Assessment of pelvic morphology using 3D imaging and analysis in unilateral Crowe-IV developmental dysplasia of the hip

2020 ◽  
Vol 102-B (10) ◽  
pp. 1311-1318
Author(s):  
Yi-Fan Huang ◽  
Yu-Hang Gao ◽  
Ye-Ran Li ◽  
Lu Ding ◽  
Jian-Guo Liu ◽  
...  
Keyword(s):  
Acetabular Component ◽  
3D Imaging ◽  
Sagittal Plane ◽  
Morphological Changes ◽  
Imaging Techniques ◽  
Developmental Dysplasia ◽  
Affected Side ◽  
Healthy Side ◽  
Hip Rotation ◽  
Dysplasia Of The Hip

Aims Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with unilateral Crowe type IV DDH using 3D imaging and analysis. Methods A total of 20 patients with unilateral Crowe-IV DDH were included in the study. The contralateral side was considered normal in all patients. A coordinate system based on the sacral base (SB) in a reconstructed pelvic model was established. The pelvic orientations (tilt, rotation, and obliquity) of the affected side were assessed by establishing a virtual anterior pelvic plane (APP). The bilateral coordinates of the anterior superior iliac spine (ASIS) and the centres of hip rotation were established, and parameters concerning size and volume were compared for both sides of the pelvis. Results The ASIS on the dislocated side was located inferiorly and anteriorly compared to the healthy side (coordinates on the y-axis and z-axis; p = 0.001; p = 0.031). The centre of hip rotation on the dislocated side was located inferiorly and medially compared to the healthy side (coordinates on the x-axis and the y-axis; p < 0.001; p = 0.003). The affected hemipelvis tilted anteriorly in the sagittal plane (mean 8.05° (SD 3.57°)), anteriorly rotated in the transverse plane (mean 3.31° (SD 1.41°)), and tilted obliquely and caudally in the coronal plane (mean 2.04° (SD 0.81°)) relative to the healthy hemipelvis. The affected hemipelvis was significantly smaller in the length, width, height, and volume than the healthy counterpart. (p = 0.014; p = 0.009; p = 0.035; p = 0.002). Conclusion Asymmetric abnormalities were identified on the affected hemipelvis in patients with the unilateral Crowe-IV DDH using 3D imaging techniques. Improved understanding of the morphological changes may influence the positioning of the acetabular component at THA. Acetabular component malpositioning errors caused by anterior tilt of the affected hemi pelvis and the abnormal position of the affected side centre of rotation should be considered by orthopaedic surgeons when undertaking THA in patients with Crowe-IV DDH. Cite this article: Bone Joint J 2020;102-B(10):1311–1318.

scholarly journals How to Restore Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology? A Pilot Study

2020 ◽  
Author(s):  
Heng Zhang ◽  
Yang Liu ◽  
Kuanxin Li ◽  
Zheng Zhang ◽  
Jianzhong Guan ◽  
...  
Keyword(s):  
Bone Defect ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Acetabular Cup ◽  
Printing Technology ◽  
Rotation Center ◽  
End Stage ◽  
Hip Rotation ◽  
Dysplasia Of The Hip

Abstract Background: It is technically challenging to restore hip rotation center exactly in total hip arthroplasty (THA) for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) due to the complicated acetabular morphology changes.In this study, we developed a new method to restore hip rotation center exactly and rapidly in THA with the assistance of three dimensional (3-D) printing technology.Methods: Seventeen patients (21 hips) with end-stage osteoarthritis secondary to DDH who underwent THA were included in this study. Simulated operations were performed on 3-D printed hip models for preoperative planning. The Harris fossa and acetabular notches were recognized and restored to locate acetabular center. The agreement in the size of acetabular cup and bone defect between simulated operations and actual operations were analyzed.Clinical and radiographic outcomes were recorded and evaluated.Results: The sizes of the acetabular cup of simulated operations on 3-D printing models showed a high rate of coincidence with the actual sizes in the operations(ICC value=0.930) There was no significant difference statistically between the sizes of bone defect in simulated operations and the actual sizes of bone defect in THA( t value=0.03，P value=0.97). The average Harris score of the patients was improved from (38.33±6.07) preoperatively to the last follow-up (88.61±3.44) postoperatively.The mean vertical and horizontal distances of hip rotation center on the pelvic radiographs were restored to (15.12 ± 1.25）mm and ( 32.49±2.83) mm respectively. No case presented dislocation or radiological signs of loosening until last follow-up.Conclusions: The application of 3-D printing technology faciliate orthopedists to recognize the morphology of Harris fossa and acetabular notches , locate the acetabular center and restore the hip rotation center rapidly and acurately.

scholarly journals The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongshan Cheng ◽  
Muyin Huang ◽  
Willem Alexander Kernkamp ◽  
Huiwu Li ◽  
Zhenan Zhu ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Type I ◽  
Type Ii ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI). Methods This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall’s coefficient of concordance was used to determine the correlation between the severity of DDH and PI. Results Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222). Conclusions No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.

Usefulness of Measuring Acetabular Anterior Coverage Using a Tomosynthesis Imaging System

2017 ◽  
Vol 27 (1) ◽  
pp. 87-91
Author(s):  
Tadahiko Ohtsuru ◽  
Yasuyuki Morita ◽  
Yuhei Horiuchi ◽  
Yasuaki Murata ◽  
Shuji Shimamoto ◽  
...  
Keyword(s):  
Anterior Margin ◽  
Sagittal Plane ◽  
Imaging System ◽  
Early Stage ◽  
Intraclass Correlation ◽  
Standing Position ◽  
Developmental Dysplasia ◽  
Strong Positive Correlation ◽  
Effective Doses ◽  
Dysplasia Of The Hip

Purpose The purpose of this study was to compare the usefulness of measuring acetabular anterior coverage by tomosynthesis and false profile (FP) radiography. Methods 70 hips in 35 patients who were diagnosed with early stage osteoarthritis of the hip, and 60 hips from 30 healthy volunteers were analysed. Plain FP radiographs were taken, and vertical-centre-anterior margin (FP-VCA) angles were measured. Acetabular anterior coverage was measured in the natural standing position using a tomosynthesis imaging system in the sagittal plane. As with FP radiography, we measured vertical-centre-anterior margin (TS-VCA) angles. Results The median values of the FP-VCA angle, and TS-VCA angle were 43.8°, 54.4°, respectively. The TS-VCA angle was significantly larger than the FP-VCA angle. For FP radiographs, the intraobserver intraclass correlation coefficient (ICC) was 0.68, and the interobserver ICC was 0.79. For tomosynthesis sagittal images, the intraobserver ICC was 0.85, and the interobserver ICC was 0.92. There was a strong positive correlation between the TS-VCA angle and the FP-VCA angle. When the FP-VCA angle was 25°, the TS-VCA angle was 35° in regression analysis. Conclusions Measuring acetabular anterior coverage using sagittal plane tomosynthesis correlates well with FP radiography. Regardless of the presence of acetabular deformities, tomosynthesis demonstrated high reproducibility, simple posture setting, low effective doses, and high versatility. A cut-off value of 35° was useful for the detection of developmental dysplasia of the hip joint using the TS-VCA angle.

scholarly journals Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Alexander Kolb ◽  
Catharina Chiari ◽  
Markus Schreiner ◽  
Stephan Heisinger ◽  
Madeleine Willegger ◽  
...  
Keyword(s):  
Navigation System ◽  
Sagittal Plane ◽  
Ultrasound Image ◽  
Frontal Plane ◽  
Developmental Dysplasia ◽  
Axial Plane ◽  
Conventional Group ◽  
Ultrasound Screening ◽  
The Impact ◽  
Dysplasia Of The Hip

Abstract To develop an electronic navigation system to increase reliability and comparability in the ultrasound screening of developmental dysplasia of the hip (DDH). The impact of the navigation system on transducer positioning and on sonographic measurements according to Graf was analyzed. Twenty hips in newborns were examined sonographically using a new navigation system capable of detecting the transducer and pelvis position in order to calculate the relative tilt in the frontal, axial, and sagittal-plane. In each newborn an ultrasound image was obtained conventionally according to Graf and a second image using the sonographic navigation system. Relative roll and pitch angles and sonographic measurements were analyzed using paired T-tests and Levene-tests. Relative tilt angles in the conventional group ranged from − 8.9° to 14.3° (frontal-plane) and − 23.8° to 14.2° (axial-plane). In the navigation-assisted group ranges from − 3.0° to 3.5° and − 2.8° to 4.5° were observed. Variances were significantly lower in the navigation-assisted group (p < 0.001 and p = 0.004 respectively). The navigation system allowed for a significant reduction of relative tilt angles between the transducer and the newborn pelvis, thus supporting an optimal transducer positioning. This is a promising approach to improve reproducibility and reliability in the ultrasound screening for DDH.

scholarly journals How to restore rotation center in total hip arthroplasty for developmental dysplasia of the hip by recognizing the pathomorphology of acetabulum and Harris fossa?

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Heng Zhang ◽  
Jiansheng Zhou ◽  
Jianzhong Guan ◽  
Hai Ding ◽  
Zhiyan Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Horizontal Distance ◽  
Total Hip ◽  
Rotation Center ◽  
Pelvic Radiographs ◽  
End Stage ◽  
Hip Rotation ◽  
Dysplasia Of The Hip

Abstract Purpose To restore rotation center exactly in total hip arthroplasty (THA) is technically challenging for patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH). The technical difficulty is attributable to the complex acetabular changes. In this study, we investigated the pathomorphology of acetabulum and Harris fossa of Crowe types I to IV and discussed the method of restoring rotation center of the hip. Methods This study retrospectively reviewed 56 patients (59 hips) who underwent cementless THA due to end-stage osteoarthritis of DDH. The pathomorphology of acetabulum and Harris fossa was observed during operations. Using the preoperative and postoperative pelvic radiographs, the vertical and the horizontal distances of hip rotation center were measured in order to evaluate the effects of restoring rotation center of the hip. Results Adult DDH acetabulum could be classified into four basic pathological types which include the shallow cup shape, the dish shape, the shell shape, and the triangular shape. Adult DDH Harris fossa could be classified into four pathological types, including the crack shape, the closed shape, the triangle shape, and the shallow shape, in accordance with the osteophyte coverage. The vertical and horizontal distances of hip rotation center on the pelvic radiographs before and after operations were as follows: the preoperative vertical distance of hip rotation center was (39.96 ± 5.65) mm, and the postoperative one was (13.83 ± 2.66) mm; the preoperative horizontal distance of hip rotation center was (42.15 ± 6.42) mm, and the postoperative one was (28.12 ± 4.56) mm. Conclusions The acetabulum and Harris fossa can display different pathological types on account of different degrees of dislocation and osteophyte hyperplasia in the end-stage osteoarthritis of adult DDH. The hip rotation center can be accurately restored by locating the acetabular center with Harris fossa and acetabular notch as the marks.

scholarly journals The role of the labrum in early treatment of unstable developmental dysplasia of the hip

2019 ◽  
Vol 4 (6) ◽  
pp. 296-301
Author(s):  
Maurizio De Pellegrin ◽  
Lucrezia Montanari ◽  
Desiree Moharamzadeh ◽  
Oliver Eberhardt
Keyword(s):  
Statistical Analysis ◽  
Ultrasound Examination ◽  
Morphological Changes ◽  
Developmental Dysplasia ◽  
Type D ◽  
Type Iv ◽  
End Of Treatment ◽  
The Us ◽  
Dysplasia Of The Hip

The objective of the paper is to analyse the role of the labrum with particular attention to its morphological changes in unstable dysplastic hips during treatment. Between January 2013 and December 2015, data were collected on 86 unstable, dysplastic hips, which were divided into type D (n = 13), type III (n = 49) and type IV (n = 24). The labrum was evaluated with ultrasound examination (US) for echogenicity and dimensions with inter-/intra-observer tests comparing the US images at diagnosis and at the end of treatment. Statistical analysis was performed. At the end of treatment of unstable, dysplastic hips, the labrum was more echogenic with a frequency of 97% and was larger with a frequency of 96%. The labrum has an active stabilizing role in unstable dysplastic hips and it undergoes a statistically significant increase of echogenicity and dimensions after treatment. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180053

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