SHOULD WE FEAR THE BORDERLINE DYSPLASTIC HIP?: EXTERNAL VALIDATION OF THE FEAR INDEX IN THE SETTING OF BORDERLINE ACETABULAR DYSPLASIA

Introduction: The Femoro-Epiphyseal Acetabular Roof (FEAR) index has recently been proposed as a useful tool in identifying hips with instability in the setting of borderline acetabular dysplasia. Beck et al. were the first to describe this parameter and demonstrated a FEAR index as the angle between a line connecting the most medial and lateral part of the sourcil and a line connecting the most medial and lateral part of the straight central third of the physeal scar. Purpose: The purposes of the current study were 1) external validation of intra-observer and inter-observer reliability and 2) to determine the correlation/association of FEAR with a clinical diagnosis of instability. Methods: The current study was a retrospective review of patients diagnosed with borderline acetabular dysplasia by a single surgeon. The study period included January 2008-April 2017 and identified patients with LCEA 20°-25°, via prospectively collected radiographic measurements in a hip preservation database. Inclusion criteria were treatment with either hip arthroscopy or PAO, LCEA of 20°-25°, and 14-40 years of age. Patients were excluded if they had a Tӧnnis grade ≥2, prior ipsilateral hip surgery, residual deformities from SCFE or Perthes. Demographics and radiographic measurements were recorded. Two individuals read all radiographs after obtaining an intra observer reliability of 97% and inter observer reliability of 88%. Sensitivity and specificity were calculated for FEAR predicting instability. A t-test was used to assess correlation of LCEA, acetabular inclination (AI), and ACEA with FEAR. Results: A total of 186 patients were included, FEAR was unable to be assessed in 5% of hips because of inability to visualize the proximal femoral physeal scar. Of the remaining 176 hips, 18% of hips had a FEAR index >5°. FEAR positive mean was 7.6°±2.8° (range=5.1°-17.5°) and FEAR negative mean was –6.9°±6.4° (range=-29.4°-3.7°). Results of FEAR predicting instability was sensitivity=33% (23/70), specificity=92% (98/106), PPV=74% (23/31), and NPV=67% (98/145). The mean AI was significantly high in FEAR(+) hips (AI mean=11.2° and FEAR(-) AI mean=9.5°; p=0.005). No difference in LCEA or ACEA was seen relative to the presence of FEAR. Discussion: In the current study, a positive FEAR index was generally indicative of the presence of clinical instability. However, the FEAR index was poorly sensitive to hip instability with 67% hips diagnosed with instability having a negative FEAR index.

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Development and External Validation of a Novel Clinical Score to Quantify the Presence of Instability Characteristics in Patients with Borderline Acetabular Dysplasia

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00431 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0043

Author(s):

Elizabeth Graesser ◽

Lee Rhea ◽

Cecilia Pascual-Garrido ◽

John Clohisy ◽

Jeffrey Nepple ◽

...

Keyword(s):

Acetabular Dysplasia ◽

External Validation ◽

Alpha Angle ◽

Hip Instability ◽

Discriminatory Ability ◽

Edge Angle ◽

C Statistic ◽

Center Edge ◽

Center Edge Angle ◽

Multicenter Prospective Cohort

Objectives: Treatment of borderline acetabular dysplasia is controversial. The existing literature lacks direct comparisons of different treatment approaches and focuses on lateral center edge angle (LCEA), failing to account for other important diagnostic characteristics. The purpose of this study was (1) to determine the most important characteristics in determining hip instability in this population, and (2) to develop a nomogram for clinical use and calculation of the Borderline Hip Instability Score (BHIS), and (3) to externally validate the BHIS in a multicenter prospective cohort of patients with borderline acetabular dysplasia. Methods: The current study included two parts. In Part 1, this study utilized a retrospective cohort study of 186 hips (178 patients) undergoing surgical treatment in setting of borderline acetabular dysplasia (LCEA 20°-25°) from a single surgeon experienced in arthroscopic and open techniques. Patients were excluded if over 40 years of age, Tonnis grade ≥2, prior ipsilateral surgery, or residual pediatric or neuromuscular disease. Multivariate analysis determined characteristics associated with presence of instability (treated with PAO +/- hip arthroscopy) or absence of instability (treated with isolated hip arthroscopy) based on clinical diagnosis of the single surgeon. During the study period, 39.8% of the cohort underwent PAO. Multivariate analysis with bootstrapping was performed and results were transformed into a nomogram and BHIS (higher score representing more instability). In Part 2, the BHIS was externally validated in a cohort of 114 patients with borderline acetabular dysplasia enrolled in a multicenter prospective cohort study across 10 other surgeons (with varied treatment approaches from arthroscopy to open procedures). Results: In Part 1, the most parsimonious and best fit model included 4 variables associated with instability: acetabular inclination (AI), anterior center edge angle (ACEA), maximum alpha angle, and internal rotation in 90 degrees of flexion (IRF). Odds ratio estimates and 95% confidence limits were 1.50 (1.28-1.76), 0.92 (0.86-0.99), 0.94 (0.90-0.98), and 1.11 (1.07-1.17), respectively. Notably, sex and LCEA were not significant predictors. The BHIS demonstrated excellent predictive (discriminatory) ability with c-statistic=0.89. Mean BHIS in the population was 50.0 (instability 57.7 ±7.9 vs. non-instability 44.8±7.3, p<0.001). BHIS demonstrated excellent predictive (discriminatory) ability with c-statistic=0.89. In Part 2, BHIS maintained excellent c-statistic=0.92 in external validation. Mean BHIS in this cohort was 53.9 (instability 66.5±11.5 vs. non-instability 43.0±10.8, p<0.001). Conclusion: In patients with borderline acetabular dysplasia, AI, ACEA, maximum alpha angle, and IRF were key factors in diagnosing significant instability treated with PAO. The BHIS effectively quantifies relative role of each factor and characterizes aspects of instability compared to the mean (BHIS=50) in this population. The BHIS score allowed for good differentiation of patients with and without instability in the development cohort, as well as the external validation cohort. Use of the BHIS score may facilitate efficient clinical characterization of important patient characteristics in the setting of borderline acetabular dysplasia.

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Imaging Markers of Hip Instability are Associated with Worse Outcomes at Two to Four-year Follow-up in Female Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00427 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0042

Author(s):

Brandy Horton ◽

Hugh West ◽

Jenny Marland ◽

James Wylie

Keyword(s):

Hip Arthroscopy ◽

Acetabular Dysplasia ◽

Posterior Wall ◽

Anterior Wall ◽

Femoral Anteversion ◽

Hip Instability ◽

Female Patients ◽

Imaging Markers ◽

Fear Index

Objectives: To investigate the effect of radiographic markers of hip instability on outcomes of female patients undergoing hip arthroscopy for femoroacetabular impingement. Methods: This was a retrospective reviewof a prospectively collected cohort of females undergoing hip arthroscopy with a diagnosis of FAI treated with femoral osteoplasty with or without labral repair. iHOT-12 was collected preoperatively and at 2 to 4-year follow-up. Radiographs were reviewed and anterior wall index (AWI), posterior wall index (PWI), femoro-epiphyseal acetabular roof (FEAR) index, and lateral center edge angle (LCEA) were recorded in all patients. Computed tomography was used to quantify femoral anteversion in all patients. A laterally oriented FEAR index is considered positive (unstable), while a medially oriented fear index is considered negative (impingement/stable). An AWI of <0.30 and a PWI<0.80 were considered anterior wall deficient (AWD) and posterior wall deficient (PWD), respectively. Patients with borderline acetabular dysplasia (LCEA≤25) were groups as medially or laterally oriented FEAR index. Similarly, patients with borderline acetabular dysplasia(LCEA≤25) were groups as elevated femoral anteversion (>15 degrees) or not. Differences in means were tested using a students t-test or an analysis of variance with a post-hoc tukey’s test. Results: There were 175 Female patients with a mean age of 33 years. Mean follow up was 34.6 months. Mean preoperative iHOT12 was 30.4. Mean postoperative iHOT12 was 74.8. Mean FA was 11.7 (Range 1 to 34) degrees. There were 64 patients with an LCEA≤25, 138 patients had no AWD or PWD, 18 patients with an AWI <0.30 and 18 patients with a PWI <0.80. One patient was excluded from the analysis for having both an AWI<0.30 and a PWI<0.8. Patients with AWD had lower mean iHOT at follow up (54.5 compared with those with no wall deficiency 77.7, p=0.001.) Patents with PWD did not (72.4 compared with those with no wall deficiency 77.7, p=0.669.) Similarly, patients with AWD had lower mean iHOT improvement at follow up (24.2 compared with those with no wall deficiency 47.0, p=0.001). Patents with PWD did not (43.1 compared with those with no wall deficiency 47.0, p=0.808). Mean FEAR index was -7.1(Range -30 to 15) degrees. The FEAR index correlated with both the iHOT12 at follow up (-0.171, p=0.024) and the improvement in the iHOT12(-0.192, p=0.011). There were 31 patients with a laterally oriented FEAR index. These patients had worse iHOT12 at follow-up (64.9 points versus 77.0 points, p=0.037) and less improvement in iHOT12 (34.3 points versus 46.6 points, p=0.015). There were 110 patients with LCEA>25, 42 patients with LCEA≤25 with a medially oriented FEAR index and 23 patients with an LCEA≤25 with a laterally oriented FEAR index. Patients with LCEA≤25 and a laterally oriented FEAR index had worse iHOT12 at follow-up (60.7 points versus 78.9 points, p=0.005) and less improvement in iHOT12 from surgery (30.0 points versus 49.5 points, p=0.002) compared to those with an LCEA>25. There were 110 patients with LCEA>25, 46 patients with LCEA≤25 and FA <15 degrees and 17 patients with LCEA≤25 and FA≥15 degrees. Patients with LCEA≤25 had worse iHOT12 at follow-up (68.0 points versus 78.9 points, p=0.010) and less improvement in iHOT12 from surgery (36.0 points versus 49.5 points, p=0.001) compared to those with an LCEA>25. Patients with LCEA≤25 and FA≥15 degrees had worse iHOT12 at follow-up (59.5 points versus 78.9 points, p=0.008) and less improvement in iHOT12 from surgery (28.2 points versus 49.5 points, p=0.003) compared to those with an LCEA>25. In addition, patients with LCEA≤25 and FA<15 degrees had less improvement iHOT12 from surgery (38.0 points versus 49.4 points, p=0.026) compared to those with an LCEA>25. Conclusion: Imaging markers of hip instability, including borderline acetabular dysplasia, increased femoral anteversion, a laterally oriented FEAR index, and anterior wall deficiency are predictive of worse outcomes of hip arthroscopy for FAI in female patients. A more thoughtful imaging analysis of female patients preoperatively may identify patients at risk of worse outcomes after hip arthroscopy and may guide treatment with other joint preserving procedures, including periacetabular or femoral osteotomy.

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Diferentes índices radiográficos versus Índice Acetabular en la decisión de colocación de Arnés de Pavlik en pacientes con diagnóstico de Displasia de Cadera

Revista Medica Vozandes ◽

10.48018/rmv302.5 ◽

2019 ◽

Vol 30 (2) ◽

Author(s):

Diego Silva Tirado ◽

Francisco Vallejo Cifuentes

Keyword(s):

Physical Examination ◽

Developmental Dysplasia ◽

Acetabular Index ◽

Orthopedic Treatment ◽

Hip Instability ◽

X Ray ◽

A Value ◽

Radiographic Measurements ◽

Grade Ii ◽

The Mean

There are different x-ray indices and classifications for the diagnosis of Hip Developmental Dysplasia, this study compared the usefulness of different x-ray parameters in patients with high acetabular indices to determine whether or not would benefit from orthopedic treatment. Patients and Methods: Retrospective cohort study. Patients aged 3 to 7 months, attended in the external consultation of Traumatology and Pediatric Orthopedics of the Hospital Vozandes Quito in the period January to December 2017 were included in the study. Signs of hip instability to physical examination, radiographic measurements: acetabular index, percentage of femoral head migration, Smith index, Tonnis classification by quadrants, formation of the radiographic acetabular eyebrow were obtained from the medical record of each patient. Results: 104 patients were evaluated, the median age at the time of diagnosis was 4.63 months, 52% were male and the mean acetabular index was 37.9 degrees. Patients were subdivided into 2 groups according to the orthopedic treatment instituted: with Pavlik harness (38.5%) and without a harness (61.5%). When comparing patients without and with harness we got an OR of 1.07 and a value of p-0.69. Patients with a Grade I Tonnis scale had a 96% chance of developing a normal hip relative to Tonnis Grade II (60%), with an OR of 21.3 and p-0.69. Conclusions: There is a group of patients with a high acetabular index and hips stable to the physical examination who would not benefit from orthopedic treatment, within all the parameters evaluated we observe that the normal radiographic acetabular eyebrow and the Tonnis scale grade I were predictor parameters of a good response at 2 months.

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Establishment of Normal Mechanical Tibial Joint Angles in Dachshunds

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1722336 ◽

2021 ◽

Author(s):

Charlotte Banks ◽

Richard Meeson ◽

Elvin Kulendra ◽

Darren Carwardine ◽

Benjamin Mielke ◽

...

Keyword(s):

Standard Deviation ◽

Surgical Planning ◽

Sagittal Plane ◽

Frontal Plane ◽

Joint Angles ◽

Interclass Correlation Coefficient ◽

Observer Reliability ◽

Radiographic Measurements ◽

Interclass Correlation ◽

The Mean

Abstract Objective The aim of this study was to establish breed-standard mechanical tibial joint reference angles in the frontal plane in Dachshunds. Study Design Craniocaudal (n = 38) and mediolateral (n = 32) radiographs of normal tibiae from Dachshunds were retrospectively reviewed. The mechanical medial proximal, mechanical medial distal, mechanical caudal proximal and mechanical cranial distal tibial angles were measured on three occasions by two separate observers using previously established methodology. Interclass correlation coefficient was used to assess the reliability of radiographic measurements. Results The mean and standard deviation for mechanical medial proximal, mechanical medial distal, mechanical caudal proximal and mechanical cranial distal were 93.1 degrees ± 4.2, 97.5 degrees ± 3.9, 75.3 degrees ± 3.7 and 85.0 degrees ± 5.3 respectively. Intra-observer reliability was good to excellent for all measures, while inter-observer reliability was moderate to excellent in the frontal plane and poor to good in the sagittal plane. Dachshund-specific joint reference angles were similar to a range of previously reported non-chondrodystrophic breeds in the frontal plane but differed to most in the sagittal plane. Conclusion Dachshund tibial joint reference angles are reported which can be used in surgical planning for correction of bilateral pes varus.

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Surgical treatment of dysplastic hip instability in children

Practical medicine ◽

10.32000/2072-1757-2019-6-39-42 ◽

2019 ◽

Vol 17 (6 (part 2)) ◽

pp. 39-42

Author(s):

P. S. Andreev ◽

◽

I. F. Akhtyamov ◽

A. P. Skvortsov ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Hip Instability ◽

Dysplastic Hip

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Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽

10.1161/circ.142.suppl_3.16884 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Brian Liu ◽

Arismendy Nunez-Garcia ◽

Cao Tran ◽

Michael Wu

Keyword(s):

Atrial Fibrillation ◽

Atrial Tachycardia ◽

Statistical Significance ◽

Univariate Analysis ◽

External Validation ◽

Posterior Wall ◽

High Rate ◽

Single Center Experience ◽

The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

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Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

Giornale Italiano di Endodonzia ◽

10.4081/j.gien.2018.10 ◽

2018 ◽

Vol 32 (1) ◽

pp. 9-16 ◽

Cited By ~ 3

Author(s):

Luiz Alexandre Chisini ◽

Guillermo Grazioli ◽

Alejandro Francia ◽

Alissa Schmidt San Martin ◽

Flavio Fernando Demarco ◽

...

Keyword(s):

Clinical Success ◽

Mineral Trioxide Aggregate ◽

Clinical Success Rate ◽

Permanent Teeth ◽

Radiographic Outcomes ◽

Bias Risk ◽

Radiographic Measurements ◽

High Bias ◽

The Mean

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

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Observations on radiological correction of acetabular dysplasia by Dega transiliac osteotomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171831 ◽

2017 ◽

Vol 5 (5) ◽

pp. 1991

Author(s):

Wazir Fahad Jan ◽

Sanjay Sarup ◽

Mohd Yahya Dar ◽

Alamgir Jahan ◽

Ovais Nazir Khan

Keyword(s):

Acetabular Dysplasia ◽

Mean Value ◽

P Value ◽

Preoperative Period ◽

Radiological Parameters ◽

Male Patients ◽

The Mean ◽

Paediatric Orthopaedic ◽

Age Range

Background: Several osteotomies have been described for the correction of acetabular dysplasia associated with variable outcomes. The purpose of our study was to evaluate the effect of Dega transiliac osteotomy in radiological correction of acetabular dysplasia by assessing the change in various radiological parameters from preoperative period to postoperative period and at a follow up of two years.Methods: This was a prospective observational study conducted on 35 patients of either sex, in the age range of 18 months to 8 years, presenting to the paediatric orthopaedic OPD, of Artemis Health Institute, Gurgaon, Haryana, India between January 2012 and September 2014 in whom a diagnosis of acetabular dysplasia was made. All the patients underwent Dega transiliac osteotomy and the effectiveness of this osteotomy in the correction of acetabular dysplasia was assessed by measuring various radiological parameters preoperatively, postoperatively, and at a follow up of two years. The various radiological parameters included acetabular index (AI), centre edge angle of wiberg (CEAW), reimer’s extrusion index (REI) and the shenton’s line (SL).Results: In present study sample of 35 cases, 29 had DDH, 4 were secondary to cerebral palsy and 2 had developed dysplasia following septic arthritis of the hip. The sex distribution showed 19 females and 16 male patients. All the patients underwent Dega transiliac osteotomy at a mean age of 42.94±21.68 months. The mean value of AI improved from 42.43±4.77 degrees in preoperative period to 19.86±2.45 degrees at follow up. The mean value of CEAW improved from - 32.49±21.60 degrees in preoperative period to 32.06±5.48 degrees at follow up. The mean value of REI, improved from 91.06±21.43 % in preoperative period to 0.29±1.18 % at follow up. The SL was broken in all the 35 patients preoperatively, while at follow up it was continuous in all the patients. These changes in all the four parameters were statistically highly significant (p value<0.001).Conclusions: Thus results of present study demonstrate that Dega osteotomy is a safe, effective and versatile surgical procedure for the treatment of acetabular dysplasia secondary to DDH and other disorders. Since the majority of the patients included in this study had the diagnosis of DDH, the results of this study are more representative of dysplasia associated with DDH.

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Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-101453 ◽

2020 ◽

Vol 54 (11) ◽

pp. 631-641 ◽

Cited By ~ 6

Author(s):

Michael P Reiman ◽

Rintje Agricola ◽

Joanne L Kemp ◽

Joshua J Heerey ◽

Adam Weir ◽

...

Keyword(s):

Diagnostic Imaging ◽

Clinical Utility ◽

Acetabular Dysplasia ◽

Ligamentum Teres ◽

Research Network ◽

Future Research ◽

Middle Aged ◽

Hip Instability ◽

Active Adults ◽

Fai Syndrome

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

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Radiological Outcomes of Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00329 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Thomas L. Lewis ◽

Robbie Ray; David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Weight Bearing ◽

Case Series ◽

Deformity Correction ◽

Third Generation ◽

Radiographic Measurements ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Category: Bunion Introduction/Purpose: Minimally invasive surgery for hallux valgus has significantly increased in popularity recently due to smaller incisions, reduced soft tissue trauma, and the ability to achieve large deformity corrections compared to traditional treatments. This study aimed to investigate the radiological outcomes and degree of deformity correction of the intermetatarsal angle (IMA) and the hallux valgus angle (HVA) following third generation (using screw fixation) Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus. Methods: A single surgeon case series of patients with hallux valgus underwent primary, third generation MICA for hallux valgus. Pre- and post-operative (6 weeks after surgery) radiological assessments of the IMA and HVA were based on weight-bearing dorso-plantar radiographs. Radiographic measurements were conducted by two foot & ankle fellowship trained consultant surgeons (RR, DG). Paired t-tests were used to determine the statistically significant difference between pre- and post-operative measurements. Results: Between January 2017 and December 2019, 401 MICAs were performed in 274 patients. Pre- and post-operative radiograph measurements were collected for 348 feet in 232 patients (219 female; 13 male). The mean age was 54.4 years (range 16.3-84.9, standard deviation (s.d.) 13.2). Mean pre-operative IMA was 15.3° (range 6.5°-27.0°, s.d. 3.4°) and HVA was 33.8° (range 9.3°-63.9°, s.d. 9.7°). Post-operatively, there was a statistically significant improvement in radiological deformity correction; mean IMA was 5.3° (range -1.2°-16.5°, s.d. 2.7°, p<0.001) and mean HVA was 8.8° (range -5.2°-24.0°, s.d. 4.5°, p<0.001). The mean post-operative reduction in IMA and HVA was 10.0° and 25.0° respectively. Conclusion: This is the largest case series demonstrating radiological outcomes following third generation Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus to date. These data show that this is an effective approach at correcting both mild and severe hallux valgus deformities. Longer term radiological outcome studies are needed to investigate whether there is any change in radiological outcomes. Correlation with patient reported outcomes is planned.

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