The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy

2022 ◽  
Author(s):  
Keisuke Uemura ◽  
Toshihito Hiraiwa ◽  
Masashi Okamoto ◽  
Kunihiko Tokunaga ◽  
Andrew E. Anderson
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Limited Ability ◽  
Edge Angle ◽  
Center Edge ◽  
Curved Periacetabular Osteotomy ◽  
Dysplasia Of The Hip ◽  
Center Edge Angle

scholarly journals Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip: A Systematic Review

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Yoichi Murata ◽  
Naomasa Fukase ◽  
Maitland Martin ◽  
Rui Soares ◽  
Lauren Pierpoint ◽  
...  
Keyword(s):  
Systematic Review ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Patient Characteristics ◽  
Developmental Dysplasia ◽  
Edge Angle ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Dysplasia Of The Hip ◽  
Center Edge Angle

Background: The treatment for borderline developmental dysplasia of the hip (BDDH) has historically been arthroscopic surgery or periacetabular osteotomy (PAO). As orthopaedic surgery is constantly evolving, a lack of comparison of outcomes for these 2 treatment methods could potentially be stalling the progression of treatment for patients with BDDH. Purpose: To evaluate the existing literature on patient characteristics, procedures, clinical outcomes, and failure rates for patients with BDDH and to determine whether PAO or hip arthroscopic surgery is a better treatment method for patients with BDDH. Study Design: Systematic review; Level of evidence, 4. Methods: Studies included were found using the following search words: “hip” and “borderline dysplasia,” “osteotomy” or “arthroscopy,” and “outcome” or “procedure.” Articles were included if they detailed participants of all sexes and ages, reported on isolated hips, and had patients diagnosed with BDDH. Results: A search was conducted across 3 databases, resulting in 469 articles for consideration, from which 12 total studies (10 on arthroscopic surgery and 2 on PAO) were chosen for a review. There were 6 studies that included patients with a lateral center-edge angle of 18° to 25°, while the remainder included patients with a lateral center-edge angle of 20° to 25°. All the studies reviewing arthroscopic surgery reported concomitant/accessory procedures, while the articles on the topic of PAO did not. It was determined that, whether treated using arthroscopic surgery or PAO, outcomes improved across all patient-reported outcome measures. Revision surgery was also common in both procedures. Conclusion: There is a lack of consensus in the literature on the best treatment option for patients with BDDH. Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes.

scholarly journals Change in 2D and 3D femoral head coverage after curved periacetabular osteotomy

10.29007/jt57 ◽  
2020 ◽  
Author(s):  
Keisuke Uemura ◽  
Masashi Okamoto ◽  
Kunihiko Tokunaga ◽  
Andrew Anderson
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Head Region ◽  
Edge Angle ◽  
Center Edge ◽  
Curved Periacetabular Osteotomy ◽  
2D And 3D ◽  
Center Edge Angle ◽  
3D Coverage

Femoral head coverage in patients with hip dysplasia (DDH) is often quantified using 2D parameters, including the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, only moderate correlations have been observed between the 2D coverage and 3D coverage. The purposes of this study were to: 1) quantify the change in 3D head coverage after curved periacetabular osteotomy (CPO), and 2) analyze the relationship between 2D and 3D head coverage preoperatively and postoperatively. Forty-three hips of 39 female cases (age: 37±10 years) who underwent CPO were analyzed. 2D coverage was quantified using the LCEA and ACEA from CT images. 3D coverage was quantified in the anterior, superior, posterior, inferior head regions. 3D measurements were performed both pre- and post-operatively and were correlated to the measurements of 2D coverage to study interactions. Preoperative 3D percent coverage in each head region was 17.8±6.7%, 36.2±7.7%, 57.6±10.2%, and 15.3±6.4% for the anterior, superior, posterior, and inferior region, respectively. Postoperatively, 3D coverage in the anterior and superior regions increased to 23.4% and 53.7%, respectively while a significant decrease was found for the posterior and inferior regions (all p<0.01). When 3D and 2D coverage was correlated, significant positive correlation was found between the 3D superior coverage and the LCEA both preoperatively (r=0.72, p<0.01) and postoperatively (r=0.67, p<0.01). However, no correlation was found between the 3D anterior coverage and the ACEA, which became significant in the postoperative period (r=0.69, p<0.01). Results indicate that preoperative anterior coverage for patients with DDH should be evaluated three-dimensionally.

scholarly journals LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Clarabelle DeVries ◽  
Jeffrey J Nepple ◽  
Lucas Fowler ◽  
Sean Akers ◽  
Gail Pashos ◽  
...  
Keyword(s):  
Femoral Head ◽  
Normative Data ◽  
Low Dose ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Edge Angle ◽  
Center Edge ◽  
Two Sectors ◽  
Posterior Sector ◽  
Center Edge Angle

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

scholarly journals Reduction by Pelvic External Fixator Followed by Innominate and Derotational Femoral Osteotomies for Late Presenting Bilateral Developmental Dysplasia of the Hip

2018 ◽  
Vol 25 (1) ◽  
pp. 76-81
Author(s):  
Teplenky Mikhail ◽  
Mekki Waleed
Keyword(s):  
External Fixator ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Acetabular Index ◽  
Edge Angle ◽  
Center Edge ◽  
Challenging Situation ◽  
Dysplasia Of The Hip ◽  
Center Edge Angle

Introduction Bilateral developmental dysplasia of the hip is a challenging situation, closed and open reduction with or without pelvic and femoral osteotomies are all proposed. Methods We investigated the feasibility of closed ilizarov reduction combined with Salter and femoral osteotomy to provide stable concentric hips. Results We retrospectively reviewed 19 patients (38 hips). Tonnis Criteria, acetabular index and Center-edge angle were measured preoperatively and postoperatively. Acetabular index changed significantly (P<0,001), 80% were excellent or good according to Mckay, 25% were Ia and 69% were IIa Severin's criteria with at least three years follow-up. Conclusion The midterm overall results are favorable for application of this technique.

Prognostication in Developmental Dysplasia of the Hip Using the Ossific Nucleus Center Edge Angle

2018 ◽  
Vol 38 (5) ◽  
pp. 260-265 ◽  
Author(s):  
Gregory B. Firth ◽  
Anthony J.F. Robertson ◽  
Yammesh Ramguthy ◽  
Manoj Ramachandran ◽  
Anton Schepers
Keyword(s):  
Developmental Dysplasia ◽  
Edge Angle ◽  
Center Edge ◽  
Dysplasia Of The Hip ◽  
Center Edge Angle

scholarly journals PREOPERATIVE 3D MODELING AND PRINTING FOR GUIDING PERIACETABULAR OSTEOTOMY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Trevor J. Shelton ◽  
Monazzam Shafagh ◽  
Arash Calafi ◽  
Holly B. Leshikar ◽  
Brian M. Haus
Keyword(s):  
3D Modeling ◽  
Periacetabular Osteotomy ◽  
Three Dimensional ◽  
3D Models ◽  
Femoral Osteotomy ◽  
Correct Prediction ◽  
Complex Disorders ◽  
Edge Angle ◽  
Center Edge ◽  
Center Edge Angle

Background: Achieving adequate acetabular correction in multiple planes is essential to the success of Periacetabular Osteotomy (PAO). Three-dimensional (3D) modeling and printing has the potential to improve preoperative planning by accurately guiding intraoperative correction. Hypothesis/Purpose: We, therefore, asked the following questions: 1) For a patient undergoing a PAO, does 3D-modeling with intraoperative 3D-printed models create a reproducible surgical plan to obtain predetermined parameters of correction including lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), Tonnis angle, and femoral head extrusion index (FHEI), 2) Can 3D computer modeling accurately predict when a normalized FHEI can be achieved without the need for a concomitant femoral sided osteotomy? Methods: A retrospective review was conducted on forty-two (42) consecutive patients that underwent a PAO. 3D-modeling software was utilized to simulate a PAO in order to achieve normal LCEA, ACEA, Tonnis angle, and FHEI. If adequate FHEI was not achieved, a femoral osteotomy was simulated. 3D-models were printed as intraoperative guides. Preoperative, simulated, and postoperative ACEA, LCEA, Tonnis angle, and FHEI were measured and compared statistically. Results: 40 patients had a traditional PAO, and 2 had an anteverting-PAO. The simulated LCEA, ACEA, Tonnis angle, and FHEI were within a median difference of 3º, 1º, 1°, and 0% of postoperative values, respectively and showed no statistical difference. Of those that had a traditional PAO, all thirty-four (34) patients were correctly predicted to need a traditional acetabular sided correction alone and the other six (6) were correctly predicted to need a concomitant femoral osteotomy for a correct prediction in 100% of patients. Conclusion: This study demonstrated that in PAO, 3D-modeling and printing allow the surgeon to accurately create a reproducible surgical plan to obtain predetermined postoperative hip coverage parameters. This new technology has the potential to improve preoperative/intra-operative decision making for hip dysplasia and other complex disorders of the hip.

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