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Orita K, Goto K, Kuroda Y, Kawai T, Okuzu Y, Morita Y, Matsuda S. Osteotomy across arcuate line in ilium needs prudence in curved periacetabular osteotomy. J Orthop 2025; 68:51-57. [PMID: 40007521 PMCID: PMC11849105 DOI: 10.1016/j.jor.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 02/02/2025] [Indexed: 02/27/2025] Open
Abstract
Background This study aimed to measure the optimal osteotomy angle and length, as well as the available width of the osteotomy site in the posterior column for the safe performance of periacetabular osteotomy. Methods Fifty-six hips in 41 patients who underwent curved periacetabular osteotomy were evaluated. Computed tomography data were subjected to multiplanar reconstruction to measure parameters in two reference planes: the functional pelvic plane and the anterior pelvic plane. The optimal osteotomy angle, osteotomy length, and available width of the posterior column were defined. We assessed the possible factors affecting the optimal osteotomy angle. Results The functional pelvic plane showed an average and maximum anterior pelvic tilt of 7.8° and 16.4°, respectively, from the anterior pelvic plane. The optimal osteotomy angles had comparable dispersions in the functional pelvic plane and anterior pelvic plane reference planes. Furthermore, as the rotation angle of the reconstructed axial views increased, i.e., the osteotomy site became closer to the arcuate line of the pelvis, the available width of the osteotomy site narrowed, and the length of the osteotomy site increased. We found significant correlations between the optimal osteotomy angle and sex, height, weight, body mass index, head lateralization index, and acetabular anteversion in all planes. The multiple regression analysis revealed that acetabular anteversion was significantly correlated with the optimal osteotomy angle in all planes, while height, weight, BMI, center edge angle, acetabular roof obliquity, and head lateralization index were correlated in some planes. Conclusions Osteotomies near the arcuate line of the pelvis are considered particularly risky because long-distance osteotomies must be performed within a narrow width. The optimal osteotomy angle is affected by many factors, including acetabular anteversion, which varies from case to case.
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Affiliation(s)
- Kazuki Orita
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
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Nishiwaki T, Hara T, Kaneuji A, Takahashi E. Spherical periacetabular osteotomy via para-sartorial intermuscular approach with bikini incision for patients with acetabular dysplasia: surgical technique and preliminary results. Hip Int 2025; 35:198-204. [PMID: 39757895 DOI: 10.1177/11207000241300061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
Abstract
PURPOSE This study introduces a new technique, spherical periacetabular osteotomy (SPO), performed via a para-sartorial intermuscular (PSIM) approach with a bikini incision, aiming to optimise the benefits of SPO, including preservation of muscles and providing cosmetic advantages. METHODS Overall, 57 joints of 52 patients (mean age 36 ± 17 years) underwent SPO via the PSIM approach. Preoperative osteoarthritis was classified according to Tönnis grade, with 34 and 23 hips categorised as grades 0 and 1, respectively. RESULTS The modified Harris Hip Scores significantly improved from 75 ± 10 to 96 ± 8 points at 6 months postoperatively. The lateral centre-edge angle improved from 6 ± 8° preoperatively to 30 ± 8° postoperatively, with a mean correctional angle of 24 ± 9°. Paresthetica of the lateral femoral cutaneous nerve occurred in 7 joints (12.3%) 3 months postoperatively. All cases except 1 achieved bone union within 3 months, and a nonunion case required additional surgery. CONCLUSIONS Although the long-term results are not yet available, SPO via the PSIM approach demonstrates promising outcomes without significant complications. Furthermore, using the PSIM approach with a bikini incision has the advantages of muscle preservation and excellent cosmesis, which are delighted for young patients.
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Affiliation(s)
- Toru Nishiwaki
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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Qu Y, Tang H, Lu N, Li W, Xu P, Zhou T. Biomechanical changes in the lumbar and hip joint after curved periacetabular osteotomy. J Orthop Surg Res 2024; 19:770. [PMID: 39563445 PMCID: PMC11575045 DOI: 10.1186/s13018-024-05250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 11/07/2024] [Indexed: 11/21/2024] Open
Abstract
BACKGROUND The alignment of the spine and pelvis significantly impacts overall body balance; therefore, alterations in hip and lumbar spine biomechanics following curved acetabular osteotomy (CPO) can help surgeons optimize acetabular correction. To achieve this goal, we conducted patient-specific finite element analyses to compare hip and lumbar disc contact pressure (CP) between patients with developmental dysplasia of the hip (DDH) and healthy individuals. Additionally, we examined the influence of CPO on the CP of both the hip and lumbar discs in patients with DDH. METHODS We conducted finite element analyses of the hip and lumbar spine before and after CPO and compared them with those of a healthy human model. Subsequently, we simulated CPO on the preoperative model. Nonlinear contact analysis was employed to calculate the CP of the acetabular cartilage and lumbar discs during a single-leg stance. RESULTS The maximum and average acetabular CP in patients with DDH were 5.4 MPa and 4.5 MPa, respectively. The average CP for the five lumbar discs were 3 MPa, 2.5 MPa, 2 MPa, 3.5 MPa, and 4.4 MPa. In contrast, the maximum and average acetabular CP in normal subjects were 3.7 MPa and 2.1 MPa, respectively, and the average CP of their lumbar discs were 1 MPa, 2 MPA, 1.88 MPa, 2.1 MPa, and 2.1 MPa, respectively. After CPO, the maximum and average CP of the hip decreased, as did the average CP of the lumbar discs. The maximum and average compressive stress of the acetabulum decreased to 3.79 MPa and 2.3 MPa, respectively, and the average compressive stress of the five intervertebral discs decreased to 1.96 MPa, 0.79 MPa, 0.78 MPa, 1.13 MPa, and 3.14 MPa, respectively. CONCLUSION Our finite element analysis indicated that CPO effectively normalizes hip contact pressure while reducing lumbar disc contact pressure. However, further investigation is required to elucidate the specific biomechanical mechanisms underlying these changes.
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Affiliation(s)
- Yongzhen Qu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao Tang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ning Lu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Wenjin Li
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ping Xu
- School of Mechanical and Electrical Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Taoyong Zhou
- School of Mechanical and Electrical Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China
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Hayashi S, Kuroda Y, Nakano N, Matsumoto T, Kamenaga T, Tsubosaka M, Kuroda R. Work productivity after periacetabular osteotomy was affected by preoperative progression of osteoarthritis and heavy workload. Arch Orthop Trauma Surg 2024; 144:5005-5012. [PMID: 39347967 DOI: 10.1007/s00402-024-05594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
INTRODUCTION Many patients who have undergone a periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) have had jobs preoperatively. Postoperative return to work and work productivity are important for livelihood security and the social economy. However, there is a lack of evidence on work productivity after PAOs. Therefore, this study investigated the return to work rates and influence of workload, clinical, and radiographic parameters on work productivity after a curved PAO. MATERIALS AND METHODS In this study, the data of 68 hip joints among 48 participants who underwent curved PAO for symptomatic DDH were analyzed. Correlations between postoperative work productivity and clinical, radiographic, and workload parameters were assessed. Work productivity was evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire. Clinical factors were assessed using the modified Harris Hip Scores (mHHS) and University of California, Los Angeles Activity scores. Preoperative and postoperative radiographic parameters were compared with postoperative work productivity. The workload was categorized using the Reichsausschuß für Arbeitszeitermittlung (REFA)-classification system. RESULTS Of the participants, 98% returned to work and 87.5% returned to their original jobs. Work productivity was significantly improved in all workload categories at the 1-year postoperative follow-up. Multivariate analysis demonstrated that preoperative Tönnis and REFA classification grades were significantly associated with the postoperative WPAI. CONCLUSION Curved PAOs can improve postoperative work productivity and return to work rates. Preoperative progression of osteoarthritis and heavy workload affect postoperative work productivity.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kinoshita K, Fujita J, Matsunaga T, Seo H, Hideshima Y, Yoshimura F, Yamamoto T. Use of oblique view in periacetabular osteotomy and delayed postoperative weight bearing reduce delayed union in the ischium after one year. Sci Rep 2024; 14:23720. [PMID: 39390253 PMCID: PMC11467257 DOI: 10.1038/s41598-024-75593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 10/07/2024] [Indexed: 10/12/2024] Open
Abstract
This study aimed to determine the efficacy of using both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative partial weight-bearing (PWB) in reducing the incidence of delayed union in the ischium at one year after curved periacetabular osteotomy. We evaluated computed tomography images to clarify the incidence of delayed union at the osteotomy sites at one year post-operatively for 117 hips in 104 patients. Fifty-eight hips in 54 patients with use of both the postero-anterior and oblique image intensifier views intra-operatively and late start of post-operative PWB were assigned to the oblique view and late PWB group (OL group) and 59 hips in 50 patients with use of only the postero-anterior image intensifier view intra-operatively and early start of post-operative PWB were assigned to the control group (C group). In univariate analyses, the incidence of delayed union in the ischium at one year post-operatively was significantly lower in the OL group (3.5%) than in the C group (22%). Use of both the postero-anterior and oblique image intensifier views during curved periacetabular osteotomy and late start of PWB were effective for reducing delayed union of the ischium at one year post-operatively.
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Affiliation(s)
- Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Jun Fujita
- Department of Orthopaedic Surgery, Fukuoka Central Hospital, Fukuoka, Japan
| | - Taiki Matsunaga
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hajime Seo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiaki Hideshima
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Fumihiro Yoshimura
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Yoshimura F, Matsunaga T, Kinoshita K, Seo H, Doi K, Yamamoto T. Assessment of the Hip Flexor Muscles Shortly after Curved Periacetabular Osteotomy using Magnetic Resonance Imaging. J Arthroplasty 2024; 39:1450-1454. [PMID: 38040063 DOI: 10.1016/j.arth.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Curved periacetabular osteotomy requires detachment and retraction of the hip flexors. In this study, we evaluated hip flexor muscle status by magnetic resonance imaging (MRI) shortly after curved periacetabular osteotomy. METHODS We retrospectively evaluated 60 hips of 56 patients by MRI 1 week and 3 months after curved periacetabular osteotomy performed from August 2017 to December 2019. We classified the condition of the flexors as follows: Grade 0, normal; Grade I, strain/edema; Grade II, partial tear; and grade III, complete tear. RESULTS At 1 week after surgery, the iliacus muscle was classified as grades I and II in 12.0 and 88.0% of hips; psoas as grades 0, I and II in 22.0, 72.0, and 6.0%; sartorius muscle as grades 0, I and II in 6.0, 62.0, and 32.0%; and rectus femoris muscle as grades 0 and I in 86.0 and 14.0%, respectively. At 3 months, 82.0, 88.0, and 96.0% of psoas, sartorius, and rectus femoris muscles, respectively, had improved to grade 0, whereas the iliacus was grades I and II in 94.0 and 6.0%, respectively. These changes in the iliacus muscle at 3 months were not significantly associated with patient characteristics, radiographic data, or clinical scores. CONCLUSIONS All the iliacus, 78% of psoas, 94% of sartorius, and 14% of rectus femoris muscles appeared abnormal on MRI 1 week after curved periacetabular osteotomy. However, at 3 months, only 18% of psoas, 12% of sartorius, and 4% of rectus femoris muscles appeared abnormal, whereas all iliacus muscles still appeared abnormal. These abnormalities did not significantly affect clinical scores.
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Affiliation(s)
- Fumihiro Yoshimura
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Taiki Matsunaga
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hajime Seo
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kenichiro Doi
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Fujita J, Doi N, Kinoshita K, Seo H, Doi K, Yamamoto T. Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy. Bone Joint J 2024; 106-B:11-16. [PMID: 38688486 DOI: 10.1302/0301-620x.106b5.bjj-2023-0621.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. Methods A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores. Results A total of 20 patients (50%) had symptoms of a LFCN injury at one year after PAO. At ≥ three years postoperatively, the symptoms had completely resolved in seven of these patients and 13 (33%) had persistent symptoms. The severity and area of symptoms did not significantly differ between one and ≥ three years postoperatively. The JHEQ showed significant differences in the patient satisfaction and mental scores between those with and those without sypmtoms of LFCN injury at ≥ three years postoperatively, while there was no significant difference in the mean SF-36 scores. Conclusion The incidence of LFCN injury after PAO using an anterior approach is high. The outcome of PAO, ≥ three years postoperatively, is poorer in patients with persistent symptoms from a perioperative LFCN injury, in that patient satisfaction and mental health scores are adversely affected.
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Affiliation(s)
- Jun Fujita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nobunao Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hajime Seo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kenichiro Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Hapa O, Hevesi M, Lee SH, Trousdale RT, Sierra RJ. Making the cut: a technical note and literature review of Bernese periacetabular osteotomy techniques with special attention to ischial osteotomy initiation and completion with an inside to anterior curved osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1691-1697. [PMID: 38055056 DOI: 10.1007/s00590-023-03787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
Periacetabular osteotomy includes a fluoroscopy-guided ischial cut without direct visualization. Previously described techniques include a mediolateral ischial cortex cut, which is associated with the risk of injuring nearby nerves. Another drawback of that technique is the difficulty connecting an ischial cortex cut with a retroacetabular cut due to orthogonal nature of the osteotomy. In general, an additional cut from medial to lateral is required. The present study aimed to describe a technique that eliminates those problems due to use of only a central cut of the ischium and the curved nature of the osteotomy.
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Affiliation(s)
- Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, İzmir, Turkey.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sheng-Hsun Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Sawano K, Nyuzuki H, Nagasaki K, Suzuki H, Suda K, Miyasaka D, Imai N, Saitoh A. A case of adolescent trichorhinophalangeal syndrome undergoing pelvic osteotomy for bilateral acetabular dysplasia. J Orthop Sci 2023; 28:1501-1504. [PMID: 34503898 DOI: 10.1016/j.jos.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kentaro Sawano
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiromi Nyuzuki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hayato Suzuki
- Division of Orthopaedic Surgery, Department of Reconstructive and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ken Suda
- Division of Orthopaedic Surgery, Department of Reconstructive and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Dai Miyasaka
- Division of Orthopaedic Surgery, Department of Reconstructive and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiko Saitoh
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Pruneski JA, Chan JJ, Wang KC, Matheney T, Bharam S. Acetabular Rim Disorders: Epidemiology, Etiology, Management, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00005. [PMID: 37549243 DOI: 10.2106/jbjs.rvw.23.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
» Anatomic disorders of the acetabular rim are a common, correctable source of hip pain in younger patients.» Some common conditions of involving abnormal acetabular rim morphology include developmental dysplasia of the hip, pincer-type femoroacetabular impingement, acetabular protrusion, and acetabular retroversion.» Treatment option for these conditions were historically limited to open osteotomy and osteoplasty procedures; however, there is increasing use of arthroscopic intervention for these patients.» Arthroscopic intervention has demonstrated short-term success in a variety of focal acetabular rim disorders; however, further research is needed to determine the long-term outcomes of these procedures and their utility in more global pathology.
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Affiliation(s)
- James A Pruneski
- Tripler Army Medical Center, Honolulu, Hawaii
- Boston Children's Hospital, Boston, Massachusetts
| | - Jimmy J Chan
- Boston Children's Hospital, Boston, Massachusetts
- Mount Sinai Health System, New York, New York
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Wei T, Xiao F, He X, Peng P, He W, He M, Wei Q. A bibliometric analysis and visualization of research trends on periacetabular osteotomy. J Hip Preserv Surg 2023; 10:181-191. [PMID: 38162277 PMCID: PMC10757413 DOI: 10.1093/jhps/hnad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/07/2023] [Accepted: 10/07/2023] [Indexed: 01/03/2024] Open
Abstract
Bernese periacetabular osteotomy (PAO) is a practical and safe acetabular reorientation technique used to correct structural hip deformities, and much relevant literature has been published over the past decades. This bibliometric study aims to determine the status of PAO research between 1994 and 2022. Information about PAO research publications from 1994 to 2022 was obtained from the Web of Science Core Collection. This bibliometric study is implemented and analyzed through three bibliometric tools with respect to publication counts, countries, institutions, authors, journals, funding agencies, references and keywords. In total, 634 publications concerning PAO were identified. The United States and Washington University in St. Louis have published the most literature in terms of country and institution. Additionally, Switzerland and the University of Bern are the country and the institution with the highest average number of citations in the PAO field. The most published and co-cited journal is Clinical Orthopaedics and Related Research. Burst keyword detection has discovered that 'patient-reported outcome', 'instability', 'risk', 'survivorship' and 'outcome' are regarded as the current research frontier. In summary, our findings provide insight into the bibliometric overview of research status in the PAO field, which may offer later investigators' references in exploring further research directions.
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Affiliation(s)
| | - Fangjun Xiao
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Peng Peng
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
| | - Wei He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Mincong He
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261, Longxi Road, Liwan District, Guangzhou 510378, P.R. China
- Guangzhou University of Chinese Medicine, No. 16, Jichang Road, Baiyun District, Guangzhou 510407, P.R. China
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Uemura K, Hiraiwa T, Okamoto M, Tokunaga K, Anderson AE. The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy. Arch Orthop Trauma Surg 2023; 143:1323-1330. [PMID: 34977962 PMCID: PMC9250550 DOI: 10.1007/s00402-021-04258-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/12/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Femoral head coverage in patients with hip dysplasia (DDH) is typically quantified using 2D measurements of the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, as the morphology of DDH is complex and varies between patients, 2D measurements may not predict the true 3D femoral head coverage. Herein, 2D and 3D coverage were quantified before and after curved periacetabular osteotomy (CPO) and their relationships were assessed. MATERIALS AND METHODS Forty-three hips that underwent CPO for DDH were analyzed. For 2D evaluation, LCEA was quantified from X-rays and CT images. The ACEA was measured from CT images (CT-ACEA) and digitally reconstructed radiographs generated from CT images (DRR-ACEA). Three-dimensional coverage was quantified from CT reconstructions of the hip and evaluated in the anterior, superior, posterior, and inferior regions of the femoral head. Two-dimensional measurements were correlated to 3D coverage to assess their relationships. RESULTS The median preoperative 3D percent coverage was 17.7, 36.1, 56.1, and 14.6% for the anterior, superior, posterior, and inferior region, respectively. After CPO, all LCEAs and ACEAs increased significantly (all p < 0.001). For the 3D coverage, anterior and superior coverage significantly increased while the posterior and inferior coverage decreased (all p < 0.001). Moderate to strong correlations were detected between the two LCEAs and the 3D superior coverage in both the preoperative and postoperative period. For the correlation between 3D anterior coverage, no significant correlation was found between the CT-ACEA while a moderate correlation was found between the DRR-ACEA (rs = 0.41, p = 0.023). CONCLUSIONS Our results indicate that the LCEA can be used to predict 3D coverage in the superior region of the femoral head. However, as the CT-ACEA or DRR-ACEA had no or only moderate correlation between the 3D anterior coverage, these measurements are not recommended for evaluating/estimating the 3D anterior coverage in patients with DDH.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT, 84108, USA
| | - Toshihito Hiraiwa
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, 84112, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, 84108, USA.
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Kinoshita K, Seo H, Matsunaga T, Doi K, Yamamoto T. Clinical Outcomes for Total Hip Arthroplasty with and without Previous Curved Periacetabular Osteotomy. J Clin Med 2023; 12:jcm12020694. [PMID: 36675623 PMCID: PMC9867272 DOI: 10.3390/jcm12020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
There are currently no reports on the clinical outcomes after total hip arthroplasty (THA) with previous curved periacetabular osteotomy (CPO), although the outcomes after THA with non-CPO types of periacetabular osteotomy have been reported. This study aimed to clarify the differences in clinical outcomes and radiographic features after THA with or without previous CPO. We performed a retrospective case-control with individual matching study. The participants were 10 patients with 11 hips that underwent cementless THA between October 1998 and October 2018 with previous CPO (osteotomy group). For the control group, we matched age, sex, and follow-up period, and included 32 patients with 33 hips that underwent cementless THA without previous CPO at a 1:3 ratio. The Harris Hip Score (HHS), cup size, position, and alignment, global offset (GO), operative time, perioperative blood loss, frequency of osteophyte removal, and major complications were compared between the two groups. The osteotomy group had no cases with revision surgery and dislocation. No significant differences were found between the two groups as follows: mean HHS, 94.9 points in the osteotomy group versus 92.7 points in the control group at the final follow-up; mean GO, 70.1 mm in the osteotomy group versus 71.4 mm in the control group; cup size, position, and alignment after THA; operative time; and perioperative blood loss. The frequency of osteophyte removal was higher in the osteotomy group. The take-home messages were that the clinical outcomes, including HHS, and radiographic features, including GO, after THA were equivalent in the two groups.
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Nakashima Y, Hara D, Ohishi M, Motomura G, Kawano I, Hamai S, Kawahara S, Sato T, Yamaguchi R, Utsunomiya T, Kitamura K. Abductor recovery after muscle-sparing periacetabular osteotomy using a lateral approach. J Hip Preserv Surg 2022; 9:259-264. [PMID: 36908558 PMCID: PMC9993449 DOI: 10.1093/jhps/hnac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022] Open
Abstract
To decrease hip abductor dysfunction after periacetabular osteotomy using a lateral/trochanteric approach, we aimed to modify transposition osteotomy of the acetabulum (TOA) to not cut the greater trochanter and abductor-iliac crest detachment. We subsequently compared abductor muscle strength recovery between TOAs with [conventional TOA (C-TOA)] and without [modified TOA (M-TOA)] trochanteric osteotomy. C-TOA and M-TOA were performed in 27 and 34 hips, respectively. Hip abduction, flexion and knee extension muscle strength were measured preoperatively and at 3, 5, 10, 24 and 52 weeks postoperatively. The muscle strength ratio of the affected and contralateral lower limbs was compared between the C-TOA and M-TOA groups. Neither the mean Merle d'Aubigné-Postel score at the final follow-up nor the postoperative center-edge angle showed significant differences between the M-TOA and C-TOA groups (15.7 versus 16.4 points; P = 0.25 and 38.5° versus P = 0.62 and 39.8°, respectively). The mean muscle strength ratios of hip abduction at 5, 12 and 24 weeks postoperatively were significantly higher in the M-TOA group than in the C-TOA group (0.62 versus 0.39, 0.76 versus 0.59 and 0.94 versus 0.70; P = 0.03, 0.04 and 0.01, respectively). There were no significant differences between groups at Postoperative Week 52 (P = 0.36). Discomfort at the greater trochanter was observed in 18 hips (66.7%) in the C-TOA group but only in 4 hips (11.2%) in the M-TOA group. In conclusion, M-TOA is less invasive than C-TOA and allows an earlier recovery of abductor muscle strength without significant correction loss.
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Affiliation(s)
- Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masanobu Ohishi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.,Department of Orthopaedic Surgery, Chihaya Hospital, 2-30-1 Chihaya, Higashi-ku, Fukuoka 813-8501, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ichiro Kawano
- Department of Rehabilitation Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.,Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.,Department of Rehabilitation Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Kamenaga T, Kuroda R. Anterior acetabular coverage and femoral head-neck measurements predict postoperative anterior impingement: A simulation study. J Orthop Res 2022; 40:2440-2447. [PMID: 35040519 DOI: 10.1002/jor.25258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023]
Abstract
The aim of this simulation study was to evaluate the relationship of elements of anterior acetabular coverage and femoral head-neck shape with the occurrence of postoperative anterior impingement after curved periacetabular osteotomy (PAO). Sixty-two patients with symptomatic developmental dysplasia of the hip who had undergone curved PAO were selected. The likelihood of developing postoperative anterior impingement was explored through simulations of the range of motion by collision detection of the pelvis and femur. Postoperative anterior impingement was defined as impingement that occurred during postoperative bone flexion <105° or postoperative internal rotation <20° at 90° flexion. The three-dimensional center-edge (CE) angles, acetabular and femoral versions, radiographic alpha angles of the femoral head, combination angles of anterior CE and alpha angles, and combined anteversions of acetabular and femoral versions were compared between patients with postoperative anterior impingement and nonimpingement. A receiver operator characteristic (ROC) analysis was conducted to determine thresholds of the examined radiographic parameters and calculate their accuracy for predicting postoperative anterior impingement. A multivariate analysis was performed to test whether combined anteversion, anterior CE angle, and combination angle are associated with excellent modified Harris Hip Scores (mHHSs). ROC analysis demonstrated a combination angle ≥108° was predictive of the occurrence of postoperative anterior impingement after curved PAO, which can lead to impaired clinical outcomes. Conversely, a combination angle <108° was significantly associated with mHHS ≥ 90 points. To avoid postoperative anterior impingement, osteochondroplasty of the femoral head or anterior CE angle control should be performed for patients with preoperative combination angles ≥90°.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Hara T, Kaneuji A, Sonoda K, Nakamura T, Fujii M, Takahashi E. Spherical Periacetabular Osteotomy. JBJS Essent Surg Tech 2022; 12:e21.00048. [PMID: 36816525 PMCID: PMC9931045 DOI: 10.2106/jbjs.st.21.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Various techniques for periacetabular osteotomy have been reported to prevent the progression of osteoarthritis in dysplastic hips1-5. Bernese periacetabular osteotomy, which involves the use of an anterior approach, is widely performed throughout the world because it offers preservation of the blood supply to the bone fragment and lateral pelvic muscles. However, Bernese periacetabular osteotomy has potential complications, such as nonunion at the osteotomy site, postoperative fracture, nonunion of the pubis and ischium, and damage to the main trunk of the obturator artery. Spherical periacetabular osteotomy (SPO) has been developed to resolve some of disadvantages of Bernese periacetabular osteotomy6. Although SPO involves some technical difficulty, the procedure is safe when performed with use of appropriate preoperative 3-dimensional planning and surgical technique. Description Preoperative 3-dimensional planning is utilized to decide the radius of the curved osteotome, locations of the reference points for the osteotomy line, and depth of the bone groove at the teardrop area. The pelvic positioning is arranged fluoroscopically to match the neutral position based on preoperative planning. A 7-cm incision is made along the medial margin of the iliac crest. An anterior iliac crest osteotomy of 4.5 cm (length) × 1 cm (medial wedge-shaped) is performed. The operative field is maintained with aluminum retractors. The osteotomy line is completed by connecting the preoperatively planned reference points on the inner cortex of the ilium. The bone groove is made along the osteotomy line with use of a high-speed burr. A blunt osteotome is inserted into the bone groove at the teardrop area until it reaches the preoperatively planned depth. The blunt osteotome makes a pathway for the curved osteotome without breaking the quadrilateral surface (QLS) or perforating the hip joint. The special curved osteotome is inserted manually until it reaches the bottom of the groove, and the posterior cortex is cut. After the top of the teardrop is divided fluoroscopically, the anterior ischial cortex is osteotomized with a sharpened spiked Cobb elevator at the infracotyloid groove. An angled curved osteotome is used for the osteotomy of the superior area of the teardrop area. The bone fragment is rotated with a spreader and an angled retractor, and fixed with 2 absorbable screws. Beta-tricalcium phosphate blocks are inserted into the bone gap. The osteotomized wedge-shaped iliac bone is repositioned and fixed. Alternatives Alternatives include the Bernese periacetabular osteotomy, rotational acetabular osteotomy, and triple innominate osteotomy. Rationale Bernese periacetabular osteotomy utilizes an anterior approach, cuts into the QLS, and preserves the posterior column. In contrast, SPO preserves the QLS and does not cut the pubis. These features of SPO have some advantages. The large osteotomized surface is advantageous for osseous fusion, and preserving the QLS and pubis protects the trunk of the obturator artery. Furthermore, the preservation of the connection between the ilium, ischium, and pubis in SPO maintains a more stable pelvic ring than in Bernese periacetabular osteotomy. The osteotomy line is arranged to prevent leg shortening caused by thin medial bone stock of the bone fragment. Although splitting the teardrop area in SPO is somewhat technically difficult, particularly in cases with a thin teardrop, it can be safely done with use of preoperative 3-dimensional planning and appropriate surgical technique.In addition, the use of our medial wedge-shaped osteotomy at the iliac crest has 2 advantages: protection of the lateral femoral cutaneous nerve and preservation of the attachment of the tensor fascia latae muscle. Expected Outcomes The advantages of SPO are a stable pelvic ring postoperatively, reduced risk of nonunion at the osteotomy site, no risk to the trunk of the obturator artery, preservation of the blood supply to the bone fragment, a small incision, and early muscle recovery. Important Tips Preoperative 3-dimensional planning of the osteotomy design is essential.The special curved osteotomes are designed so that osteotomy of the posterior cortex is completed when the handles are perpendicular to the pelvis.The special curved osteotomes are made with a radius of either 50 or 60 mm, which are the most suitable sizes for the Japanese population. Larger-diameter osteotomes may be required for different races.As the rotated bone fragment is relatively small, it is difficult to obtain rigid fixation of the osteotomy site. Hence, the fragment can move slightly in the early phase after surgery. Careful rehabilitation is needed. Acronyms and Abbreviations AIIS = anterior inferior iliac spineASIS = anterior superior iliac spineLFCN = lateral femoral cutaneous nerveG.T. = greater trochanterK-wire = Kirschner wireBeta (β)-TCP = beta-tricalcium phosphate.
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Affiliation(s)
- Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan,Email for corresponding author:
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, JCHO Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan
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Atkins PR, Agrawal P, Mozingo JD, Uemura K, Tokunaga K, Peters CL, Elhabian SY, Whitaker RT, Anderson AE. Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip. J Orthop Res 2022; 40:2113-2126. [PMID: 34812545 PMCID: PMC9124729 DOI: 10.1002/jor.25227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/04/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is commonly described as reduced femoral head coverage due to anterolateral acetabular deficiency. Although reduced coverage is the defining trait of DDH, more subtle and localized anatomic features of the joint are also thought to contribute to symptom development and degeneration. These features are challenging to identify using conventional approaches. Herein, we assessed the morphology of the full femur and hemi-pelvis using an articulated statistical shape model (SSM). The model determined the morphological and pose-based variations associated with DDH in a population of Japanese females and established which of these variations predict coverage. Computed tomography (CT) images of 83 hips from 47 patients were segmented for input into a correspondence-based SSM. The dominant modes of variation in the model initially represented scale and pose. After removal of these factors through individual bone alignment, femoral version and neck-shaft angle, pelvic curvature, and acetabular version dominated the observed variation. Femoral head oblateness and prominence of the acetabular rim and various muscle attachment sites of the femur and hemi-pelvis were found to predict 3D CT-based coverage measurements (R2 = 0.5-0.7 for the full bones, R2 = 0.9 for the joint). Statement of Clinical Significance: Currently, clinical measurements of DDH only consider the morphology of the acetabulum. However, the results of this study demonstrated that variability in femoral head shape and several muscle attachment sites were predictive of femoral head coverage. These morphological differences may provide insight into improved clinical diagnosis and surgical planning based on functional adaptations of patients with DDH.
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Affiliation(s)
- Penny R. Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | | | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Ross T. Whitaker
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
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Mechanical Influence of Pubic Nonunion on the Stress Distribution After Curved Periacetabular Osteotomy: Patient-Specific Three-Dimensional Finite Element Analysis. J Arthroplasty 2022; 37:1390-1395. [PMID: 35217183 DOI: 10.1016/j.arth.2022.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/30/2021] [Accepted: 02/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pubic nonunion after curved periacetabular osteotomy (CPO) reportedly occurs in 1%-17% of patients and causes pubic pain in 21%. Furthermore, pubic nonunion is associated with a risk of ischial ramus stress fracture, but the mechanical influence of pubic nonunion has not been fully clarified. METHODS Patient-specific finite element (FE) analysis was performed using Mechanical Finder software. Three FE models (pre-CPO, union, and nonunion models) were constructed from preoperative and postoperative computed tomographic data. The contact area (mm2) and contact pressure (MPa) in the hip joint as well as the equivalent stress (MPa) at the ischial ramus were evaluated among the 3 FE models. RESULTS Patient-specific FE models were generated using 18 consecutive hips treated with CPO. The mean contact pressure in the hip joint was not significantly different between the union and nonunion models (0.50 ± 0.10 vs 0.50 ± 0.09 MPa, P = .88). However, the mean equivalent stress at the ischial ramus in the nonunion models was 1.7 times higher than that in the union models (1.13 ± 0.77 vs 0.64 ± 0.45 MPa, P < .01). CONCLUSION FE analysis revealed that pubic nonunion did not affect the mechanical distribution in the hip joint itself but increased the mean equivalent stress at the ischial ramus. This finding suggests the importance of achieving pubic union after CPO to avoid the risk of ischial ramus stress fracture.
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Hayashi S, Hashimoto S, Kuroda Y, Matsumoto T, Kamenaga T, Kuroda R. Combination of Anterior Acetabular Coverage and Femoral Head Shape Predicts Femoroacetabular Impingement After Periacetabular Osteotomy. J Arthroplasty 2022; 37:219-225. [PMID: 34718108 DOI: 10.1016/j.arth.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) after periacetabular osteotomy (PAO) may be affected by both anterior acetabular coverage and femoral head shape. This study aimed to radiographically evaluate the relationship of the combination of acetabular coverage and femoral head shape with the occurrence of FAI after curved PAO. METHODS In this study, 76 hip joints from patients with symptomatic developmental dysplasia of the hip underwent curved PAO. The relationship between the combined postoperative anterior center-edge and alpha angles (ie, the combination angle) and the occurrence of postoperative FAI was evaluated. Clinical factors and the preoperative and postoperative 3-dimensional center-edge angles, acetabular versions, femoral versions, radiographic alpha angles of the femoral head, and the combination angle were measured and compared to clinical outcomes. RESULTS The modified Harris Hip Scores, University of California, Los Angeles activity scores, and acetabular coverage angles were significantly improved following curved PAO. Receiver operator characteristic curve analysis demonstrated that the combination angle over 108° may be a predictive factor for the occurrence of FAI after curved PAO. Multivariate analysis demonstrated that an age <40 years (odds ratio 6.6, 95% confidence interval 1.2-36.4, P = .037) and a combination angle <108° (odds ratio 9.2, 95% confidence interval 1.7-50.0, P = .010) were significantly associated with modified Harris Hip Scores ≧90 points. CONCLUSION A combination angle >108° may be a predictive factor for the occurrence of FAI after curved PAO and impaired clinical outcomes. To avoid postoperative FAI, we propose that osteochondroplasty of the femoral head should be performed for patients with preoperative combination angles >90°.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Cantrell CK, Goedderz CJ, Selley RS, Sink EL, Stover MD. Highly Cited Articles in Periacetabular Osteotomy Research. Hip Pelvis 2022; 34:87-95. [PMID: 35800125 PMCID: PMC9204236 DOI: 10.5371/hp.2022.34.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study is to identify highly cited articles and examine trends and characteristics in research on periacetabular osteotomy. Materials and Methods The 50 most highly cited articles on periacetabular osteotomy research were identified using Scopus. Data regarding article demographics and publication were collected from each article and an analysis was performed. Results The mean citation count was 125±37. The article with the highest total citation count (796), five-year citation count (327), and five-year citation density (65/year) was reported by Reinhold Ganz. The five-year citation density showed strong correlation with total citation density (r=0.930, P<0.001). Reinhold Ganz, the most productive author, was listed on 13 articles in the cohort with 455 weighted citation points. Conclusion This study provides a collection of articles examining periacetabular osteotomies and demonstrates that citation count can be regarded as an acceptable measure of the contemporary academic influence of an article.
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Affiliation(s)
- Colin K. Cantrell
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Cody J. Goedderz
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan S. Selley
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Ernest L. Sink
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Michael D. Stover
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Kamachi Y, Kinoshita K, Sakamoto T, Matsunaga T, Yamamoto T. Bone union status of all osteotomy sites one year after curved periacetabular osteotomy based on computed tomography. Orthop Traumatol Surg Res 2021; 107:102955. [PMID: 33945851 DOI: 10.1016/j.otsr.2021.102955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Curved periacetabular osteotomy (CPO) is a joint-preservation surgery to treat acetabular dysplasia. It is performed via an anterior approach with the osteotomy of the anterosuperior iliac spine (ASIS). One of the complications associated with CPO includes non-union of the osteotomy sites. However, all osteotomy sites including the ASIS have not been simultaneously evaluated. Therefore, we investigated: (1) the bone union status of all osteotomy sites; and (2) the predictors of non-union at one year after CPO based on computed tomography (CT). HYPOTHESIS The bone union status may be different in each osteotomy site. PATIENTS AND METHODS This retrospective review included 147 hips of 124 patients with symptomatic acetabular dysplasia who underwent CPO from 2011 to 2018. At one year postoperatively, we evaluated the bone union status of all osteotomy sites: the ASIS, ischium, pubis, and ilium using CT and investigated the predictors for achieving bone union. RESULTS Bone union was confirmed in both the ASIS and ilium in all cases. In contrast, ischial and pubic non-union was confirmed 15/147 hips (10.2%) and 42/147 hips (28.5%), respectively. The multivariate analysis revealed that the predictors of ischial non-union were both large width of the gap at the pubic osteotomy site and small postoperative acetabular roof obliquity, and that the predictor of pubic non-union was large width of the gap at the pubic osteotomy site. DISCUSSION At one year after CPO, both the ASIS and ilium obtained complete bone union, while ischial and pubic non-union were observed. Large width of the gap at the pubic osteotomy site was the predictor of both ischial and pubic non-union. In CPO, sufficient bone union can be achieved at the ASIS and the ilium, while it is necessary to reduce the width of the gap at the pubic osteotomy site to prevent ischial and pubic non-union. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yuki Kamachi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan
| | - Taiki Matsunaga
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, 814-0180 Fukuoka, Japan.
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Kaneuji A, Hara T, Takahashi E, Fukui K, Ichiseki T, Kawahara N. A Novel Minimally Invasive Spherical Periacetabular Osteotomy: Pelvic Ring Preservation and Patient-Specific Osteotomy by Preoperative 3-Dimensional Templating. J Bone Joint Surg Am 2021; 103:1724-1733. [PMID: 33988546 DOI: 10.2106/jbjs.20.00940] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spherical periacetabular osteotomy (SPO) is a novel osteotomy involving splitting the teardrop, using patient-specific preoperative planning, and requiring only a 7-cm skin incision. We report preoperative planning methods and short-term results of SPO. METHODS In preoperative planning, computed tomography (CT) images were imported into 3-dimensional templating software. The radius of the curved chisel was mapped to pass through the teardrop, the infracotyloid groove of the ischium, and the area between the anterior superior iliac spine and the anterior inferior iliac spine. The osteotomy height and the predicted depth of osteotome insertion were measured, and those values were reproduced during surgery. We performed a retrospective analysis of data on 52 consecutive patients (55 hips) with hip dysplasia who underwent SPO and were followed for at least 2 years: 27 hips had Tönnis grade 0, 21 had grade 1, and 7 had grade 2. The mean age at surgery was 38 years (range, 17 to 56 years). The rotated bone fragment and iliac crest were fixed with absorbable screws. Statistical analysis was performed with the paired t test. RESULTS The mean (range) of the lateral center-edge and sourcil angles were 6.0° (-20° to 18°) and 26.0 (13° to 38°), respectively, before surgery and 30.0° (15° to 43°) and 3.8° (-4° to 27°), respectively, after surgery (p < 0.001). However, 11 hips (20%) showed a loss of correction of bone rotation (<3 mm) or the sourcil angle (<3°). Radiographs showed bone union in all hips within 3 months after the surgery. Early second surgery related to absorbable screws was performed in 2 hips. No patient had required conversion to total hip arthroplasty at the time of writing. Clinical scores were significantly improved at the 2-year follow-up (p < 0.001). Paresthesia of the lateral femoral cutaneous nerve area was very common but had resolved in 92% of the patients at the 2-year follow-up. CONCLUSIONS SPO is a novel minimally invasive periacetabular osteotomy that has the potential disadvantage of early loss of correction (observed in 20% of the hips in the present study) but may provide the benefit of decreasing the risk of nonunion at the pubis osteotomy site. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, Iizuka City, Fukuoka, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Kiyokazu Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
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Suzuki M, Kinoshita K, Sakamoto T, Seo H, Kinoshita S, Yamamoto T. Leg Length Change After Curved Periacetabular Osteotomy and Its Impact on the Clinical Outcomes. J Arthroplasty 2021; 36:3089-3096. [PMID: 33975744 DOI: 10.1016/j.arth.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Curved periacetabular osteotomy (CPO) is one of the periacetabular osteotomies for the treatment of acetabular dysplasia. Several complications have been described after CPO, however, there have been no reports on the leg length change (LLC). This study aimed to investigate the LLC after CPO and its impact on the clinical outcomes. METHODS This study was a retrospective review of 70 consecutive hips in 67 patients with symptomatic acetabular dysplasia who underwent CPO between March 2016 and April 2019. Preoperative and postoperative leg lengths were measured using anteroposterior radiographs, and the clinical outcomes were evaluated based on the Harris hip score (HHS) and Medical Outcomes Survey 36-item Short Form Health Survey (SF-36). RESULTS The mean LLC (and standard deviation) after CPO was -0.08 ± 3.10 mm. The mean HHS significantly improved from 73.5 points to 91.9 points (P < .001). The physical component and role component scores of SF-36 significantly improved from 35.1 to 46.1 (P < .001) and from 39.5 to 47.0 (P < .001), respectively. No significant differences were found between the preoperative and postoperative mental component scores of SF-36. In addition, among 70 hips, 35 hips exhibited leg length elongation (0 to plus 6.82 mm) after CPO, whereas 35 hips exhibited leg length shortening (0 to minus 6.23 mm). No significant differences were found in HHS and SF-36 between the leg elongation group and leg shortening group. CONCLUSION The mean LLC after CPO was -0.08 ± 3.10 mm, and this change does not affect the postoperative clinical outcomes.
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Affiliation(s)
- Masahiro Suzuki
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hajime Seo
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Sakae Kinoshita
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Fukushima K, Saito H, Koyama T, Ohashi Y, Uchiyama K, Takahira N, Takaso M. Incidences of deep vein thrombosis and major bleeding under the administration of fondaparinux for thromboprophylaxis after periacetabular osteotomy: a retrospective observational study. J Hip Preserv Surg 2021; 8:293-297. [PMID: 35414948 PMCID: PMC8994105 DOI: 10.1093/jhps/hnab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for patients with developmental dysplasia of the hip. Although deep vein thrombosis (DVT) is considered a serious complication of orthopaedic surgery, there is no consensus regarding a thromboprophylaxis strategy after PAO. We have routinely administered fondaparinux for DVT prophylaxis in adult patients undergoing PAO. The aim of this study was to investigate the incidences of DVT and major bleeding under the administration of fondaparinux for thromboprophylaxis after PAO. A total of 95 patients (100 hips) who underwent PAO with post-operative administration of fondaparinux for thromboprophylaxis were retrospectively enrolled. The incidences of DVT on ultrasound, major bleeding, and administration cessation were evaluated. Asymptomatic DVT occurred in one patient, major bleeding occurred in 14 hips and the administration of fondaparinux was stopped in 17 hips. Given the observed incidence of major bleeding, safer DVT prophylaxis modalities should be considered during PAO.
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Affiliation(s)
- Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Hiroki Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Tomohisa Koyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
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25
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Doi N, Kinoshita K, Sakamoto T, Minokawa A, Setoguchi D, Yamamoto T. Incidence and clinical outcome of lateral femoral cutaneous nerve injury after periacetabular osteotomy. Bone Joint J 2021; 103-B:659-664. [PMID: 33789480 DOI: 10.1302/0301-620x.103b4.bjj-2020-0990.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.
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Affiliation(s)
- Nobunao Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
| | - Ayumi Minokawa
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
| | - Daisuke Setoguchi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine Graduate School of Medicine, Fukuoka, Japan
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26
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Matsunaga T, Kamachi Y, Kinoshita K, Sakamoto T, Yamamoto T. Magnetic Resonance Imaging Assessment of Abductor Muscles Shortly After Curved Periacetabular Osteotomy. J Arthroplasty 2021; 36:429-433. [PMID: 32933799 DOI: 10.1016/j.arth.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Curved periacetabular osteotomy (CPO) is performed via an anterior approach without detachment of the hip abductor muscles. This study aimed to evaluate the abductor muscle status shortly after CPO on magnetic resonance imaging (MRI). METHODS We prospectively evaluated 38 hips in 38 patients 1 week and 3 months after CPO between October 2017 and July 2019. The status of the abductor muscles was assessed on MRI using the following criteria: grade 0, normal; grade I, strain/edema; grade II, partial tear; and grade III, complete tear. We also evaluated associations between muscle status and patients' characteristics. RESULTS One week after CPO, the gluteus maximus was classified as grade 0 in all patients. The gluteus medius was grade 0 in 84.2% of patients and grade I in 15.8%. The gluteus minimus was grade I in 55.3% of patients and grade II in 44.7%. Three months after CPO, both the gluteus maximus and gluteus medius were grade 0 in all patients, while the gluteus minimus was still grade I in 47.4%. There were no significant differences between patients with a grade 0 and grade I gluteus minimus at 3 months after CPO in patients' characteristics (age and body mass index) or clinical scores (Harris Hip Score and Japanese Orthopedics Association score). CONCLUSION Both the gluteus minimus and medius showed abnormal appearances on MRI 1 week after CPO, whereas only the gluteus minimus showed abnormalities 3 months after CPO. This abductor muscle status did not affect the postoperative Harris Hip Score or Japanese Orthopedics Association score.
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Affiliation(s)
- Taiki Matsunaga
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Kamachi
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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27
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Takahashi Y, Takahira N, Uchiyama K, Fukushima K, Moriya M, Shibuya M, Tsuda K, Tozaki K, Kudo S, Kaneda H, Sekita J, Takaso M. Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia. BMC Musculoskelet Disord 2020; 21:637. [PMID: 32988377 PMCID: PMC7520950 DOI: 10.1186/s12891-020-03625-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO. Methods A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO. Results The pre- and post-operative sports activity participation rates were 55.8 and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier. Conclusions Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.
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Affiliation(s)
- Yoshiki Takahashi
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery of Clinical Medicine, Rehabilitation Sciences and Functional Restoration, Science of Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan. .,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan.
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Mitsutoshi Moriya
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
| | - Manaka Shibuya
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan.,Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0375, Japan
| | - Kouji Tsuda
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Kiyoshi Tozaki
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Sho Kudo
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Hiroaki Kaneda
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Junya Sekita
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0373, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-city, Kanagawa, 252-0374, Japan
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Kamenaga T, Hayashi S, Hashimoto S, Fukuda K, Takayama K, Tsubosaka M, Takashima Y, Niikura T, Kuroda R, Matsumoto T. Pelvic morphology medial to the femoral head center predicts anterior coverage and range of motion after curved periacetabular osteotomy. J Orthop Res 2020; 38:2031-2039. [PMID: 32034795 DOI: 10.1002/jor.24624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/30/2020] [Indexed: 02/04/2023]
Abstract
This study observed anterior coverage extent after lateral rotation of the acetabulum, without anterior or posterior rotation, during curved periacetabular osteotomy by three-dimensional simulation, and determined if preoperative pelvic morphology affects postoperative anterior coverage and range of motion. Thirty patients scheduled for consecutive primary curved periacetabular osteotomy for developmental hip dysplasia at our hospital between 2016 and 2017 were included. Virtual acetabular osteotomies were performed to achieve a postoperative lateral center-edge angle of 30°. We measured anterior center-edge angles before curved periacetabular osteotomy through the medial one-third and one-quarter of the femoral head as an index reflecting the pelvic morphology medial to the femoral head center. The range of motion simulation was performed after virtual curved periacetabular osteotomy. Single linear regression analysis was performed to examine correlations between preoperative pelvic morphology parameters and anterior center-edge angles after virtual osteotomy. Furthermore, linear regression analysis was used to assess correlations between center-edge angles and simulated range of motions (P < .05). Anterior center-edge angle after virtual osteotomy was more strongly correlated with the anterior center-edge angle through the medial one-third (r = .92, P < .0001) and one-quarter (r = .84, P < .0001) of the femoral head. Flexion angle and internal rotation at 90° flexion showed significant correlations with anterior center-edge angle through the medial one-third (r = -.62, P = .0003; r = -.57, P = .001) and one-quarter (r = -.60, P = .0005; r = -.55, P = .002) of the femoral head and anterior center-edge angle after virtual osteotomy (r = -.67, P = .0005; r = -.62, P = .0003). Measuring preoperative parameters reflecting pelvic morphology enables surgeons to predict postoperative anterior coverage and range of motion in curved periacetabular osteotomy cases.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Takashima
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Imai H, Kamada T, Miyawaki J, Maruishi A, Mashima N, Miura H. Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia. INTERNATIONAL ORTHOPAEDICS 2020; 44:1055-1061. [PMID: 32342143 PMCID: PMC7260271 DOI: 10.1007/s00264-020-04578-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
Abstract
Aim of the study To compare the outcomes after computer-assisted peri-acetabular osteotomy (PAO) and conventional PAO performed for hip dysplasia (DDH). Methods Ninety-one patients (98 hips) were enrolled in this study. In each case, DDH was treated with either conventional PAO, in which the angle and direction of the osteotomy was determined by intra-operative X-ray examination, or with computer-assisted PAO, which used the 3D navigation system. Forty hips underwent conventional PAO and 58 hips underwent computer-assisted PAO. Results Japanese Orthopaedic Association hip scores improved significantly from 70.0 points pre-operatively to 90.7 points post-operatively in patients with conventional PAO, and from 74.5 points pre-operatively to 94.2 points post-operatively in patients with computer-assisted PAO. In all patients with computer-assisted PAO, the post-operative AHI and VCA angle were within the radiographic target zone. Some patients with conventional PAO had post-operative AHI and VCA angle outside of the target zone. We performed total hip arthroplasty (THA) on five of the 98 PAO hips (5.1%) after an average follow-up period of 5.4 years. None of 58 hips (0%) with computer-assisted PAO was revised. Discussion Computer-assisted PAO enabled intra-operative confirmation of osteotomy sites, and the position of the osteotomized bone fragment could be confirmed in real time. Adequate anterior and lateral coverage of the femoral head in patients with computer-assisted PAO resulted in no need for early conversion to THA, in contrast to conventional PAO. Conclusion Computer-assisted PAO not only improved accuracy and safety but also achieved sufficient anterior and lateral displacement to prevent the progression of DDH.
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Affiliation(s)
- Hiroshi Imai
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Tomomi Kamada
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Joji Miyawaki
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Maruishi
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Sciatic Nerve Palsy following Curved Periacetabular Osteotomy. Case Rep Orthop 2020; 2020:8569285. [PMID: 32257486 PMCID: PMC7106866 DOI: 10.1155/2020/8569285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Curved periacetabular osteotomy (CPO) is used for the treatment of dysplastic hips. Previous studies have reported satisfying outcomes and low rate of severe complications associated with this procedure; however, no case of postoperative sciatic nerve palsy has been reported. In this study, we describe a case of postoperative sciatic nerve palsy following CPO due to nerve strangulation by scar tissue without direct injury. A female patient had severe buttock pain and posterior leg numbness after she underwent left-side CPO. Postoperative magnetic resonance imaging showed that the sciatic nerve was strangulated by the surrounding soft tissue. There was no bone fragment, active infection, bone necrosis, tumor, or spine disease. Therefore, we diagnosed nerve palsy by soft tissue strangulation, and revision surgery was indicated. During revision surgery, the sciatic nerve was observed to be strangulated by the scarring soft tissue, and the nerve had no mobility. After detachment, the pain and numbness disappeared. Direct injury of the sciatic nerve should not be caused by CPO; however, there is a possibility of postoperative sciatic nerve palsy due to the scarring soft tissue. Early diagnosis and appropriate treatment are important for optimal postoperative clinical outcomes.
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Yoshimoto K, Hamai S, Higaki H, Gondoh H, Shiomoto K, Ikebe S, Hara D, Komiyama K, Nakashima Y. Dynamic hip kinematics before and after periacetabular osteotomy in patients with dysplasia. J Orthop Sci 2020; 25:247-254. [PMID: 31000375 DOI: 10.1016/j.jos.2019.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 02/16/2019] [Accepted: 03/27/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND We prospectively analyzed the hip kinematics in patients with developmental dysplasia of the hip (DDH) before and after periacetabular osteotomy (PAO) and in healthy subjects while squatting to determine the influence of coverage of the femoral head on hip kinematics. METHODS 14 hips in 14 patients with DDH and 10 hips in 10 volunteers were included. Continuous radiographs while squatting and computed tomography images were obtained to assess the in vivo kinematics of the hip and the rim-neck distance using density-based 3D-to-2D model-to-image registration techniques. RESULTS The maximum hip flexion angles were 100.4° and 94.9° before and after PAO (p = 0.0863), respectively. The maximum hip flexion angles after PAO did not significantly differ from those of normal hips (102.2°; p = 0.2552). The hip abduction angles at maximum hip flexion were 31.7° and 26.2° before and after PAO (p = 0.1256), respectively. The rim-neck distance decreased from averaged 12.2 mm-8.9 mm (p = 0.0044) after PAO. The lateral center edge angle (LCEA) and anterior center edge angle (ACEA) significantly improved 14.7°-42.4° and 50.4°-54.0° after PAO (p < 0.0001, p = 0.0347), respectively; in particular, the ACEA after PAO did not significantly differ from that in the normal hips (p = 0.1917). The ACEA was not correlated with hip flexion, or the rim-neck distance (p = 0.9601, 0.8764). The LCEA was also not correlated with hip abduction (p = 0.1683). CONCLUSION Patients after PAO showed no significant difference in maximum hip flexion while squatting compared to before PAO and normal hips. Horizontalized weight-bearing acetabulum with normalized ACEA could be adequate correction of the acetabular fragment to restore hip RoM without coxalgia that induce the inability to perform squats after PAO.
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Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Hirotaka Gondoh
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985 Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Grupp RB, Hegeman RA, Murphy RJ, Alexander CP, Otake Y, McArthur BA, Armand M, Taylor RH. Pose Estimation of Periacetabular Osteotomy Fragments With Intraoperative X-Ray Navigation. IEEE Trans Biomed Eng 2020; 67:441-452. [PMID: 31059424 PMCID: PMC7297497 DOI: 10.1109/tbme.2019.2915165] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE State-of-the-art navigation systems for pelvic osteotomies use optical systems with external fiducials. In this paper, we propose the use of X-ray navigation for pose estimation of periacetabular fragments without fiducials. METHODS A two-dimensional/three-dimensional (2-D/3-D) registration pipeline was developed to recover fragment pose. This pipeline was tested through an extensive simulation study and six cadaveric surgeries. Using osteotomy boundaries in the fluoroscopic images, the preoperative plan was refined to more accurately match the intraoperative shape. RESULTS In simulation, average fragment pose errors were 1.3 ° /1.7 mm when the planned fragment matched the intraoperative fragment, 2.2 ° /2.1 mm when the plan was not updated to match the true shape, and 1.9 ° /2.0 mm when the fragment shape was intraoperatively estimated. In cadaver experiments, the average pose errors were 2.2 ° /2.2 mm, 3.8 ° /2.5 mm, and 3.5 ° /2.2 mm when registering with the actual fragment shape, a preoperative plan, and an intraoperatively refined plan, respectively. Average errors of the lateral center edge angle were less than 2 ° for all fragment shapes in simulation and cadaver experiments. CONCLUSION The proposed pipeline is capable of accurately reporting femoral head coverage within a range clinically identified for long-term joint survivability. SIGNIFICANCE Human interpretation of fragment pose is challenging and usually restricted to rotation about a single anatomical axis. The proposed pipeline provides an intraoperative estimate of rigid pose with respect to all anatomical axes, is compatible with minimally invasive incisions, and has no dependence on external fiducials.
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Goshi A, Fukunishi S, Okahisa S, Okada T, Yoshiya S. Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system: A case report. Medicine (Baltimore) 2018; 97:e13519. [PMID: 30508981 PMCID: PMC6283227 DOI: 10.1097/md.0000000000013519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Curved periacetabular osteotomy (CPO) is a procedure with excellent surgical outcome that has been proposed for patients with development dysplasia of the hip (DDH). However, the surgical outcomes depend on the surgeon's experience and proficiency. PATIENT CONCERNS A 38-year-old female indicated she was experiencing left hip pain while walking. DIAGNOSES The patient was diagnosed with early-stage hip osteoarthritis due to DDH. INTERVENTIONS The patient underwent CPO while a 3-dimensional flat-panel C-arm (Artis zeego; Sciemens Healthcare, Forchheim, Germany) was used to confirm the real-time 3-dimensional computed tomography (CT) images during surgery. It was possible to confirm the accurate osteotomy curve using CT images twice during surgery: at the time of the ischial osteotomy and the quadrilateral surface osteotomy. OUTCOMES An ideal C-shaped osteotomy line was created as shown on the postoperative CT images. In addition, neither posterior column fracture nor intra-articular osteotomy was confirmed. LESSONS The CPO using Artis zeego resulted is a satisfactory outcome, and this is the 1st report in the world to discuss the benefits of Artis zeego in pelvic osteotomy.
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Nishiwaki T, Oya A, Fukuda S, Nakamura S, Nakamura M, Matsumoto M, Kanaji A. Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles. Hip Int 2018; 28:642-648. [PMID: 29739254 DOI: 10.1177/1120700018772047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Herein, we describe and evaluate a curved periacetabular osteotomy (CPO) via an intermuscular approach (IM-CPO) between the sartorius and iliac muscles. METHODS Between January 2009 and January 2016, IM-CPO was performed in 17 joints (16 patients), and a traditional CPO was performed in 17 joints. The length of incision at wound closure, operative time, intraoperative blood loss, serum creatinine kinase (CK) level the day after surgery, correctional angle, walking ability assessed using the gait items of the Harris Hip Score (at 3 and 6 months after surgery), and perioperative complications were evaluated. Group differences were assessed using t-tests. RESULTS The IM-CPO and CPO groups did not differ in the mean operative time (130 minutes and 124 minutes, respectively), mean serum CK the day after surgery (349 IU/L and 425 IU/L, respectively), or mean correctional angle (24.9° and 24.6°, respectively). The mean incision length was significantly shorter in the IM-CPO group (8.3 cm) compared to that in the CPO group (9.5 cm). The mean walking ability was significantly higher in the IM-CPO group (24.2 points) compared to that in the CPO group (20.9 points) at 3 months after surgery, but not at 6 months after surgery (26.4 points and 24.9 points, respectively). No serious complications were observed in either group. CONCLUSION In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.
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Affiliation(s)
- Toru Nishiwaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akihito Oya
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Fukuda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Hamai S, Kohno Y, Hara D, Shiomoto K, Akiyama M, Fukushi JI, Motomura G, Ikemura S, Fujii M, Nakashima Y. Minimum 10-Year Clinical Outcomes After Periacetabular Osteotomy for Advanced Osteoarthritis Due to Hip Dysplasia. Orthopedics 2018; 41:300-305. [PMID: 30092112 DOI: 10.3928/01477447-20180806-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/29/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to examine the minimum 10-year clinical outcomes, including patient-reported and functional outcomes, of periacetabular osteotomy in patients with advanced osteoarthritis. A total of 46 hips in 44 patients with advanced osteoarthritis who underwent periacetabular osteotomy between 1992 and 2006 were retrospectively reviewed. Mean age at surgery was 47.5 years, and mean follow-up was 16.9±4.7 years. Survivorship was determined using the Kaplan-Meier method, and the associated risk factors for the endpoint-conversion to total hip arthroplasty less than 15 years after surgery-were evaluated. The Oxford Hip Score and the University of California, Los Angeles activity score were evaluated at final follow-up. The survival rates at 15 and 20 years after surgery were 80% and 59%, respectively. Multivariate analysis indicated that body mass index greater than 24 kg/m2 (P=.034; odds ratio, 1.72) was significantly associated with the endpoint as an independent risk factor. For 32 hips of 31 patients with preserved native joints at final follow-up, the Oxford Hip Score and the University of California, Los Angeles score averaged 41±5 and 5.2±1.8, respectively, equivalent (P=.28 and P=.215, respectively) to the scores of 14 hips of 13 patients with conversion to total hip arthroplasty (38±8.7 and 5.8±1.4, respectively). The results of this mid-term study may be useful for surgical decision-making among patients with advanced osteoarthritis who want to preserve native hip joints. [Orthopedics. 2018; 41(5):300-305.].
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Seo H, Naito M, Kinoshita K, Minamikawa T, Yamamoto T. Clinical Outcomes According to Femoral and Acetabular Version After Periacetabular Osteotomy. JB JS Open Access 2018; 3:e0048. [PMID: 30280134 PMCID: PMC6145566 DOI: 10.2106/jbjs.oa.17.00048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Patients with acetabular dysplasia often have abnormal femoral and acetabular version. The effect of combined femoral and acetabular version on clinical outcomes after periacetabular osteotomy for the treatment of acetabular dysplasia remains unclear. The purposes of the present study were (1) to evaluate the association of combined femoral and acetabular version with clinical outcome after periacetabular osteotomy and (2) to investigate the association of femoral version independently with clinical outcome after periacetabular osteotomy. Methods: We retrospectively reviewed the records for 92 consecutive patients (95 hips) who had undergone periacetabular osteotomy for the treatment of symptomatic acetabular dysplasia. The patient cohort comprised 85 females and 7 males with a mean age of 38.9 years at the time of surgery. The mean duration of follow-up was 4.8 years (range, 2.0 to 7.2 years). Femoral and acetabular version and the alpha angle were measured on postoperative computed tomography scans. Clinical outcomes included range of motion and the modified Harris hip score. Analysis of variance was used to investigate the effect of femoral version on clinical outcomes. Analysis of covariance was used to adjust for potential covariates. Results: Combined femoral and acetabular version after periacetabular osteotomy was slightly, but significantly, correlated with postoperative flexion (r = 0.222; p = 0.031) and internal rotation in flexion (r = 0.326; p = 0.001). Patients with mild femoral version (<15°) experienced significantly less postoperative internal rotation in flexion than those with severe femoral version (>35°); however, this difference was lost after adjustment for potential covariates. There were no differences among femoral version groups (mild, moderate, and severe) in terms of improvements in the clinical outcomes of pain, function, and activity. Conclusions: Combined femoral and acetabular version after periacetabular osteotomy was significantly correlated with postoperative range of motion. Abnormality of femoral version associated with acetabular dysplasia did not demonstrate any effect on the clinical outcomes of periacetabular osteotomy. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hajime Seo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Masatoshi Naito
- Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tomohiko Minamikawa
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Computer-assisted surgery prevents complications during peri-acetabular osteotomy. INTERNATIONAL ORTHOPAEDICS 2018; 42:2555-2561. [PMID: 29582116 DOI: 10.1007/s00264-018-3906-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of study is to evaluate the accuracy of a navigation system during curved peri-acetabular osteotomy (CPO). METHODS Forty-seven patients (53 hips) with hip dysplasia were enrolled and underwent CPO with or without navigation during surgery. Clinical and radiographical evaluations were performed and compared between the navigation group and non-navigation group, post-operatively. RESULTS The clinical outcomes were not significantly different between the navigation and non-navigation groups. Furthermore, post-operative reorientation of the acetabular fragment was similar between the navigation and non-navigation groups. However, the discrepancy between the pre-operative planning line and post-operative osteotomy line was significantly improved in the navigation group compared with that in the non-navigation group (p < 0.05). Further, the complication rate was significantly improved in the navigation group (p < 0.001). CONCLUSION The accuracy of the osteotomy's position was significantly improved by using the navigation. Therefore, the use of navigation during peri-acetabular osteotomy can avoid complications.
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Computer-Assisted Optimization of the Acetabular Rotation in Periacetabular Osteotomy Using Patient's Anatomy-Specific Finite Element Analysis. Appl Bionics Biomech 2018. [PMID: 29515650 PMCID: PMC5817303 DOI: 10.1155/2018/9730525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Periacetabular osteotomy (PAO) is a complex surgical procedure to restore acetabular coverage in the dysplastic hip, and the amount of acetabular rotation during PAO plays a key role. Using computational simulations, this study assessed the optimal direction and amount of the acetabular rotation in three dimensions for a patient undergoing PAO. Anatomy-specific finite element (FE) models of the hip were constructed based on clinical CT images. The calculated acetabular rotation during PAO were 9.7°, 18°, and 4.3° in sagittal, coronal, and transverse planes, respectively. Based on the actual acetabular rotations, twelve postoperative FE models were generated. An optimal position was found by gradually varying the amount of the acetabular rotations in each anatomical plane. The coronal plane was found to be the principal rotational plane, which showed the strongest effects on joint contact pressure compared to other planes. It is suggested that rotation in the coronal plane of the osteotomized acetabulum is one of the primary surgical parameters to achieve the optimal clinical outcome for a given patient.
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The prevalence and risk factors for delayed union of the superior pubic ramus at one year after curved periacetabular osteotomy: its risk factor and outcome. INTERNATIONAL ORTHOPAEDICS 2017; 42:1253-1258. [DOI: 10.1007/s00264-017-3706-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Incidence of delayed union one year after peri-acetabular osteotomy based on computed tomography. INTERNATIONAL ORTHOPAEDICS 2017; 42:1029-1034. [DOI: 10.1007/s00264-017-3656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022]
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Akiho S, Yamamoto T, Kinoshita K, Matsunaga A, Ishii S, Ishimatsu T. The Utility of False-Profile Radiographs for the Detection of Osteoarthritis Progression in Acetabular Dysplasia. JB JS Open Access 2017; 2:e0023. [PMID: 30229227 PMCID: PMC6133147 DOI: 10.2106/jbjs.oa.17.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Both the lateral center-edge angle and acetabular roof obliquity on anteroposterior radiographs are well-known prognostic predictors of osteoarthritis progression in patients with acetabular dysplasia. However, few studies have evaluated osteoarthritis progression on false-profile radiographs. In the present study, osteoarthritis progression was evaluated on anteroposterior and false-profile radiographs. Methods: We retrospectively evaluated 76 patients with acetabular dysplasia with Tönnis grade-0 or 1 osteoarthritis, from a group of 179 patients (209 hips), who had undergone unilateral periacetabular osteotomy from 1995 to 2005. We evaluated the hip joint of the contralateral, untreated side. All patients were followed for ≥10 years. Of the 76 patients, 52 patients with Tönnis grade-0 or 1 osteoarthritis at the latest follow-up were categorized into the non-progression group and the remaining 24 patients with Tönnis grade-2 or 3 osteoarthritis were categorized into the progression group. We evaluated patient characteristics as well as radiographic parameters, including the preoperative lateral center-edge angle, acetabular roof obliquity, and anterior center-edge angle. Results: The mean duration of follow-up was 12.6 years (range, 10 to 19 years). On univariate analysis, body weight, body mass index, and all radiographic parameters indicating the severity of acetabular dysplasia significantly differed between the 2 groups. On multivariate analysis, both the anterior center-edge angle and acetabular roof obliquity were considered to be significant predictive factors for osteoarthritis progression. On receiver operating characteristic curve analysis, the cutoff values for the lateral center-edge angle, acetabular roof obliquity, and anterior center-edge angle were 15.5°, 15.5°, and 12.5°, respectively. Conclusions: In addition to the lateral center-edge angle and acetabular roof obliquity, we showed that the anterior center-edge angle is a possible prognostic predictor of osteoarthritis progression. These findings indicate that radiographic parameters based on the false-profile view are relevant. Additionally, patients with an anterior center-edge angle of ≤12.5° and a lateral center-edge angle of ≤15.5° seem to be at higher risk of osteoarthritis progression over a 10-year period. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shunsuke Akiho
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ayumi Matsunaga
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satohiro Ishii
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Ishimatsu T, Naito M, Kinoshita K, Ishii S, Yamamoto T. Three-dimensional computed tomography analysis on bony birth canal after bilateral periacetabular osteotomy. J Orthop Sci 2017; 22:531-535. [PMID: 28254156 DOI: 10.1016/j.jos.2017.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Curved periacetabular osteotomy (CPO) is one of the joint preserving procedures for developmental dysplasia of the hip. CPO requires osteotomy of the medial wall of the acetabulum, which may cause narrowing of the bony birth canal and this step may result in increased risk of cesarean delivery. We analyzed the narrowest part of the bony birth canal using three-dimensional computed tomography (3D-CT) before and after bilateral CPO. METHODS Between February 2007 and March 2014, there were 29 cases of bilateral CPO in which both pre- and post-operative 3D-CT were available. Transverse diameters of the pelvic inlet, contraction, outlet, expansion, and teardrop were analyzed. Among them, the narrowest part of the bony birth canal was investigated, which being smaller than the normal lower threshold value for vaginal delivery (95 mm) was considered as a risk for cesarean delivery. RESULTS The transverse diameters of both pelvic expansion and teardrop significantly decreased after CPO (both p < 0.01), while other diameters showed no significant changes. Among these two diameters, the narrowest diameter of the bony birth canal was the pelvic teardrop in all 29 cases. That in 24 patients (82.8%) was greater than 95 mm, while that in five patients (17.2%) showed less than 95 mm. CONCLUSIONS Based on 3D-CT analysis, the narrowest part of the bony birth canal after bilateral CPO was the pelvic teardrop. In this study, 82.8% of the patients showed pelvic teardrop diameter greater than 95 mm, while that of the other patients (17.2%) were less than 95 mm.
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Affiliation(s)
- Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Masatoshi Naito
- Department of Orthopaedic Surgery, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Satohiro Ishii
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: a mean follow-up of 20 years. Arch Orthop Trauma Surg 2017; 137:465-469. [PMID: 28197751 DOI: 10.1007/s00402-017-2636-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rotational acetabular osteotomy (RAO), a joint-conserving surgery in which the femoral head coverage by autologous cartilage is improved to achieve joint stability, is one of the most common joint-conserving surgeries for acetabular dysplasia of the hip in adult patients. Favorable outcome of RAO for pre- and initial coxarthrosis has been reported with middle- to long-term observation; however, surgery should be selected for advanced coxarthrosis. The objective of this study was to investigate the long-term clinical outcomes and radiological arthritis changes in patients who were treated with RAO and could be followed for 15 years or longer, and to investigate the joint conservation rate by preoperative arthritis stage. PATIENTS AND METHODS The subjects were 156 patients (178 joints) treated with rotational acetabular osteotomy alone between January 1989 and June 2000. Of those, 106 patients (115 joints) were retrospectively investigated. The mean age at the time of surgery was 41.4 years (14-60 years), and the mean duration of follow-up was 20 years and 4 months (15-26 years and 7 months). RESULTS There were no significant differences in the Harris hip score among the three groups before surgery; however, the score was significantly lower in the advanced than pre/initial coxarthrosis cases at final follow-up. The joint conservation rate with the end point defined as time of total hip arthroplasty was 70.4% at 20 years after surgery. By stage, joint conservation rates were 88.9, 78.9, and 59.3% in pre-, initial, and advanced coxarthrosis cases, respectively, demonstrating a significantly lower rate in the advanced coxarthrosis cases (p = 0.034). The mean time to conversion was 23, 14.5, and 13.7 years in the pre-, initial, and advanced coxarthrosis cases, respectively. CONCLUSION The outcome of rotational acetabular osteotomy in most hips with pre- or initial coxarthrosis was satisfactory. Rotational acetabular osteotomy is an effective surgery for treating symptomatic developmental dysplasia of the hip in selected patients.
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Transpositional periacetabular osteotomy with allografting in patients with severe dysplasia: mid-term results. Hip Int 2017; 27:35-41. [PMID: 27791243 DOI: 10.5301/hipint.5000417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to analyse the extent of surgical correction and the early clinical results obtained using periacetabular osteotomy with allogenic bone grafting in patients with severe acetabular dysplasia. METHODS 44 hips in 38 patients were confirmed to have severe acetabular dysplasia and underwent this procedure. The mean follow-up period was 4.2 (range 1.5-8.2) years. Severe acetabular dysplasia was defined as a centre-edge angle less than 0°, an acetabular-head index less than 50% and an acetabular roof obliquity greater than 30°. Periacetabular osteotomy was performed with transpositional osteotomy of the acetabulum. The patients were divided into 2 groups according to the radiographic appearance: 34 hips in the early stage group and 10 hips in the advanced stage group. Postoperatively, the hips were radiographically assessed for dysplasia correction. The clinical results and hip function were measured using the Harris Hip Score. RESULTS The average preoperative Harris Hip Score improved from 70 to 91 points at the latest follow-up. The average centre-edge angle, acetabular-head index and acetabular roof obliquity improved from -9° to 36°, 41% to 91% and 31° to 2°, respectively. Continuity of the Shenton line improved from 15 to 35 hips. No instances of nonunion or of transported segment collapse were encountered in this series; however, a grafted allogenic bone was absorbed in 1 case. CONCLUSIONS The usage of allogenic bone grafting combined with periacetabular osteotomy is an effective technique for treating severe acetabular dysplasia. In this series, the early clinical and radiographic results were excellent.
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Comparison of femoral head translation following eccentric rotational acetabular osteotomy and rotational acetabular osteotomy. Hip Int 2017; 27:49-54. [PMID: 27791241 DOI: 10.5301/hipint.5000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Eccentric rotational acetabular osteotomy (ERAO) is a modification of rotational acetabular osteotomy (RAO); it has been reported that ERAO allows the femoral head to translate medially and distally. However, no study has compared femoral head translation following RAO or ERAO. The purpose of this study was to compare immediate postoperative translation of the femoral head after RAO and ERAO in comparison with the preoperative position by radiological methods. METHODS Patients treated by RAO or ERAO between 2006 and 2014 were retrospectively evaluated. 19 hips (17 patients) were treated with RAO, and 25 hips (22 patients) were treated with ERAO. The acetabular roof angle and the location of the femoral head were measured on anteroposterior pelvic radiographs. RESULTS The mean preoperative acetabular roof angle was 20.9° in the RAO group and 22.0° in the ERAO group, showing no significant difference. The mean acetabular roof angle immediately postoperatively was -0.5° in the RAO group and -0.4° in the ERAO group, again showing no significant difference. The mean femoral head translation immediately postoperatively was 3.1 mm (95% confidence interval (CI), 1.5-4.7 mm) laterally and 3.0 mm (95% CI, 1.3-4.7 mm) proximally in the RAO group and 0.8 mm (95% CI, -0.7-2.3 mm) medially and 2.8 mm (95% CI, 1.5-4.1 mm) distally in the ERAO group; this difference was very highly significant (p<0.001). CONCLUSIONS In contrast with RAO, ERAO resulted in significant femoral head translation both medially and distally immediately postoperatively.
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Fukushima K, Takahira N, Uchiyama K, Moriya M, Takaso M. Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt. SICOT J 2017; 3:14. [PMID: 28186873 PMCID: PMC5302880 DOI: 10.1051/sicotj/2016051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. Methods: The model was prepared from the patient’s Digital Imaging and Communications in Medicine (DICOM) formatted data from computed tomography (CT), for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following the osteotomy. Results: Our models clearly reflected the anatomical shape of the patient’s hip. Our models allowed for surgical simulation, making realistic use of the chisel and drill. Our method of pre-operative simulation for PAO allowed for the assessment of accurate osteotomy line, determination of the position of the osteotomized fragment, and prevented anterior impingement after the operation. Conclusion: Our method of pre-operative simulation might improve the safety, accuracy, and results of PAO.
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Affiliation(s)
- Kensuke Fukushima
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Mitsutoshi Moriya
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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Amano T, Hasegawa Y, Seki T, Takegami Y, Murotani K, Ishiguro N. A pre-operative predictive score for the outcome of eccentric rotational acetabular osteotomy in the treatment of acetabular dysplasia and early osteoarthritis of the hip in adults. Bone Joint J 2017; 98-B:1326-1332. [PMID: 27694585 DOI: 10.1302/0301-620x.98b10.37515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/30/2016] [Indexed: 11/05/2022]
Abstract
AIMS The influence of identifiable pre-operative factors on the outcome of eccentric rotational acetabular osteotomy (ERAO) is unknown. We aimed to determine the factors that might influence the outcome, in order to develop a scoring system for predicting the prognosis for patients undergoing this procedure. PATIENTS AND METHODS We reviewed 700 consecutive ERAOs in 54 men and 646 women with symptomatic acetabular dysplasia or early onset osteoarthritis (OA) of the hip, which were undertaken between September 1989 and March 2013. The patients' pre-operative background, clinical and radiological findings were examined retrospectively. Multivariate Cox regression analysis was performed using the time from the day of surgery to a conversion to total hip arthroplasty (THA) as an endpoint. A risk score was calculated to predict the prognosis for conversion to THA, and its predictive capacity was investigated. RESULTS The congruity of the hip, age, the pre-operative minimum width of the joint space and range of abduction were identified as factors predicting conversion to THA. For three groups of patients (scoring 0 to 5, 6 to 7, and 8 to 9 points), the Kaplan-Meier event-free rates of survival at 15 years post-operatively for conversion to THA were 99.6%, 85.2% and 67.3%, respectively. CONCLUSION These four pre-operative factors are easily measured and predict the prognosis for patients following ERAO. They may be used for decision making when offering surgical treatment to patients with acetabular dysplasia and early onset osteoarthritis. Cite this article: Bone Joint J 2016;98-B:1326-32.
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Affiliation(s)
- T Amano
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Y Hasegawa
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - T Seki
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Y Takegami
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - K Murotani
- Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan
| | - N Ishiguro
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Abstract
BACKGROUND Periacetabular osteotomy is an excellent intervention for patients at early-stage osteoarthritis, but surgical education for this technique is more difficult than that for total hip arthroplasty. SUBJECTS AND METHODS 47 joints were included from patients who underwent eccentric rotational acetabular osteotomy (ERAO) performed by 6 trainees under the instructing physician's guidance. We evaluated operative time, blood loss, radiographic parameters, clinical scores, perioperative complications, and 10-year survival rates. We also compared trainees' cases with 47 joints from patients in a sex- and age-matched control group that underwent ERAO performed by the instructing physician. RESULTS Hip surgery trainees took an average of 152 minutes and the instructor took 103 minutes. Blood loss during surgery by the trainees and the instructor was 382 and 276 g, respectively. Postoperatively, for the trainee and instructor groups, respectively, the Harris Hip Score improved to 88.9 and 93.7 points; the average centre-edge angle improved to 34.0°and 36.1°; and the average acetabular head index was 93.9% and 95.7%. Perioperative and postoperative complications were observed in 14 patients of the trainee group and 3 patients of the instructor group, which were significantly different (p = 0.0061). The 10-year survival rates were 97.8% and 100% for the trainee and instructor groups, respectively. CONCLUSIONS Postoperative imaging evaluations showed no evident differences in coverage. Postoperative clinical outcomes were also satisfactory. Thus, under proper guidance, education to hip surgery trainees on operative techniques is possible. Instructors need to make more effort to prevent complications by providing good education.
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Hagio T, Naito M, Nakamura Y, Muraoka K. Do labral tears influence poor outcomes after periacetabular osteotomy for acetabular dysplasia? Bone Joint J 2016; 98-B:741-6. [PMID: 27235514 DOI: 10.1302/0301-620x.98b6.36034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 02/04/2016] [Indexed: 11/05/2022]
Abstract
AIMS Acetabular dysplasia is frequently associated with intra-articular pathology such as labral tears, but whether labral tears should be treated at the time of periacetabular osteotomy (PAO) remains controversial. The purpose of this study was to compare the clinical outcomes and radiographic corrections of PAO for acetabular dysplasia between patients with and without labral tears pre-operatively. PATIENTS AND METHODS We retrospectively reviewed 70 hips in 67 patients with acetabular dysplasia who underwent PAO. Of 47 hips (45 patients) with labral tears pre-operatively, 27 (25 patients) underwent PAO alone, and were classified as the labral tear alone (LT) group, and 20 (20 patients) underwent combined PAO and osteochondroplasty, and were classified as the labral tear osteochondroplasty (LTO) group. The non-labral tear (NLT) group included 23 hips in 22 patients. RESULTS There were no significant differences between groups for post-operative Harris hip scores, degree of progression of osteoarthritis or rate of reoperation. The pre-operative alpha angle was significantly larger in the LTO group compared with the other groups (p < 0.0001). CONCLUSION PAO provides equivalent short-term relief of pain and functional outcome in patients with or without labral tears. The rate of progression of osteoarthritis and reoperation was not significantly increased in patients with labral tears. TAKE HOME MESSAGE PAO provides equivalent short-term pain relief and functional outcomes in patients with acetabular dysplasia with and without labral tears. We did not find significantly increased risks of progression of osteoarthritis or re-operation in those with labral tears. Cite this article: Bone Joint J 2016;98-B:741-6.
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Affiliation(s)
- T Hagio
- Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - M Naito
- Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Y Nakamura
- Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - K Muraoka
- Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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Amano T, Hasegawa Y, Seki T, Takegami Y, Murotani K, Ishiguro N. Preoperative prognosis score is a useful tool regarding eccentric rotational acetabular osteotomy in patients with acetabular dysplasia. J Orthop Sci 2016; 21:348-53. [PMID: 27012377 DOI: 10.1016/j.jos.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is unknown how possible preoperative factors influence the postoperative outcome of eccentric rotational acetabular osteotomy (ERAO). We aimed to determine these factors and to develop a scoring system for predicting the prognosis after ERAO in patients with symptomatic hip dysplasia. PATIENTS We included 700 patients (54 men, 646 women) who underwent ERAO during September 1989 to March 2013. The patients' clinical background, preoperative clinical findings, and preoperative imaging findings were examined retrospectively. Univariate and multivariate Cox regression were performed using the time from the day of surgery to a Harris hip score (HHS) <80 as an endpoint. A failure score was defined to predict the prognosis for an HHS <80, and its predictive capacity was assessed. RESULTS Ninety patients had an HHS <80. Forty-two patients underwent conversion to total hip arthroplasty (THA) after their HHS decreased to <80. Five factors were identified in relation to an HHS <80: a history of congenital dislocation of the hip, joint congruity, body mass index, the preoperative minimum joint space width, and the preoperative abduction range of motion. We estimated the weight of each factor using the results of multivariate Cox regression, and the outcome prediction scoring was obtained (0-17 points). For three groups of patients (total points of each factors: 0-5, 6-9, and ≥10 points), the Kaplan-Meier event-free survival rates at 15 years postoperatively for an HHS <80 were 97%, 81%, and 55%, respectively; the survival rates for THA conversion using this prediction scoring were 99%, 96%, and 85%, respectively. CONCLUSIONS Five preoperative factors can easily and clearly predict the prognosis following ERAO. The prognosis score may be a useful tool when making a decision regarding operative treatments in adult patients with acetabular dysplasia.
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Affiliation(s)
- Takafumi Amano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan.
| | - Yukiharu Hasegawa
- Department of Hip and Knee Reconstructive Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Kenta Murotani
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan
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