, operational and radiographic methods. The aim of our present study was to exhibit divergence of inclination and anteversion via the three measurements. Methods Inclination and anteversion were defined according to the definitions put forward by Murray. Three-dimensional models of pelvis of CT data were brought forth. Acetabular axis was determined by the rim of acetabula. Reference planes were established by bone landmarks including anterior superior iliac spine, pubic tubercles and sacral crests. Inclinations and anteversions were calculated according to the definitions. Results Forty-nine cases were involved in the research. Data of inclination form anatomical, operational and radiographic showed 37.48 ± 11.07, 45.12 ± 14.76 and 48.76 ± 14.36, and anteversion were 18.12 ± 7.59, 24.97 ± 9.68, 14.30 ± 5.64. A substantial deviation was noted in the inclinations (P < 0.01) and anteversions (P < 0.01). Conclusion Our findings suggested that the inclinations and anteversions of the three measurements varied, which might in turn interfere the decision of orthopedists.
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Affiliation(s)
- R Y Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - W H Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - X C Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - L Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - S H Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.
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24
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Weinberg DS, Williamson DFK, Millis MB, Liu RW. Decreased and increased relative acetabular volume predict the development of osteoarthritis of the hip: an osteological review of 1090 hips. Bone Joint J 2017; 99-B:432-439. [PMID: 28385930 DOI: 10.1302/0301-620x.99b4.bjj-2016-0177.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/02/2016] [Indexed: 11/05/2022]
Abstract
AIMS Recently, there has been considerable interest in quantifying the associations between bony abnormalities around and in the hip joint and osteoarthritis (OA). Our aim was to investigate the relationships between acetabular undercoverage, acetabular overcoverage, and femoroacetabular impingement (FAI) with OA of the hip, which currently remain controversial. MATERIALS AND METHODS A total of 545 cadaveric skeletons (1090 hips) from the Hamann-Todd osteological collection were obtained. Femoral head volume (FHV), acetabular volume (AV), the FHV/AV ratio, acetabular version, alpha angle and anterior femoral neck offset (AFNO) were measured. A validated grading system was used to quantify OA of the hip as minimal, moderate, or severe. Multiple linear and multinomial logistic regression were used to determine the factors that correlated independently with the FHV, AV, and the FHV/AV ratio. RESULTS Female cadavers had smaller FHVs (standardised beta -0.382, p < 0.001), and AVs (standardised beta -0.351, p < 0.001), compared with male patients, although the FHV/AV ratio was unchanged. Every 1° increase in alpha angle increased the probability of having moderate OA of the hip compared with minimal OA by 7.1%. Every 1 mm decrease in AFNO increased the probability of having severe or moderate OA of the hip, compared with minimal OA, by 11% and 9%, respectively. The relative risk ratios of having severe OA of the hip compared with minimal OA were 7.2 and 3.3 times greater for acetabular undercoverage and overcoverage, respectively, relative to normal acetabular cover. CONCLUSION Acetabular undercoverage and overcoverage were independent predictors of increased OA of the hip. The alpha angle and AFNO had modest effects, supporting the hypothesis that bony abnormalities both in acetabular dysplasia and FAI are associated with severe OA. Cite this article: Bone Joint J 2017;99-B:432-9.
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Affiliation(s)
- D S Weinberg
- Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - D F K Williamson
- Case Western Reserve University, 2109 Adelbert Rd, Cleveland, OH 44106, USA
| | - M B Millis
- Boston Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA
| | - R W Liu
- Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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25
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Lee C, Kim Y, Kim HW, Kim YS, Jang J. A robust method to extract the anterior pelvic plane from CT volume independent of pelvic pose. Comput Assist Surg (Abingdon) 2017; 22:20-26. [PMID: 28245365 DOI: 10.1080/24699322.2017.1293737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The anterior pelvic plane (APP) is commonly used as a reference plane to assess acetabular orientation. However, conventional methods for determining the APP may not be accurate and are prone to user variability. To overcome these issues, we developed a robust method to accurately extract the APP independent of pelvic pose using three-dimensional pelvic computed tomography (CT). MATERIALS AND METHODS Twenty-eight studies for suspected nonmusculoskeletal conditions were obtained. The APP was determined by four landmarks that were automatically extracted from user-defined regions of interest (ROIs) with compensation of pelvic pose. The APP defined from these landmarks was quantitatively compared to the APPs determined by an expert and an unskilled. Intraobserver reliability was measured to evaluate the time-interval variability. Finally, we evaluate the robustness of this method to patient posture using an arbitrarily rotated volume. The intraclass correlation coefficients (ICCs) were calculated to determine the interobserver and intraobserver reliabilities. RESULTS The ICC values for the four landmarks and the APP were similar between the semiautomated method and expert determination (ICC >0.937). The ICC values for intraobserver reliability over time for our method were all 1, demonstrating high reliability. Furthermore, agreement between the parameters determined from the original volume and the rotated volume was nearly perfect. CONCLUSIONS Our method is a useful measurement tool for the APP as it is robust, and the results were similar to an experienced surgeon's determination. Furthermore, it was independent to the direction of the CT slice and more robust than a measurement by an unskilled.
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Affiliation(s)
- Changhwan Lee
- a Department of Biomedical Engineering , Hanyang University , Seoul , Korea
| | - Yeesuk Kim
- b Department of Orthopedic Surgery , College of Medicine, Hanyang University , Seoul , Korea
| | - Hyung Wook Kim
- c Institute of Innovative Surgical Technology , Hanyang University , Seoul , Korea
| | - Young Soo Kim
- c Institute of Innovative Surgical Technology , Hanyang University , Seoul , Korea
| | - Jongseong Jang
- c Institute of Innovative Surgical Technology , Hanyang University , Seoul , Korea
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Analysis of acetabular orientation and femoral anteversion using images of three-dimensional reconstructed bone models. Int J Comput Assist Radiol Surg 2017; 12:855-864. [PMID: 28063078 DOI: 10.1007/s11548-016-1514-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Radiographic measurements using two-dimensional (2D) plain radiographs or planes from computed tomography (CT) scans have several drawbacks, while measurements using images of three-dimensional (3D) reconstructed bone models can provide more consistent anthropometric information. We compared the consistency of results using measurements based on images of 3D reconstructed bone models (3D measurements) with those using planes from CT scans (measurements using 2D slice images). METHODS Ninety-six of 561 patients who had undergone deep vein thrombosis-CT between January 2013 and November 2014 were randomly selected. We evaluated measurements using 2D slice images and 3D measurements. The images used for 3D reconstruction of bone models were obtained and measured using [Formula: see text] and [Formula: see text] (Materialize, Leuven, Belgium). RESULTS The mean acetabular inclination, acetabular anteversion and femoral anteversion values on 2D slice images were 42.01[Formula: see text], 18.64[Formula: see text] and 14.44[Formula: see text], respectively, while those using images of 3D reconstructed bone models were 52.80[Formula: see text], 14.98[Formula: see text] and 17.26[Formula: see text]. Intra-rater reliabilities for acetabular inclination, acetabular anteversion, and femoral anteversion on 2D slice images were 0.55, 0.81, and 0.85, respectively, while those for 3D measurements were 0.98, 0.99, and 0.98. Inter-rater reliabilities for acetabular inclination, acetabular anteversion and femoral anteversion on 2D slice images were 0.48, 0.86, and 0.84, respectively, while those for 3D measurements were 0.97, 0.99, and 0.97. CONCLUSION The differences between the two measurements are explained by the use of different tools. However, more consistent measurements were possible using the images of 3D reconstructed bone models. Therefore, 3D measurement can be a good alternative to measurement using 2D slice images.
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Boese CK, Jostmeier J, Oppermann J, Dargel J, Chang DH, Eysel P, Lechler P. The neck shaft angle: CT reference values of 800 adult hips. Skeletal Radiol 2016; 45:455-63. [PMID: 26695396 DOI: 10.1007/s00256-015-2314-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis. MATERIALS AND METHODS Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120°), physiologic (≥120° to <135°), and coxa valga (≥135°). Intra- and inter-rater reliability were analyzed. RESULTS Primary research question: Mean NSA for male adults was 129.6° (range 113.2°-148.2°; SD 5.9°) and 131.9° (range 107.1°-151.9°; SD 6.8°) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001). CONCLUSIONS While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA.
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Affiliation(s)
- Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany.
| | - Janine Jostmeier
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Johannes Oppermann
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - De-Hua Chang
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Philipp Lechler
- Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
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Musielak B, Jóźwiak M, Rychlik M, Chen BPJ, Idzior M, Grzegorzewski A. Does hemipelvis structure and position influence acetabulum orientation? BMC Musculoskelet Disord 2016; 17:131. [PMID: 26984181 PMCID: PMC4794903 DOI: 10.1186/s12891-016-0982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022] Open
Abstract
Background Although acetabulum orientation is well established anatomically and radiographically, its relation to the innominate bone has rarely been addressed. If explored, it could open the discussion on patomechanisms of such complex disorders as femoroacetabular impingement (FAI). We therefore evaluated the influence of pelvic bone position and structure on acetabular spatial orientation. We describe this relation and its clinical implications. Methods This retrospective study was based on computed tomography scanning of three-dimensional models of 31 consecutive male pelvises (62 acetabulums). All measurements were based on CT spatial reconstruction with the use of highly specialized software (Rhinoceros). Relations between acetabular orientation (inclination, tilt, anteversion angles) and pelvic structure were evaluated. The following parameters were evaluated to assess the pelvic structure: iliac opening angle, iliac tilt angle, interspinous distance (ISD), intertuberous distance (ITD), height of the pelvis (HP), and the ISD/ITD/HP ratio. The linear and nonlinear dependence of the acetabular angles and hemipelvic measurements were examined with Pearson’s product − moment correlation and Spearman’s rank correlation coefficient. Correlations different from 0 with p < 0.05 were considered statistically significant. Results Comparison of the axis position with pelvis structure with orientation in the horizontal plane revealed a significant positive correlation between the acetabular anteversion angle and the iliac opening angle (p = 0.041 and 0.008, respectively). In the frontal plane, there was a positive correlation between the acetabular inclination angle and the iliac tilt angle (p = 0.025 and 0.014, respectively) and the acetabular inclination angle and the ISD/ITD/HP ratio (both p = 0.048). Conclusions There is a significant correlation of the hemipelvic structure and acetabular orientation under anatomic conditions, especially in the frontal and horizontal planes. In the anteroposterior view, the more tilted-down innominate bone causes a more caudally oriented acetabulum axis, whereas in the horizontal view this relation is reversed. This study may serve as a basis for the discussion on the role of the pelvis in common disorders of the hip.
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Affiliation(s)
- Bartosz Musielak
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Fredry 10, Poznan, 61-701, Poland.
| | - Marek Jóźwiak
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Fredry 10, Poznan, 61-701, Poland
| | - Michał Rychlik
- Division of Virtual Engineering, Poznan University of Technology, Piotrowo 3, Poznan, 60-965, Poland
| | - Brian Po-Jung Chen
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Fredry 10, Poznan, 61-701, Poland
| | - Maciej Idzior
- Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Fredry 10, Poznan, 61-701, Poland
| | - Andrzej Grzegorzewski
- Department of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Kościuszki 4, Łódź, Poland
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