Editorial Commentary: Is the Lateral Center-Edge Angle Sufficient for the Approximation of Acetabular Coverage?

Objectives: Outcomes from hip arthroscopy for dysplasia and global pincer FAI have fallen short of those for patients with normal acetabular coverage, but no study has investigated arthroscopic outcomes across the spectrum of acetabular coverage. Our objective is to report comparative hip arthroscopic outcomes of patients with low (borderline dysplasia), normal, and high (global pincer FAI) lateral acetabular coverage. Methods: A retrospective analysis of prospectively-collected data from a large multi-center registry (seven United States centers) was performed. Primary hip arthroscopy patients were assigned to one of three groups based on preoperative lateral center-edge angle (LCEA): borderline dysplasia (≤25°), normal (26-38°), and pincer FAI (≥39°). Repeated measures ANOVA compared pre-operative to 2-year minimum post-operative iHOT-12 scores. Subsequent ANOVA determined the effect of acetabular coverage on magnitude of change in scores. Results: Of 437 patients, the only statistical difference between groups was lower prevalence of acetabuloplasty in the borderline dysplasia group (p=0.001). A significant improvement in the pre-operative to post-operative iHOT-12 scores for patients with normal acetabular coverage, acetabular undercoverage, and acetabular overcoverage was observed; F(1, 339)=311.06; p<0.001, with no statistical differences in pre-operative (p=0.505) and post-operative (p<0.488) iHOT-12 scores when comparing the groups based on acetabular coverage. Mean iHOT-12 scores increased from 37.3 pre-operatively to 68.7 postoperatively, p<0.001, in the borderline dysplasia group, from 34.4 to 72, p<0.001, in the normal coverage group, and from 35.3 to 69.4, p<0.001, in the pincer group. These pre-operative scores increased by 31.4, 37.8, and 34.1, respectively, with no effect for acetabular coverage on the magnitude of change from pre-operative to post-operative iHOT-12 scores, F(2,339) =1.18; p=0.310. 10 subjects (2.3%) underwent conversion arthroplasty and 19 patients (4.4%) underwent revision arthroscopy with no significant effect of acetabular coverage on the incidence of revision or conversion surgery, X2 (6,433)=11.535, P = 0.073. Conclusion: Lateral acetabular coverage did not influence outcomes from primary hip arthroscopy performed in patients with low (borderline dysplasia), normal, and high (global pincer FAI) LCEA. Borderline dysplasia and moderate global pincer FAI with no or minimal osteoarthritis do not compromise successful 2-year minimum outcomes or survivorship following primary hip arthroscopy when performed by experienced surgeons.

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Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117700589 ◽

2017 ◽

Vol 5 (4) ◽

pp. 232596711770058 ◽

Cited By ~ 10

Author(s):

James D. Wylie ◽

Ashley L. Kapron ◽

Christopher L. Peters ◽

Stephen K. Aoki ◽

Travis G. Maak

Keyword(s):

Acetabular Coverage ◽

3 Dimensional ◽

Edge Angle ◽

Center Edge ◽

Lateral Center Edge Angle ◽

Center Edge Angle

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Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

The American Journal of Sports Medicine ◽

10.1177/0363546517741704 ◽

2017 ◽

Vol 46 (3) ◽

pp. 632-641 ◽

Cited By ~ 24

Author(s):

Omer Mei-Dan ◽

Matthew J. Kraeutler ◽

Tigran Garabekyan ◽

Jesse A. Goodrich ◽

David A. Young

Keyword(s):

Soft Tissue ◽

Hip Arthroscopy ◽

Case Series ◽

Edge Angle ◽

Center Edge ◽

Hip Distraction ◽

The Mean ◽

Distraction Force ◽

Lateral Center Edge Angle ◽

Center Edge Angle

Background: Hip arthroscopy has traditionally been performed with a perineal post, resulting in various groin-related complications, including pudendal nerve neurapraxias, vaginal tears, and scrotal necrosis. Purpose: To assess the safety of a technique for hip distraction without the use of a perineal post. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed a consecutive cohort of 1000 hips presenting to a dedicated hip preservation clinic; all patients had hip pain and were subsequently treated with hip arthroscopy. Demographic variables, hip pathology, and lateral center edge angle were recorded for each case. In the operating room, the patient’s feet were placed in traction boots in a specifically designed distraction setup, and the operative table was placed in varying degrees of Trendelenburg. With this technique, enough resistance is created by gravity and friction between the patient’s body and the bed to allow for successful hip distraction without the need for a perineal post. In a subset of 309 hips (n = 281 patients), the degrees of Trendelenburg as well as the distraction force were analyzed. Results: The mean ± SD Trendelenburg angle used among the subset of 309 hips was 11° ± 2°. The mean initial distraction force necessary was 90 ± 28 lb, which decreased to 65 ± 24 lb by 30 minutes after traction initiation ( P < .0001). The most important variables in determining initial force for this cohort of patients were, in order of magnitude, sex ( P < .0001), weight ( P < .0001), and lateral center edge angle ( P < .01). No groin-related complications occurred among the entire cohort of patients, including soft tissue or nerve-related complications. The rate of deep venous thrombosis was 2 in 1000. Conclusion: The use of the Trendelenburg position and a specially designed distraction setup during hip arthroscopy allows for safe hip distraction without a perineal post, thereby eliminating groin-related soft tissue and nerve complications. Certain patient variables can be used to estimate the required distraction force and inclination angle with this method.

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Lateral Center-edge Angle on Conventional Radiography and Computed Tomography

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-012-2651-6 ◽

2012 ◽

Vol 471 (7) ◽

pp. 2233-2237 ◽

Cited By ~ 23

Author(s):

Shafagh Monazzam ◽

James D. Bomar ◽

Krishna Cidambi ◽

Peter Kruk ◽

Harish Hosalkar

Keyword(s):

Computed Tomography ◽

Conventional Radiography ◽

Edge Angle ◽

Center Edge ◽

Lateral Center Edge Angle ◽

Center Edge Angle

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The anterior center edge angle in Lequesne’s false profile view: interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-008-0694-7 ◽

2008 ◽

Vol 129 (6) ◽

pp. 787-791 ◽

Cited By ~ 20

Author(s):

P. O. Zingg ◽

C. M. L. Werner ◽

A. Sukthankar ◽

M. Zanetti ◽

B. Seifert ◽

...

Keyword(s):

Pelvic Tilt ◽

Cadaver Study ◽

Acetabular Coverage ◽

Correlation Dependence ◽

Edge Angle ◽

Center Edge ◽

Profile View ◽

Center Edge Angle

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Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up

Medwave ◽

10.5867/medwave.2020.11.8082 ◽

2020 ◽

Vol 20 (11) ◽

pp. e8082-e8082

Author(s):

Cristian Barrientos ◽

Julián Brañes ◽

Rodrigo Olivares ◽

Rodrigo Wulf ◽

Álvaro Martinez ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hip Arthroscopy ◽

Periacetabular Osteotomy ◽

Case Series ◽

Resonance Imaging ◽

Edge Angle ◽

Center Edge ◽

Lateral Center Edge Angle ◽

Center Edge Angle

Purpose To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. Methods Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. Results A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. Conclusion To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

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Value of susceptibility-weighted imaging for the assessment of angle measurements reflecting hip morphology

Scientific Reports ◽

10.1038/s41598-020-77671-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Sarah M. Böker ◽

Lisa C. Adams ◽

Ute Lina Fahlenkamp ◽

Gerd Diederichs ◽

Bernd Hamm ◽

...

Keyword(s):

Imaging Modality ◽

Linear Regression Analysis ◽

Maximum Intensity Projection ◽

Additional Information ◽

Edge Angle ◽

Center Edge ◽

Hip Morphology ◽

Line Imaging ◽

Lateral Center Edge Angle ◽

Center Edge Angle

AbstractRadiographs are the clinical first line imaging modality for evaluating hip morphology and pathology. MRI offers additional information and is the method of choice to evaluate soft tissue, bone marrow and preradiographic signs of osteoarthritis. Radiographs are used to measure the most morphometric parameters. The aim of this study was to compare susceptibility weighted MRI (SWMR) with radiographs to evaluate hip morphology. 40 Patients were examined with standard MR-sequences, coronal SWMR and radiographs in anteroposterior pelvic view. Coronal maximum intensity projection (MIP) images of both hips were automatically reconstructed on SWMR and T1weighted images. Sharp´s angle, Tönnis angle, lateral center–edge angle of Wiberg and caput-collum-diaphyseal angle were measured on coronal SWMR MIP-images, T1weighted MIP-images and radiographs. Measurements were compared by linear regression analysis and Bland-Altmann Plots, using radiographs as reference standard. Additionally, a ratio between the signal intensity of muscles and bone on SWMR and T1weighted MIP-images was calculated and compared between these two sequences. SWMR enables the reliable assessment of Sharp´s angle (SWMR: R2 = 0.80; T1weighted: R2 = 0.37), Tönnis angle (SWMR: R2 = 0.86; T1weighted: not measurable), lateral center–edge angle of Wiberg (SWMR: R2 = 0.88; T1weighted: R2 = 0.40) and caput-collum-diaphyseal angle (SWMR: R2 = 0.38; T1weighted: R2 = 0.18) compared to radiographs with a higher accuracy than conventional MR imaging. The ratio between the intensity of muscles and bone was significant higher on SWMR (2.00 and 2.02) than on T1weighted MIP-images (1.6 and 1.42; p < 0.001).

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