MRI-based 3D models of the hip joint enables radiation-free computer-assisted planning of periacetabular osteotomy for treatment of hip dysplasia using deep learning for automatic segmentation

ABSTRACT Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

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Dysplastic Hip Joint Configuration After Bernese Periacetabular Osteotomy

10.21203/rs.3.rs-366929/v1 ◽

2021 ◽

Author(s):

Kamil Kołodziejczyk ◽

Adam Czwojdziński ◽

Andrzej Sionek ◽

Jarosław Czubak

Keyword(s):

Surgical Treatment ◽

Femoral Head ◽

Normal Distribution ◽

Hip Joint ◽

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Hip Joints ◽

Radiological Parameters ◽

Significant Difference ◽

Dysplastic Hip

Abstract Background: Residual hip dysplasia is one of the factors contributing to early hip joint osteoarthritis. The main problems caused by residual dysplasia are pain and instability of the hip joint caused by the lack of sufficient bony covering of the femoral head. The aim of this work was to radiologically assess the configuration change of a dysplastic hip joint after surgical treatment using the Bernese periacetabular osteotomy procedure.Methods: We assessed the radiological parameters of patients with hip dysplasia treated by Bernense periacetabular osteotomy by performing a digital antero-posterior pelvis X-ray: central edge angle and femoral head coverage, medialization, distalization and ilio-ischial angle parameters. For normally distributed parameters, we used Student’s t-test; for parameters without a normal distribution, we used the Wilcoxon signed-rank test. Correlations were assessed according to a normal distribution using the Pearson and Spearman method.Results: For all parameters, we observed statistically significant differences in the measurements of dysplastic hip joints before and after the surgery. We also observed a statistically significant difference between the structure of dysplastic hip joints prior to the surgery and healthy hip joints from the control group based on all radiological parameters. The resulting medialization was 2.68 mm, distalization was 3.65 mm, and the ilio-ischial angle was changed by 2.62°. There was also an improvement in the femoral head bony covering: CEA by 17.61° and FHC by 16.46%.Conclusions: Based on all the radiological parameters, we presented the difference between healthy and dysplastic hip joints. Learning the parameter values that are used to describe dysplastic hip joints will allow us to improve the imaging of the condition and will also allow for better planning and proper qualification of patients for surgical treatment of hip joint dysplasia.Trial registration: Consent of the bioethics commission Medical Centre of Postgraduate Education 83/PB/2015 18.11.2015 Warsaw

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Three-Dimensional Magnetic Resonance Imaging Bone Models of the Hip Joint Using Deep Learning: Dynamic Simulation of Hip Impingement for Diagnosis of Intra- and Extra-articular Hip Impingement

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211046916 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110469

Author(s):

Guodong Zeng ◽

Celia Degonda ◽

Adam Boschung ◽

Florian Schmaranzer ◽

Nicolas Gerber ◽

...

Keyword(s):

Hip Joint ◽

Automatic Segmentation ◽

3D Models ◽

Bone Segmentation ◽

Resonance Imaging ◽

Hip Impingement ◽

Mri Scans ◽

Fully Automatic ◽

The Difference ◽

Ct And Mri

Background: Dynamic 3-dimensional (3D) simulation of hip impingement enables better understanding of complex hip deformities in young adult patients with femoroacetabular impingement (FAI). Deep learning algorithms may improve magnetic resonance imaging (MRI) segmentation. Purpose: (1) To evaluate the accuracy of 3D models created using convolutional neural networks (CNNs) for fully automatic MRI bone segmentation of the hip joint, (2) to correlate hip range of motion (ROM) between manual and automatic segmentation, and (3) to compare location of hip impingement in 3D models created using automatic bone segmentation in patients with FAI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors retrospectively reviewed 31 hip MRI scans from 26 symptomatic patients (mean age, 27 years) with hip pain due to FAI. All patients had matched computed tomography (CT) and MRI scans of the pelvis and the knee. CT- and MRI-based osseous 3D models of the hip joint of the same patients were compared (MRI: T1 volumetric interpolated breath-hold examination high-resolution sequence; 0.8 mm3 isovoxel). CNNs were used to develop fully automatic bone segmentation of the hip joint, and the 3D models created using this method were compared with manual segmentation of CT- and MRI-based 3D models. Impingement-free ROM and location of hip impingement were calculated using previously validated collision detection software. Results: The difference between the CT- and MRI-based 3D models was <1 mm, and the difference between fully automatic and manual segmentation of MRI-based 3D models was <1 mm. The correlation of automatic and manual MRI-based 3D models was excellent and significant for impingement-free ROM ( r = 0.995; P < .001), flexion ( r = 0.953; P < .001), and internal rotation at 90° of flexion ( r = 0.982; P < .001). The correlation for impingement-free flexion between automatic MRI-based 3D models and CT-based 3D models was 0.953 ( P < .001). The location of impingement was not significantly different between manual and automatic segmentation of MRI-based 3D models, and the location of extra-articular hip impingement was not different between CT- and MRI-based 3D models. Conclusion: CNN can potentially be used in clinical practice to provide rapid and accurate 3D MRI hip joint models for young patients. The created models can be used for simulation of impingement during diagnosis of intra- and extra-articular hip impingement to enable radiation-free and patient-specific surgical planning for hip arthroscopy and open hip preservation surgery.

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Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03789-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

P. Fürnstahl ◽

F. A. Casari ◽

J. Ackermann ◽

M. Marcon ◽

M. Leunig ◽

...

Keyword(s):

Pilot Study ◽

Femoral Head ◽

Periacetabular Osteotomy ◽

3D Models ◽

Contralateral Side ◽

Anatomic Reconstruction ◽

Patient Specific ◽

Rank Test ◽

Computer Assisted ◽

Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe. Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test. Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively. Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

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Magnetic resonance imaging of hip joint cartilage and labrum

Orthopedic Reviews ◽

10.4081/or.2011.e9 ◽

2011 ◽

Vol 3 (2) ◽

pp. 9 ◽

Cited By ~ 8

Author(s):

Christoph Zilkens ◽

Falk Miese ◽

Marcus Jager ◽

Bernd Bittersohl ◽

Rüdiger Krauspe

Keyword(s):

Surgical Procedures ◽

Hip Joint ◽

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Cartilage Damage ◽

Joint Damage ◽

Hip Dislocation ◽

Resonance Imaging ◽

Surgical Hip Dislocation ◽

Hip Anatomy

Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

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Hip muscle and joint contact forces before, 6 and 12 months after minimally invasive periacetabular osteotomy

Hip International ◽

10.1177/1120700020925411 ◽

2020 ◽

pp. 112070002092541

Author(s):

Henrik Sørensen ◽

Ole Skalshøi ◽

Dennis Brandborg Nielsen ◽

Julie Sandell Jacobsen ◽

Kjeld Søballe ◽

...

Keyword(s):

Minimally Invasive ◽

Contact Force ◽

Hip Joint ◽

Muscle Function ◽

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Contact Forces ◽

Joint Contact Force ◽

Hip Muscle ◽

Joint Contact

Background: Previous studies on different periacetabular osteotomy approaches for correction of hip dysplasia disagree on the time course of normalisation of muscle function postoperatively, some stating that especially hip flexor function is not fully normalised after 12 months. Purpose: The purpose of this study was to evaluate hip function during walking before, and 6 and 12 months after minimally invasive periacetabular osteotomy. Methods: Using conventional 3D inverse dynamics followed by static optimisation, we calculated hip net joint moment and angular impulse, as well as individual muscle forces and hip joint contact force, during walking for 32 patients with hip dysplasia and 32 matched controls. Results: None of the extensor and abductor measures were significantly different between controls and patients tested preoperatively, nor between any of the 3 time points patients were tested. For all of the flexor measures, patients’ preoperative values were lower than controls’, but had increased to values above the controls 6 months postoperatively. Conclusion: Hip muscle function during walking seemed normalised after 6 months after minimally invasive periacetabular osteotomy, while joint contact force did not fully normalise until 12 months postoperatively, perhaps because the hip joint structures need a longer time to heal than the muscles and a potential pain alleviating strategy was still in effect. Trial registry: Movement pattern in patients with hip dysplasia https://clinicaltrials.gov/ct2/show/NCT01344421 , NCT01344421.

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Accurate and Automatic 3D Segmentation of Femur and Pelvis from CT Images of the Hip based on Deep Learning

Journal of Imaging Science and Technology ◽

10.2352/j.imagingsci.technol.2021.65.3.030411 ◽

2021 ◽

Author(s):

Kaiyi Liang ◽

Hongchao Fu ◽

Hui Zhou ◽

Lingxia Jiang ◽

Xiaohua Yin ◽

...

Keyword(s):

Deep Learning ◽

Hip Joint ◽

Surgical Planning ◽

Computation Time ◽

Segmentation Algorithm ◽

Prosthesis Design ◽

Computer Assisted ◽

3D Segmentation ◽

Specificity And Sensitivity ◽

Augmentation Strategies

Background: Prosthesis design of hip joint and computer-assisted surgical planning can benefit from segmentation-based computed tomography (CT). Purpose: To automatically segment the three-dimensional (3D) hip joint images, the authors developed a deep learning-based segmentation algorithm and verified its feasibility with CT image of hip joint. Methods: Conventional image augmentation strategies and specific image augmentation strategies, which were designed to mimic the deformed shape and blurring boundaries of the diseased hips, were applied to obtain a large number of training samples of diseased hips to avoid overfitting. A 3D segmentation algorithm named light 3D U-net, which segmented images from coarse to fine, was developed to improve the segmentation accuracy and reduce the computation time in 3D hip joint image with multiple targets. Results and Discussion: The test results showed that the proposed method would exceed 0.9 in the aspects of Dice score, Specificity, and Sensitivity. Comparing with traditional method, the proposed method is more efficient, accurate, and robust. The proposed method has shown great potential to be applied in prosthesis design and computer-assisted surgical planning.

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Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

10.21203/rs.3.rs-37205/v3 ◽

2020 ◽

Author(s):

Philipp Fürnstahl ◽

Fabio A. Casari ◽

Joëlle Ackermann ◽

Magda Marcon ◽

Michael Leunig ◽

...

Keyword(s):

Pilot Study ◽

Femoral Head ◽

Periacetabular Osteotomy ◽

3D Models ◽

Contralateral Side ◽

Anatomic Reconstruction ◽

Patient Specific ◽

Rank Test ◽

Computer Assisted ◽

Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

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Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

10.21203/rs.3.rs-37205/v2 ◽

2020 ◽

Author(s):

Philipp Fürnstahl ◽

Fabio A. Casari ◽

Joëlle Ackermann ◽

Magda Marcon ◽

Michael Leunig ◽

...

Keyword(s):

Pilot Study ◽

Femoral Head ◽

Periacetabular Osteotomy ◽

3D Models ◽

Contralateral Side ◽

Anatomic Reconstruction ◽

Patient Specific ◽

Rank Test ◽

Computer Assisted ◽

Sphericity Index

Abstract Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

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Evaluation of Sacroiliac Wedge Rotation to Increase Acetabular Ventroversion

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632486 ◽

1999 ◽

Vol 12 (04) ◽

pp. 173-177 ◽

Cited By ~ 2

Author(s):

R. L. Aper ◽

M. D. Brown ◽

M. G. Conzemius

Keyword(s):

Hip Joint ◽

Hip Dysplasia ◽

Clinical Effect ◽

Pelvic Osteotomy ◽

Alternative Method ◽

Angular Measurements ◽

Si Joint ◽

In Vivo Effects ◽

Canine Hip Dysplasia

SummaryTreatment of canine hip dysplasia (CHD) via triple pelvic osteotomy (TPO) is widely accepted as the treatment that best preserves the existing hip joint. TPO, however, has several important disadvantages. In an effort to avoid some of the difficulties associated with TPO an alternative method of creating acetabular ventroversion (AW) was sought. The purpose of this study was to explore the effects of placement of a wedge in the sacroiliac (SI) joint on A W and to compare this to the effect of TPO on A W . On one hemipelvis a 30° pelvic osteotomy plate was used for TPO. The contralateral hemipelvis had a 28° SI wedge inserted into the SI joint. Pre- and postsurgical radiographs of each pelvis were taken and the angular measurements were recorded. On average, the 28° SI wedge resulted in 20.9° of A W, the 30° canine pelvic osteotomy plate resulted in 24.9° A W . Significant differences were not found (p >0.05) between the two techniques. Sacroiliac wedge rotation effectively creates A W and has several theoretical advantages when compared to TPO. The in vivo effects of sacroiliac wedge rotation should be studied in order to evaluate the clinical effect of the technique.Sacroiliac wedge rotation was tested as an alternative method to increase the angle of acetabular ventroversion. This technique effectively rotated the acetabulum and has several theoretical advantages when compared to triple pelvic osteotomy.

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