Use of 3D Printed Models to Determine Accurate Bone Cuts during a Periacetabular Osteotomy for Developmental Hip Dysplasia

2021 ◽  
Author(s):  
Adam Driesman ◽  
Daniel Buchalter ◽  
David J. Kirby ◽  
Nicole Wake ◽  
Pablo Castaneda
Keyword(s):  
3D Printing ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Ct Scans ◽  
Acetabular Inclination ◽  
Radiographic Outcomes ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Radiographic Measurements ◽  
3D Printed

AbstractThe periacetabular osteotomy (PAO) is a powerful tool to delay the progression of hip arthritis by reorienting the acetabulum. This study aimed to use three-dimensional (3D)-printed models of the pelvis, reconstructed from the computed tomography (CT) scans of patients, to model how the level of dysplasia and its location ilium osteotomy affect radiographic outcomes following PAO. This pilot study aims to determine if preoperative 3D printing/planning can assist in predicting radiographic outcomes. We performed a retrospective review of five patients with differing levels of hip dysplasia for whom we had obtained CT scans before PAO surgery. For each patient, we printed two pelvis models that would undergo standardized cuts of the PAO procedure, with variations only in the distance of the ilium start point (one-third of the distance between the anterior superior iliac spine and anterior inferior iliac spine [AIIS] vs. two-thirds of the distance). We then mobilized the acetabular fragment into eight reproducible positions in space by moving the ilium cut a combination of 0, 1, or 2 cm anterior/lateral. Each position of the newly realigned acetabula was examined under fluoroscopy to obtain a standardized anteroposterior view, and to obtain standardized radiographic measurements in the form of lateral center edge angle (CEA), acetabular depth, Tonnis angle, and acetabular inclination. We performed 80 simulations of the PAO with varying degrees of acetabular mobilization. On average, in the models where the supra-acetabular cut was closer to the AIIS, we found more significant degrees of radiographic correction, regarding Tonnis angles (12.91 vs. 7.95, p = 0.0175), acetabular inclination (20.25 vs. 9.875, p = 0.027), and lateral CEA (11.75 vs. 2.5, p = 0.061). Patients who had greater dysplasia also had more significant degrees of radiographic Tonnis angle correction with the same mobilization movements of the acetabula (p = 0.005). When utilizing 3D printing to model PAO in dysplasia pelvises, we found that both a higher level of preoperative dysplasia and starting the supra-acetabular osteotomy closer to the AIIS were associated with more powerful corrections following smaller manipulations.

scholarly journals Successful Outcomes at Midterm Follow-up of Periacetabular Osteotomy Done for Mild Hip Dysplasia

2017 ◽  
Vol 01 (04) ◽  
pp. 167-172 ◽  
Author(s):  
G. Potter ◽  
Eduardo Novais ◽  
Robert Trousdale ◽  
Rafael Sierra
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Demographic Variables ◽  
Harris Hip Score ◽  
Control Group ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Significant Difference

AbstractYoung hip surgeons are often faced with the decision to either perform arthroscopic surgery or a periacetabular osteotomy (PAO) in patients with symptomatic mild hip dysplasia (MHD). There is, however, a paucity of data on the results of PAO in this group. The aim of this paper is to report the results of PAOs in patients with MHD and compare those to hips with more severe forms of hip dysplasia (SHD). This data can then be used to compare emerging data reporting the results of hip arthroscopy for MHD. From January, 1996 to May, 2009, 299 hips in 268 patients were identified that underwent PAO at one institution. After removing those with <2 years of follow-up, 182 hips were followed up. The average age of the cohort was 31 years, and 85% were female. Nineteen hips with lateral center edge (LCE) angle from 18 to 25° and a Tönnis angle (TA) between 10 and 15° were considered to have MHD. This group was compared with the rest of the cohort (SHD). The mean clinical follow-up for the MHD group was 121 months. There was no significant difference in demographic variables between the groups. There were no complications in the MHD cohort. Surgical correction resulted in significant improvements in all radiographic measurements consistent with hip dysplasia in both groups. The Harris Hip Score (HHS) improved significantly in both groups ([MHD: 52–92] [SHD: 66–89]). Two hips (10.5%) in the MHD group and 15 hips (9.2%) in the SHD group underwent future THA (p = 0.69). The survivorship free from THA was 100%, 100%, and 86% at 3, 5, and 10 years, respectively, in the MHD group. The corresponding rates for hips in the control group at 3, 5, and 10 years, respectively, were 99%, 95%, and 81%. PAO in patients with MHD provides predictable improvements in pain, function, and results that are durable and comparable to hips with SHD. This data should be used to compare the early and midterm results of arthroscopic surgery performed in mildly dysplastic hips.

scholarly journals Custom 3D-printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0012
Author(s):  
Joseph Tracey ◽  
Danny Arora ◽  
Selene Parekh
Keyword(s):  
3D Printing ◽  
Tilt Angle ◽  
Three Dimensional ◽  
Case Series ◽  
The United States ◽  
Radiographic Measurements ◽  
Declination Angle ◽  
3D Printed ◽  
Talar Tilt ◽  
Radiographic Alignment

Category: Hindfoot Introduction/Purpose: Third generation total talar prostheses (TTP) are viable options for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The use of modern three-dimensional (3D) printing allows for the production of custom implants that exactly mimic the patient’s anatomy. The aim of this study is to determine the accuracy of 3D printing in reproducing a synthetic talus, and in doing so, restoring more normal anatomic relationships. We hypothesize that this mode of replication will restore and maintain normal radiographic alignment of the ankle, subtalar, and forefoot joints in the setting of talar AVN. Methods: A retrospective analysis was performed on all patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Pertinent demographic and operative factors were recorded. Radiographic measurements were taken pre- and post-operatively to determine native talar dimensions, TTP implant dimensions, and the corresponding radiographic alignment about the forefoot, hindfoot, and ankle. Results: Fourteen patients, treated for AVN between 2016-2017, were identified in our cohort. Talar arc length and width were not found to be significantly changed, however talar height was significantly increased with use of TTP. Five alignment dimensions were measured (tibiotalar alignment, talar tilt angle, Boehler’s angle, talar declination angle, and Meary’s Angle), of which, only talar tilt angle was significantly changed. Instances of Meary’s angle correction were observed in cavus and planus foot deformity. Conclusion: This study represents the largest case series of TTP performed in the United States, and is the first to investigate the 3D printed TTP. As a proof-of-concept, 3D printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. Additionally, the procedure maintained normal alignment in non-pathologic joints. Total talar prosthesis, based on our cohort, is a viable option to restore more normal anatomic alignment.

scholarly journals One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Gerardo Zanotti ◽  
Fernando Comba ◽  
Eduardo Genovesi ◽  
Martin Buttaro ◽  
Francisco Piccaluga
Keyword(s):  
Surgical Technique ◽  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Combined Treatment ◽  
Radiographic Examination ◽  
Edge Angle ◽  
One Stage ◽  
Center Edge ◽  
Center Edge Angle

Aim: We purposed to describe the surgical technique and preliminary outcomes of combined arthroscopic and periacetabular osteotomy (PAO) for the treatment of non-arthritic hip dysplasia. Methods: Between May and August 2015, 4 patients (3 female, 1 male) with an average age of 29 years old (range; 22-33) had undergone one-stage hip arthroscopy and periacetabular osteotomy. Primary symptom was pain associated with instability. Upon radiographic examination, mean lateral center-edge angle of Wiberg was 12° (range; 7°-18°). Intra-articular findings were computed and primary outomes were as follows: radiographic angular correction; time to healing after pelvis osteotomy and functional results according to Merle D’Aubigné Score. Results: Minimum follow-up was 6 months whereas maximum was 9 months. Mean surgical time was 98 minutes for hip arthroscopy and 132 minutes for the osteotomy. In all cases, a lesion of the antero-superior labrum and the chondro-labral junction was found and repaired. After correction, overall postoperative center-edge angle was 29° (range; 25°-35°). Bone healing was certified in all cases at 6 months postoperatively. Overall Merle D’Aubigné Score was 17/18 points. Conclusion: Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. Former arthroscopy enables the diagnosis of cartilage lesions and intra-articular pathology as well as it aids in proceeding or not to an open correction.

scholarly journals Is transverse screw fixation really necessary in PAO?—A comparative in vivo study

2021 ◽  
Author(s):  
Vincent J Leopold ◽  
Juana Conrad ◽  
Christian Hipfl ◽  
Maximilian Müllner ◽  
Thilo Khakzad ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Fixation Technique ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. This study aims to assess the in vivo stability of fixation in PAO with and without the use of a transverse screw. We performed a retrospective study to analyse consecutive patients who underwent PAO between January 2015 and June 2017. Eighty four patients (93 hips) of which 79% were female were included. In 54 cases, no transverse screw was used (group 1) compared with 39 with transverse screw (group 2). Mean age was 26.5 (15–44) in group 1 and 28.4 (16–45) in group 2. Radiological parameters relevant for DDH including lateral center edge angle of Wiberg (LCEA), Tönnis angle (TA) and femoral head extrusion index (FHEI) were measured preoperatively, post-operatively and at 3-months follow-up. All patients were mobilized with the same mobilization regimen. Post-operative LCEA, TA and FHEI were improved significantly in both groups for all parameters (P ≤ 0.0001). Mean initial correction for LCEA (P = 0.753), TA (P = 0.083) and FHEI (P = 0.616) showed no significant difference between the groups. Final correction at follow-up of the respective parameters was also not significantly different between both groups for LCEA (P = 0.447), TA (P = 0.100) and FHEI (P = 0.270). There was no significant difference between initial and final correction for the respective parameters. Accordingly, only minimal loss of correction was measured, showing no difference between the two groups for LCEA (P = 0.227), TA (P = 0.153) and FHEI (P = 0.324). Transverse screw fixation is not associated with increased fragment stability in PAO. This can be taken into account by surgeons when deciding on the fixation technique of the acetabular fragment in PAO.

scholarly journals Pelvic osteotomies for acetabular dysplasia: Are there outcomes, survivorship and complication differences between different osteotomy techniques?

2021 ◽  
Author(s):  
Edward C Beck ◽  
Anirudh K Gowd ◽  
Katlynn Paul ◽  
Jorge Chahla ◽  
Alejandro J Marquez-Lara ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Pelvic Osteotomy ◽  
Harris Hip Score ◽  
Rotational Acetabular Osteotomy ◽  
Complication Rates ◽  
Radiographic Measurements ◽  
Wide Range ◽  
Patient Reported ◽  
Pao Surgery

Abstract The purpose of this study was to evaluate the safety and efficacy of Periacetabular osteotomy (PAO), rotational acetabular osteotomy (RAO), and eccentric rotational acetabular osteotomy (ERAO) for treating hip dysplasia by comparing complication rates, survivorship, and functional outcomes after treatment. A systematic review in the MEDLINE and CINAHL databases was performed, and studies reporting outcomes after pelvic osteotomy for hip dysplasia with a minimum of 1-year follow-up or reported postoperative complications was included. Patient demographics, radiographic measurements, patient reported outcomes including the modified Harris hip score (mHHS), complications using the modified Clavien-Dindo classification, and reoperations were extracted from each study. A meta-analysis of outcome scores, complications, change in acetabular coverage, and revision rates for the 3 pelvic osteotomies was performed. A total of 47 articles detailing outcomes of 6,107 patients undergoing pelvic osteotomies were included in the final analysis. When stratified by procedure, RAO had a statistically greater change in LCEA when compared to PAO (33.9° vs 18.0°; P &lt;0.001). The average pooled mHHS improvement was 15.6 (95% CI: 8.3–22.8, I2= 99.4%). Although ERAO had higher mean score improvements when compared to RAO and PAO, the difference was not statistically significant (P &gt;0.05). Lastly, patients undergoing PAO had a statistically greater complication rate than those undergoing ERAO and RAO (P &lt;0.001 for both), while revision rate was not statistically different between the 3 techniques. In summary, there are many more publications on PAO surgery with a wide range of reported complications. Complications after ERAO and RAO surgery are lower than PAO surgery in the literature, but it is unclear whether this represents an actual difference or a reporting bias. Lastly, there are no significant differences between revisions, or postoperative reported outcomes between the 3 techniques.

scholarly journals Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

2017 ◽  
Vol 7 (1) ◽  
pp. 51-57
Author(s):  
Steven A Olson ◽  
Julie A Neumann ◽  
Kathleen D Rickert ◽  
Brian D Lewis ◽  
Kendall E Bradley ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Operative Time ◽  
Perioperative Complications ◽  
Periacetabular Osteotomy ◽  
Wound Complications ◽  
Complication Rates ◽  
Center Edge ◽  
Estimated Blood Loss ◽  
Articular Pathology

ABSTRACT Purpose To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia. Materials and methods Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre- and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined. Results Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAO-alone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group. Conclusion This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone. Level of evidence Level III, retrospective comparative study How to cite this article Neumann JA, Rickert KD, Bradley KE, Lewis BD, France MA, Olson SA. Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone? The Duke Orthop J 2017;7(1):51-57.

scholarly journals The use of image analysis software increases the accuracy of the periacetabular osteotomy fragment placement

2021 ◽  
Author(s):  
Alison J Dittmer Flemig ◽  
Anthony Essilfie ◽  
Brandon Schneider ◽  
Stacy Robustelli ◽  
Ernest L Sink
Keyword(s):  
Image Analysis ◽  
Periacetabular Osteotomy ◽  
Target Range ◽  
Control Group ◽  
Study Group ◽  
Analysis Tool ◽  
Analysis Software ◽  
Image Analysis Software ◽  
Acetabular Fragment ◽  
Center Edge

ABSTRACT The purpose of this study was to report on the use of image analysis technology to enhance accuracy of intra-operative imaging and evaluation of periacetabular osteotomy (PAO) correction. This was a retrospective study reporting on the first 25 cases of PAO performed with the use of an image analysis tool. This technology was used intra-operatively to assess the position of the supine coronal image in comparison to pre-operative standing images using a ratio of pelvic tilt (PT). Intra-operative PT, Tönnis angle, lateral center–edge angle (LCEA) and anterior wall index were compared to post-operative images. Post-operative radiographic parameters in the study group were compared with a control group of PAO cases performed prior to the implementation of the new software. The image analysis software was able to obtain intra-operative supine imaging that was equivalent to pre-operative standing imaging. When comparing the PAOs performed with the use of the software versus those without, the study group trended toward being more likely within the surgeon’s defined target range of radiographic values, which was statistically significant for LCEA. This tool can be used to assure the surgeon that the intra-operative image being used for surgical decision-making is representative of the functional radiograph. PAOs performed with the use of this technology showed enhanced accuracy of surgical correction for the parameters within our defined target ranges. This may increase the ability of the surgeon to place the acetabular fragment more precisely within his or her goal parameters for acetabular reorientation correction.

scholarly journals OUTCOME OF SURGICAL TREATMENT IN PATIENTS WITH BORDERLINE ACETABULAR DYSPLASIA: A COMPARATIVE ANALYSIS OF HIP ARTHROSCOPY AND PERIACETABULAR OSTEOTOMY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Jeffrey J Nepple ◽  
Maria Schwabe ◽  
Elizabeth Graesser ◽  
Cecilia Pascual-Garrido ◽  
John C Clohisy
Keyword(s):  
Surgical Outcomes ◽  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Treatment Decision ◽  
Patient Characteristics ◽  
Diagnosis And Treatment ◽  
Radiographic Measurements ◽  
Significant Difference

Background: Optimal treatments of patients with borderline hip dysplasia, defined as LCEA 20°-25°, is controversial. These patients can have symptomatic impingement and/or instability. The optimal treatment of either hip arthroscopy (HA) alone or periacetabular osteotomy (PAO) (with/without hip arthroscopy) has not been established. Purpose: The purpose of this study was to evaluate surgical outcomes of patients with borderline hip dysplasia at a minimum of 2-year follow-up. Methods: A longitudinal cohort was utilized to identify patients with borderline acetabular dysplasia defined via prospective radiographic measurements. Demographics and radiographic measurements were recorded. Patient evaluation, diagnosis and treatment decisions (PAO v HA) were made by one treating surgeon. Outcome were assessed at baseline and a minimum 2 years postoperative. Descriptive and comparative statistics were performed. Failure was defined as reoperation, or failure to reach mHHS MCID (8 points) or PASS (mHHS <74). Results: Total of 113 hips were included at 4.7 years postoperatively (range 2.0-11.2 years). Overall, 76% were female and 42% of hips had PAO (65% combined with hip arthroscopy), while 58% had isolated hip arthroscopy (HA). For PAO group, mHHS improved from 57.9 to 82.8 postoperatively, compared to 62.6 to 84.0 for the HA group. Similarly, HOOS pain (PAO 48.2 to 79.1, HA 61.2 to 82.0) and HOOS Sports (PAO 36.5 to 73.0, HA 47.8 to 74.4) demonstrated similar improvements. Comparing the PAO and HA groups, the change in PRO was significantly greater for the PAO group for HOOS Pain (10.5 ±23.2, p=0.02) and HOOS ADL (9.4 ±20.5, p=0.04) which was primarily due to a lower baseline score (similar final score). No significant difference was detected for other PROs. Reoperations in the PAO group were 2% (1 hip arthroscopy) and 6% for hip arthroscopy group (3 hip arthroscopies, 1 PAO). The failure rate was 17% for PAO and 15% for HA (p=0.86). Discussion: Surgical outcomes at minimum of 2 years in patients with borderline hip dysplasia in selected patients undergoing PAO or hip arthroscopy were good. Significant differences in patient characteristics and radiographic parameters were present between hips indicated for PAO vs. HA emphasizing the need for careful diagnosis and treatment decision-making.

scholarly journals Characterization of version in the dysplastic hip and the need for subsequent femoral derotational osteotomy after periacetabular osteotomy

2020 ◽  
Author(s):  
Andrea M Spiker ◽  
Kara G Fields ◽  
Joseph T Nguyen ◽  
Alexandra C Wong ◽  
Ernest L Sink
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Three Dimensional ◽  
Center Edge ◽  
Derotational Osteotomy ◽  
Patient Reported ◽  
Relationship Of ◽  
The Relationship ◽  
Lateral Center Edge Angle

Abstract Hip dysplasia is a three-dimensional pathomechanical condition that is often more complex than the standard method of measuring lateral center edge angle (CEA) can quantify. Yet there is a paucity of literature examining the differences in version seen between dysplastic and non-dysplastic femoroacetabular impingement (FAI) hips, the relationship of acetabular and femoral version (FV) within dysplastic hips and the contribution of each of these factors to symptoms and outcomes of dysplasia treatment. We sought to describe the acetabular version (AcetV) and FV in dysplastic hips and quantify how these measurements compared with non-dysplastic FAI hips. We also sought to analyze the association of these factors with patient-reported outcomes (PROs) after periacetabular osteotomy (PAO) and determine the need for subsequent femoral derotational osteotomy after PAO. A total of 113 dysplastic patients who underwent PAO (92% female, mean age 24) were compared with 1332 (45% female, mean age 25) non-dysplastic FAI (CEA &gt; 25°) patients. We found that dysplastic hips had a statistically higher AcetV and FV than non-dysplastic FAI hips. There was a very weak correlation between AcetV and FV in dysplastic hips, suggesting that patients with higher AcetV did not necessarily have higher FV. There was no association with AcetV or FV and patient outcomes in our very limited analysis of PROs after PAO, and only 5% of patients with excessive FV (&gt;20°) required subsequent femoral derotational osteotomy, suggesting that in a majority of patients with hip dysplasia, FV may not impact the post-operative clinical course.

scholarly journals Overcorrection of the acetabular roof angle or anterior center–edge angle may cause decrease of range of motion after curved periacetabular osteotomy

2020 ◽  
Author(s):  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Tomoyuki Kamenaga ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Periacetabular Osteotomy ◽  
Weight Bearing ◽  
Linear Regression Analysis ◽  
Femoral Anteversion ◽  
Acetabular Roof ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Roof Angle

ABSTRACT The aim of this study was to evaluate the relationship between the correction of radiographic parameters and clinical range of motion (ROM) after periacetabular osteotomy (PAO). Sixty-nine patients with hip dysplasia were enrolled and underwent curved PAO. The pre- and post-operative 3D center–edge (CE) angles, total anteversion (acetabular and femoral anteversion), and radiographic acetabular roof angle were measured and compared with the post-operative ROM. The aim of surgery was to rotate the central acetabular fragment laterally without anterior or posterior rotation. Multiple linear regression analysis demonstrated that post-operative internal rotation at 90° flexion was significantly associated with the post-operative Tönnis sourcil angle (rr = 0.31, P = 0.02) and that the post-operative ROM of flexion and internal rotation at 90° flexion were significantly associated with the anterior CE (flex; rr = −0.44, P = 0.001, internal rotation at 90° flexion; rr = −0.44, P &lt; 0.001). However, we found no association between the lateral CE, femoral anteversion, or total anteversion and the post-operative ROM. We demonstrated that the overcorrection of the acetabular roof angle or anterior CE angle may cause a decrease in the range of motion after curved PAO. Therefore, surgeons need to be careful during surgery to prevent the overcorrection of the weight-bearing area and anterior acetabular coverage of the acetabular fragment to avoid femoroacetabular impingement after PAO.

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