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Inaba Y, Tezuka T, Oba M, Choe H, Ike H. Periacetabular osteotomy using computed tomography-based navigation: preoperative planning and accuracy evaluation. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03210-2. [PMID: 38888819 DOI: 10.1007/s11548-024-03210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Since 2011, we have used computed tomography (CT)-based navigation to perform safe and accurate rotational acetabular osteotomy (RAO) for treating developmental dysplasia of the hip. We developed a new method with four fiducial points to improve the accuracy of a published technique. In this study, we introduced a new method to achieve reorientation in accordance with planning and evaluated its accuracy. METHODS This study included 40 joints, which underwent RAO used CT-based navigation. In 20 joints, reorientation was confirmed by touching the lateral aspect of the rotated fragment with navigation and checking whether it matched the preoperative plan. A new fiducial point method was adopted for the remaining 20 joints. To assess the accuracy of the position of the rotated fragment in each group, postoperative radial reformatted CT images were obtained around the acetabulum and three-dimensional evaluation was performed. The accuracy of acetabular fragment repositioning was evaluated using the acetabular sector angle (ASA). RESULTS The absolute value of ΔASA, which represents the error between preoperative planning and the actual postoperative position, was significantly smaller in the new fiducial method group than the previous method group in the area from 11:30 to 13:30 (p < 0.05). The Harris Hip Score at 1 year after surgery did not differ significantly between the previous and new fiducial point methods. CONCLUSION The new fiducial point method significantly reduced reorientation error in the superior-lateral area of the acetabulum: significantly fewer errors and fewer cases of under-correction of lateral acetabular coverage were recorded. The four-reference fiducial method facilitates reorientation of the acetabulum as planned, with fewer errors. The effect of the improved accuracy of the fiducial point method on clinical outcomes will be investigated in the future work.
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Affiliation(s)
- Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Taro Tezuka
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Masatoshi Oba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Hsu CP, Lin CF, Yang CC, Jeng JY, Huang CH. Gender differences in ethmoid sinus morphology_ 3D reconstruction of computed tomographic images. BMC Med Imaging 2024; 24:139. [PMID: 38858620 PMCID: PMC11165772 DOI: 10.1186/s12880-024-01319-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The ethmoid sinus (ES) is a three-dimensional (3D) complex structure, a clear understanding of the ES anatomy is helpful to plan intranasal surgery. However, most prior studies use 2D measurements, which may not accurately depict the 3D structure. The current study measured the gender differences in ES morphology based on 3D reconstruction of computed tomography (CT) images. METHODS The 3D models were reconstructed using CT images. Twenty-one males and 15 females were enrolled in the study. The ES dimensions, including width, height and aspect ratio (AR) of each cutting-plane section, were measured at 10% increments along with the anteroposterior axis of the ES. The gender differences in the above parameters were further evaluated by an independent t-test. RESULTS The width of the ES for males is 12.0 ± 2.1 mm, which was significantly greater than that in females (10.0 ± 2.1 mm). The average height for males is 18.4 ± 3.5 mm, and 18.2 ± 3.4 mm for females. The AR of female (male) is around 0.56 (0.63) for the anterior ES and 0.66 (0.75) for the posterior. There are significant differences between genders in the parameters of width and AR (p < 0.05). CONCLUSION This study found that the aspect ratio greatly varies along the length of ES, indicating that the cross-section of the ES in the anterior is closer to an elliptical shape and turns closer to a circular shape near its posterior. There is a significant difference between genders in width and aspect ratio. The results would be helpful to know the complex anatomic details of the ethmoid sinus.
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Affiliation(s)
- Chi-Pin Hsu
- Taiwan High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan
- Department of Mechanical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Chih-Feng Lin
- Department of Otolaryngology Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Chi Yang
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jeng-Ywan Jeng
- Taiwan High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chang-Hung Huang
- Biomechanics Research Laboratory, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Cheng H, Ren N, Gu W, Zhang Z, Li Y, Sun W, Chai W, Luo D, Zhang H. Comparison of Anterior Center-Edge Angle Measured From the Acetabular Sourcil Versus the Anterior Bone-Edge of the Acetabulum: A Descriptive Laboratory Study. Orthop J Sports Med 2024; 12:23259671231221295. [PMID: 38304054 PMCID: PMC10832420 DOI: 10.1177/23259671231221295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background Measuring anterior hip coverage on false-profile (FP) radiographs is important for judging anterior hip coverage. Conventionally, the anterior center-edge angle (ACEA) is measured from the anterior edge of the acetabular sourcil (sourcil ACEA); however, the anterior bone edge is also used as the anterior landmark. Purpose To determine whether the sourcil ACEA or the bone-edge ACEA better represents the anterior coverage of the hip joint. Study Design Descriptive laboratory study. Methods We retrospectively observed 49 hips in 49 patients who underwent isolated periacetabular osteotomy. The sourcil ACEA was measured according to the standard procedure. Then, 3-dimensional (3D) volumetric models were made from computed tomographic data. The acetabular surface of the 3D model was labeled and projected onto a simulated FP radiograph, enabling the edge of the acetabulum to be identified. This simulated FP radiograph was used to measure the "true ACEA," as well as the sourcil ACEA and the bone-edge ACEA, and the 3 measurements were compared. Statistical analysis was performed-including testing for normal distribution, measuring interobserver agreement, evaluating differences between measurements, and validating correlation. Results The mean sourcil ACEA was 8.6° (range, -3.9° to 31.7°) smaller than that of the true ACEA (P < .001); there was a strong correlation (r = 0.81; P < .001) between the 2. The mean bone-edge ACEA was 16.8° (range, -1.7° to 45.4°) greater than that of the true ACEA (P < .001); there was a moderate correlation (r = 0.57; P < 0.001) between the 2. Conclusion Both the sourcil ACEA and bone-edge ACEA differed from the true ACEA. However, compared with the bone-edge ACEA, the sourcil ACEA was numerically closer to the true ACEA and had a stronger correlation with it . Clinical Relevance While the exact edge of the true bearing surface of the articular cartilage may not be visible on the FP radiograph, the sourcil ACEA can be effectively utilized as a reliable surrogate when evaluating the anterior acetabular coverage in hip preservation surgery.
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Affiliation(s)
- Hui Cheng
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Ningtao Ren
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wang Gu
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Zhendong Zhang
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Yong Li
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wei Sun
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Dianzhong Luo
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Hong Zhang
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
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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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Cheng H, Zhang L, Luo D, Ren N, Zhang Z, Gu W, Hu Y, Zhang H. Determining anterior hip coverage in patients with hip dysplasia using the anterior center-edge angle on Lequesne's false-profile radiograph and on computed tomography. J Hip Preserv Surg 2023; 10:42-47. [PMID: 37275833 PMCID: PMC10234381 DOI: 10.1093/jhps/hnac048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/02/2022] [Accepted: 11/21/2022] [Indexed: 06/07/2023] Open
Abstract
Anterior hip coverage is important for hip stability. As a parameter of anterior hip coverage, the anterior center-edge angle on false-profile radiograph (ACEA FP) is associated with clinical outcomes. With the widespread application of computed tomography (CT), the anterior center-edge angle on CT (ACEA CT) has also been used to measure anterior hip coverage. Little is known about the reproducibility of the ACEA FP and ACEA CT in patients with hip dysplasia or the correlation between the ACEA CT and ACEA FP. In total, 49 hips of 49 patients who underwent periacetabular osteotomy in our center were included. The lateral center-edge angle, Tönnis angle, ACEA FP and ACEA CT were determined. We assessed the intraobserver and interobserver reliability of the ACEA FP and ACEA CT, the effect of the Tönnis angle on the reliability of the ACEA FP and ACEA CT and the correlation between the ACEA CT and ACEA FP. The intraobserver and interobserver interclass correlation coefficients of the ACEA FP were good, and those of the ACEA CT were very good. The Tönnis angle was weakly correlated with inconsistent ACEA FP measurements (P = 0.008) but not with inconsistent ACEA CT measurements (P = 0.600). No correlation between ACEA FP and ACEA CT measurements was observed (P = 0.213-0.665). The reproducibility of the ACEA CT is more consistent than that of the ACEA FP. The oblique acetabular roof had an effect on determining the ACEA FP but not on determining the ACEA CT. No correlation was observed between the measured ACEA FP and ACEA CT values, so the clinical evidence obtained from the ACEA FP cannot be directly applied to the ACEA CT.
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Affiliation(s)
| | | | - Dianzhong Luo
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Ningtao Ren
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Zhendong Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Wang Gu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | | | - Hong Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
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6
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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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Liu Z, Li H, Wang S, Wu Q, Liu H. A Preliminary Cadaveric MRI Study of Fetal Hip Development. Front Surg 2022; 9:847135. [PMID: 35237653 PMCID: PMC8882625 DOI: 10.3389/fsurg.2022.847135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose The earlier the detection of the hip joint is discovered, the better the final result. The purpose of this study aimed to investigate the fetal hip development using magnetic resonance imaging (MRI), so as to alert clinicians to possible abnormal development during intrauterine life. Method Measurements of 34 cadaver fetuses (68 hips) were obtained regarding acetabular width and depth, anterior bony acetabular index (ABAI), anterior cartilaginous acetabular index (ACAI), posterior bony acetabular index (PBAI), and posterior cartilaginous acetabular index (PCAI). The standard values of each acetabular measurement index were obtained, and the gestational age-measurement index change trend chart was drawn to comprehensively analyze the normal development law of the fetal hip joint. Results With the development of fetuses, the width and depth of acetabular increase linearly, and the slope of acetabular width was larger than that of depth. In addition, two change points during the 24th and 34th weeks of gestation were detected with regard to width. ABAI and PBAI also decreased. ABAI demonstrated an approximately linear trend, while PBAI shows a non-linear trend. During the 36th week, the change point in PBAI was observed. ACAI and PCAI exhibited slow increases, indicating a non-linear trend. During the 21st and 36th weeks of gestation, the change points regarding ACAI were observed. During the 22nd week of gestation, the change point for PCAI was observed. Conclusion Plots of the parameters obtained via MRI examinations of cadaver fetuses across gestational age comprehensively illustrated the fetal hip development. This developmental information about the hip joint has the potential to guide clinicians in the early detection of abnormal hip joint development during intrauterine life.
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Affiliation(s)
- Zhenqing Liu
- Department of Radiology, Guangzhou Woman and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Woman and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shuai Wang
- Department of Radiology, Guangzhou Woman and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qianqian Wu
- Department of Radiology, Guangzhou Woman and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongsheng Liu
- Department of Radiology, Guangzhou Woman and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Hongsheng Liu
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Salih S, Grammatopoulos G, Burns S, Hall-Craggs M, Witt J. Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage? Bone Jt Open 2022; 3:12-19. [PMID: 34985308 PMCID: PMC9047077 DOI: 10.1302/2633-1462.31.bjo-2021-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC). Methods This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017. Overall, 97 hips in 75 patients had 3D analysis by Clinical Graphics, giving measurements for LCEA, acetabular index (AI), and FHC. Roentgenographical LCEA, AI, posterior wall index (PWI), and anterior wall index (AWI) were measured from supine AP pelvis radiographs. The correlation between CT and roentgenographical measurements was calculated. Sequential multiple linear regression was performed to determine the relationship between roentgenographical measurements and CT FHC. Results CT-measured LCEA and AI correlated strongly with roentgenographical LCEA (r = 0.92; p < 0.001) and AI (r = 0.83; p < 0.001). Radiological LCEA correlated very strongly with CT FHC (r = 0.92; p < 0.001). The sum of AWI and PWI also correlated strongly with CTFHC (r = 0.73; p < 0.001). CT measurements of LCEA and AI were 3.4° less and 2.3° greater than radiological LCEA and AI measures. There was a linear relation between radiological LCEA and CT FHC. The linear regression model statistically significantly predicted FHC from LCEA, F(1,96) = 545.1 (p < 0.001), adjusted R2 = 85.0%, with the prediction equation: CT FHC(%) = 42.1 + 0.77(XRLCEA) Conclusion CT and roentgenographical measurement of acetabular parameters are comparable. Currently, a radiological LCEA greater than 25° is considered normal. This study demonstrates that those with hip pain and normal radiological acetabular parameters may still have deficiencies in FHC. More sophisticated imaging techniques such as 3D CT should be considered for those with hip pain to identify deficiencies in FHC. Cite this article: Bone Jt Open 2022;3(1):12–19.
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Affiliation(s)
- Saif Salih
- Department of Trauma and Orthopaedics, Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | | | - Johan Witt
- University College London Hospital, London, UK
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9
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DeFroda SF, Alter TD, Lambers F, Malloy P, Clapp IM, Chahla J, Nho SJ. Quantification of Acetabular Coverage on 3-Dimensional Reconstructed Computed Tomography Scan Bone Models in Patients With Femoroacetabular Impingement Syndrome: A Descriptive Study. Orthop J Sports Med 2021; 9:23259671211049457. [PMID: 34820460 PMCID: PMC8607491 DOI: 10.1177/23259671211049457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accurate assessment of osseous morphology is imperative in the evaluation of patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. Through use of computed tomography (CT), 3-dimensional (3D) reconstructed hip models may provide a more precise measurement for overcoverage and undercoverage and aid in the interpretation of 2-dimensional radiographs obtained in the clinical setting. Purpose To describe new measures of acetabular coverage based on 3D-reconstructed CT scan bone models. Study Design Cross-sectional study; Level of evidence, 3. Methods Preoperative CT scans were acquired on the bilateral hips and pelvises of 30 patients before arthroscopic surgical intervention for FAIS. Custom software was used for semiautomated segmentation to generate 3D osseous models of the femur and acetabulum that were aligned to a standard coordinate system. This software calculated percentage of total acetabular coverage, which was defined as the surface area projected onto the superior aspect of the femoral head. The percentage of coverage was also quantified regionally in the anteromedial, anterolateral, posteromedial, and posterolateral quadrants of the femoral head. The acetabular clockface was established by defining 6 o'clock as the inferior aspect of the acetabular notch. Radial coverage was then calculated along the clockface from the 9-o'clock to 5-o'clock positions. Results The study included 20 female and 10 male patients with a mean age of 33.6 ± 11.7 years and mean body mass index of 27.8 ± 6.3. The average percentage of total acetabular coverage for the sample was 57% ± 6%. Acetabular coverages by region were as follows: anteromedial, 78% ± 7%; anterolateral, 18% ± 7%, posterolateral, 33% ± 13%, and posteromedial, 99% ± 1%. The acetabular coverage ranged from 23% to 69% along the radial clockface from 9 to 5 o'clock. Conclusion This study demonstrated new 3D measurements to characterize acetabular coverage in patients with FAIS and elucidated the distribution of acetabular coverage according to these measurements.
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Affiliation(s)
- Steven F DeFroda
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA.,Arcadia University, Montgomery, Pennsylvania, USA
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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10
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Ibrahim MM, Smit K, Poitras S, Grammatopoulos G, Beaulé PE. Correlation of Patient-Reported Outcomes After Periacetabular Osteotomy With Femoral Head Coverage and Acetabular Orientation: A Single-Center Cohort Study. Am J Sports Med 2021; 49:1209-1219. [PMID: 33661717 DOI: 10.1177/0363546521992108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). PURPOSE (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. RESULTS At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P < .001). CONCLUSION Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.
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Affiliation(s)
- Mazen M Ibrahim
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Kevin Smit
- Division of Orthopedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Paul E Beaulé
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Nishikino S, Koyama H, Furuhashi H, Hoshino H, Matsuyama Y. Validation of a new 2.5D radiographic index evaluating acetabular coverage using ACX software. Hip Int 2020; 30:16-21. [PMID: 30602342 DOI: 10.1177/1120700018820883] [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 Several radiographic signs have been described to assess acetabular coverage. However, plain radiographs only have 2 dimensions (2D) and cannot accurately show acetabular coverage. QUESTIONS/PURPOSES We developed the ACX Dynamics software to calculate the radial centre-edge angle (RCEA), which represents the acetabular coverage of the femoral head at each acetabular edge point on the radial plane. This study validated the accuracy of the RCEA, as calculated by ACX Dynamics, as a quantitative parameter for acetabular coverage. PATIENTS AND METHODS We reviewed the anteroposterior (AP) pelvic radiographs and computed tomography (CT) of 650 hips from 325 patients who presented with chief complaint of symptoms at the hip joint. Of 109 hip radiographs (68 patients) that satisfied the criteria, 50 randomised, blinded AP pelvic radiographs were chosen. We determined the absolute RCEA difference (°) [= RCEA ACX (°) - RCEA CT (°)], determined the correlation between RCEA ACX (°) and RCEA CT (°), and examined the RCEA's intra-observer and inter-observer reliability in 50 hips. RESULTS The absolute RCEA difference from A45° to P75° was 1.9-3.1°. The correlation between the RCEA ACX (°) and RCEA CT (°) was > 0.7 in all lesions (p < 0.001). Using the intraclass correlation coefficient, the intra-observer reliability of the RCEA was 0.83-0.97 in the whole range, which is a highly reproducible and reasonable parameter, and the inter-observer reliability was > 0.80 in A45°-P0°. CONCLUSIONS The RCEA ACX (°) can be used as a simple quantitative parameter for assessing acetabular coverage using AP pelvic radiograph.
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Affiliation(s)
- Shoichi Nishikino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Koyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroki Furuhashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hironobu Hoshino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Computer-Assisted Planning, Simulation, and Navigation System for Periacetabular Osteotomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1093:143-155. [PMID: 30306479 DOI: 10.1007/978-981-13-1396-7_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Periacetabular osteotomy (PAO) is an effective approach for surgical treatment of hip dysplasia in young adults. However, achieving an optimal acetabular reorientation during PAO is the most critical and challenging step. Routinely, the correct positioning of the acetabular fragment largely depends on the surgeon's experience and is done under fluoroscopy to provide the surgeon with continuous live x-ray guidance. Our developed system starts with a fully automatic detection of the acetabular rim, which allows for quantifying the acetabular 3D morphology with parameters such as acetabular orientation, femoral head extrusion index (EI), lateral center-edge (LCE) angle, and total and regional femoral head coverage (FHC) ratio for computer-assisted diagnosis, planning, and simulation of PAO. Intraoperative navigation is conducted to implement the preoperative plan. Two validation studies were conducted on four sawbone models to evaluate the efficacy of the system intraoperatively and postoperatively. By comparing the preoperatively planned situation with the intraoperatively achieved situation, average errors of 0.6° ± 0.3°, 0.3° ± 0.2°, and 1.1° ± 1.1° were found, respectively, along three motion directions (flexion/extension, abduction/adduction, and external rotation/internal rotation). In addition, by comparing the preoperatively planned situation with the postoperative results, average errors of 0.9° ± 0.3° and 0.9° ± 0.7° were found for inclination and anteversion, respectively.
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Uemura K, Atkins PR, Maas SA, Peters CL, Anderson AE. Three-dimensional femoral head coverage in the standing position represents that measured in vivo during gait. Clin Anat 2018; 31:1177-1183. [PMID: 30117200 DOI: 10.1002/ca.23262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
Individuals with over- or under-covered hips may develop hip osteoarthritis. Femoral head coverage is typically evaluated using radiographs, and/or computed tomography (CT) or magnetic resonance images obtained supine. Yet, these static assessments of coverage may not provide accurate information regarding the dynamic, three-dimensional (3-D) relationship between the femoral head and acetabulum. The objectives of this study were to: (1) quantify total and regional 3-D femoral head coverage in a standing position and during gait, and (2) quantify the relationship between 3-D femoral head coverage in standing to that measured during gait. The kinematic position of the hip during standing and gait was measured in vivo for 11 asymptomatic morphologically normal subjects using dual fluoroscopy and model-based tracking of 3-D CT models. Percent coverage in the standing position and during gait was measured overall and on a regional basis (anterior, superior, posterior, inferior). Coverage in standing was correlated with that measured during gait. For total coverage, very little change in coverage occurred during gait (range: 35.0-36.7%; mean: 36.2%). Coverage at each time point of gait strongly correlated with coverage during standing (r = 0.929-0.989). The regions thought to play an important role in weight bearing (i.e. anterior, superior, posterior) were significantly correlated with coverage in standing during the stance phase. Our results suggest that coverage measured in a standing position is a good surrogate for coverage measured during gait. Clin. Anat. 31:1177-1183, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Musculoskeletal Research Laboratories, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA
| | - Christopher L Peters
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Andrew E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Department of Physical Therapy, University of Utah, Dumke Health Professions Building, 520 Wakara Way, Suite 240, Salt Lake City, Utah, 84108, USA
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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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Ibrahim MM, Poitras S, Bunting AC, Sandoval E, Beaulé PE. Does acetabular coverage influence the clinical outcome of arthroscopically treated cam-type femoroacetabular impingement (FAI)? Bone Joint J 2018; 100-B:831-838. [PMID: 29954207 DOI: 10.1302/0301-620x.100b7.bjj-2017-1340.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI. Patients and Methods Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS). Results At a mean follow-up of 2.7 years (1 to 8, sd 1.6), all functional outcome scores significantly improved overall. Radiographically, only preoperative anterior coverage had a negative correlation with the improvement of the HOOS symptom subscale (r = -0.28, p = 0.005). No significant difference in relative change in HOOS subscale scores was found according to the presence or absence of radiographic signs of retroversion. Discussion Our study demonstrated the anterior coverage as an important modifier influencing the functional outcome of arthroscopically treated cam-type FAI. Cite this article: Bone Joint J 2018;100-B:831-8.
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Affiliation(s)
- M M Ibrahim
- Arthroplasty and Adult Reconstruction, Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa, Ottawa, Ontario, Canada and Lecturer of Orthopaedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - S Poitras
- Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - A C Bunting
- Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa
| | - E Sandoval
- Arthroplasty and Adult Reconstruction, Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa,, Ottawa, Ontario, Canada and Alai Sports Medicine Clinic, Madrid, Spain
| | - P E Beaulé
- University of Ottawa, Ottawa, Ontario, Canada and The Ottawa Hospital/l'Hôpital d'Ottawa, Ottawa, Ontario, Canada
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CORR Insights ®: Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults with Varying Morphologies. Clin Orthop Relat Res 2017; 475:1034-1036. [PMID: 27650994 PMCID: PMC5339128 DOI: 10.1007/s11999-016-5089-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/12/2016] [Indexed: 01/31/2023]
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