|
1
|
Asturias A, Kiani S, Sadjadi R, Swarup I. The Treatment of Hip Dysplasia in Adolescent Patients. Curr Rev Musculoskelet Med 2025; 18:217-227. [PMID: 40038222 PMCID: PMC12116402 DOI: 10.1007/s12178-025-09953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2025] [Indexed: 03/06/2025]
Abstract
PURPOSE OF REVIEW Adolescent hip dysplasia represents a unique challenge for pediatric orthopaedic surgeons. The disease spectrum is broad and the complications of untreated disease can be severe. The purpose of this review is to provide a framework for understanding and treating adolescent hip dysplasia and when to consider nonoperative versus operative interventions. RECENT FINDINGS Combined hip arthroscopy and periacetabular osteotomy may be considered for patients with concomitant symptomatic labral tears, which is often diagnosed by history and advanced imaging. Hip dysplasia in adolescent patients is an important diagnosis. There are various clinical and radiographic parameters and the most important ones are lateral center edge angle, Tonnis grade, and joint congruency. Management is based on symptoms and radiographic findings. Nonoperative management is typically recommended for patients with symptomatic borderline dysplasia. Surgical management includes periacetabular osteotomy for patients with symptomatic hip dysplasia that have failed nonoperative treatment. Concomitant hip arthroscopy may be considered for patients with symptomatic labral tear, but is generally not recommended in isolation if there is evidence of dysplasia. Outcomes are generally good after operative management of hip dysplasia in adolescent patients.
Collapse
Affiliation(s)
- Alicia Asturias
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA.
| | - Sara Kiani
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
| | - Ryan Sadjadi
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA, 94143-0728, USA
| |
Collapse
|
|
2
|
Metz AK, Lewis DC, Froerer DL, Featherall J, Rosenthal RM, Khalil AZ, Aoki SK. Dysplastic Hips Have Decreased Iliofemoral Ligament Thickness on Coronal Sequences in Magnetic Resonance Imaging: A Matched Cohort Analysis. Arthroscopy 2025; 41:992-999. [PMID: 38944323 DOI: 10.1016/j.arthro.2024.05.033] [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] [Received: 11/13/2023] [Revised: 05/18/2024] [Accepted: 05/30/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE To characterize hip capsule thickness on advanced imaging in patients with and without hip dysplasia and to also evaluate differences in capsular thickness between patients with borderline and patients with true dysplasia. METHODS Patients evaluated by the senior author for concerns of hip pathology from June 2020 to June 2021 were queried and images reviewed to determine dysplasia status by lateral center-edge angle (LCEA) ≤25°. A group of patients without dysplasia was identified and matched for age, sex, and body mass index. Hip capsular thickness was quantified using magnetic resonance imaging. A subanalysis was conducted to compare patients with true dysplasia (LCEA < 20°) with patients with borderline dysplasia (LCEAs between 20° and 25°). The analysis included independent samples t tests, χ2 tests, and multivariable regression. RESULTS A total of eighty patients were included, with a mean age of 31.8 ± 11.7 years, a mean body mass index of 26.6 ± 6.5 points, and 70% (56) female patients. Patients with dysplasia had a mean LCEA of 19.8 ± 4.3°. Patients with dysplasia had decreased capsular thickness compared with patients without dysplasia (2.75 ± 0.96 mm vs 3.52 ± 1.22 mm, P = .003). Multivariable regression showed decreased capsular thickness associated with decreased LCEAs (β = 2.804, R = 0.432, P < .001) and dysplasia (β = -0.709, R2 = 0.056, P = .004). Results of a subanalysis of the dysplastic group examining differences between accepted definitions of borderline dysplasia and true dysplasia showed no significant differences in capsular thickness between the 2 groups (P = .379). CONCLUSIONS Patients with hip dysplasia were found to have thinner iliofemoral ligaments in the coronal plane on magnetic resonance imaging on magnetic resonance imaging. Further investigation is needed to evaluate any potential implications with hip instability, given the thinner hip capsule demonstrated in this study. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
Collapse
Affiliation(s)
- Allan K Metz
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Daniel C Lewis
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Devin L Froerer
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Featherall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Reece M Rosenthal
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Ameen Z Khalil
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
| |
Collapse
|
|
3
|
Maak TG. CORR Insights®: Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage. Clin Orthop Relat Res 2025; 483:359-362. [PMID: 39589349 PMCID: PMC11753754 DOI: 10.1097/corr.0000000000003326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 11/04/2024] [Indexed: 11/27/2024]
Affiliation(s)
- Travis G Maak
- Professor, Orthopaedic Surgery Department, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
|
4
|
Rivas DJL, Weinstein S, Tatum M, Aitken HD, Ford A, Dempewolf S, Willey MC, Goetz JE. Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage. Clin Orthop Relat Res 2025; 483:343-358. [PMID: 39387480 PMCID: PMC11753756 DOI: 10.1097/corr.0000000000003268] [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: 04/11/2024] [Accepted: 09/13/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. QUESTIONS/PURPOSES To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the "acetabular sourcil" location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? METHODS Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the "time" separating the 3D acetabular contributions of the sourcil edges was performed. RESULTS The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. CONCLUSION Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. CLINICAL RELEVANCE This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.
Collapse
Affiliation(s)
- Dominic J. L. Rivas
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Stuart Weinstein
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Marcus Tatum
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Holly D. Aitken
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Alison Ford
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Spencer Dempewolf
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Michael C. Willey
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Jessica E. Goetz
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
|
5
|
Beck EC, Entessari M, Agarwalla A, Mason T, St Jeor JD, Stubbs AJ. Patients Undergoing Microfracture With Allograft Cartilage and Autologous Platelet-Rich Plasma Augmentation for Chondromalacia in the Hip Achieving High Rates of Meaningful Outcomes at 2-Year Follow-Up. Arthroscopy 2025:S0749-8063(25)00040-4. [PMID: 39892431 DOI: 10.1016/j.arthro.2025.01.022] [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: 08/14/2024] [Revised: 12/17/2024] [Accepted: 01/07/2025] [Indexed: 02/03/2025]
Abstract
PURPOSE To evaluate rates of achieving meaningful outcomes and clinical failure at 2 years after undergoing microfracture augmented with allograft cartilage with autologous platelet-rich plasma and to identify predictors of conversion to total hip arthroplasty (THA). METHODS Data from a prospective series of consecutive patients with Outerbridge grade 4 chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with allograft cartilage between January 2017 and June 2022 were analyzed. Patient-reported outcomes were collected preoperatively and at a minimum of 2 years postoperatively. The Hip Outcome Score-Activities of Daily Living Subscale, Hip Outcome Score-Sports-Specific Subscale, modified Harris Hip Score, and Non-arthritic Hip Score thresholds for achieving the minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit at 2 years after surgery were calculated. Logistic regression analysis was performed to identify any association between nonmodifiable variables and clinical failure. RESULTS A total of 108 hips (80.6% follow-up) among 106 patients had 2-year follow-up and were included in the final analysis. The mean age and body mass index (BMI) were 37.9 ± 10.1 years and 26.8 ± 4.7, respectively, with a mean follow-up time of 31.9 ± 8.4 months (range, 24-53 months). There was a statistically significant improvement in all functional score averages over the 2-year period (P < .05). A total of 84.7%, 75.5%, and 70.4% of patients reached at least 1 threshold for achieving the minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit, respectively. There were 11 patients (10.2%) who underwent conversion to THA, with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA (P < .05 for all). Finally, chondromalacia size or chondromalacia index (e.g., Outerbridge grade × surface area) was not associated with clinical failure or achievement of meaningful outcomes (P > .05 for all). CONCLUSIONS Patients undergoing microfracture with allograft cartilage and autologous platelet-rich plasma augmentation for acetabular or femoral head chondromalacia showed a statistically significant improvement in outcome scores and high rates of achieving meaningful outcomes at 2-year follow-up regardless of chondromalacia defect size. The rate of conversion to THA was 10.2%, with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Edward C Beck
- Department of Orthopedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, U.S.A..
| | - Mina Entessari
- Department of Orthopedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, U.S.A
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Thomas Mason
- College of Medicine, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Jeffery D St Jeor
- Department of Orthopedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, U.S.A
| | - Allston J Stubbs
- Department of Orthopedic Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, U.S.A
| |
Collapse
|
|
6
|
Alshaikhsalama A, Archer H, Xi Y, Ljuhar R, Wells JE, Chhabra A. HIPPO artificial intelligence: Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia. World J Exp Med 2024; 14:99359. [PMID: 39713082 PMCID: PMC11551701 DOI: 10.5493/wjem.v14.i4.99359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 09/23/2024] [Accepted: 10/24/2024] [Indexed: 10/31/2024] Open
Abstract
BACKGROUND Hip dysplasia (HD) is characterized by insufficient acetabular coverage of the femoral head, leading to a predisposition for osteoarthritis. While radiographic measurements such as the lateral center edge angle (LCEA) and Tönnis angle are essential in evaluating HD severity, patient-reported outcome measures (PROMs) offer insights into the subjective health impact on patients. AIM To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence (AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs. METHODS Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database. Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score (HHS), international hip outcome tool (iHOT-12), short form (SF) 12 (SF-12), and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation. RESULTS The median patient age was 28.6 years (range 15.7-62.3 years) with 82.3% of patients being women and 17.7% being men. The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds, respectively. Manual measurements exhibited weak correlations with HHS, including LCEA (r = 0.18) and Tönnis angle (r = -0.24). AI-derived metrics showed similar weak correlations, with the most significant being Caput-Collum-Diaphyseal (CCD) with iHOT-12 at r = -0.25 (P = 0.042) and CCD with SF-12 at r = 0.25 (P = 0.048). Other measured correlations were not significant (P > 0.05). CONCLUSION This study suggests AI can aid in HD assessment, but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes, complementing AI-derived measurements in HD management.
Collapse
Affiliation(s)
- Ahmed Alshaikhsalama
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, United States
| | - Holden Archer
- Department of Radiology, University of Texas Southwestern, Dallas, TX 75390, United States
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States
| | - Richard Ljuhar
- Department of Radiology, Image Biopsy, Vienna 1190, Austria
| | - Joel E Wells
- Department of Orthopedic Surgery, Baylor Scott and White, Dallas, TX 75235, United States
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States
| |
Collapse
|
|
7
|
Archer H, Xia S, Salzlechner C, Götz C, Chhabra A. Artificial Intelligence in Musculoskeletal Radiographs: Scoliosis, Hip, Limb Length, and Lower Extremity Alignment Measurements. Semin Roentgenol 2024; 59:510-517. [PMID: 39490043 DOI: 10.1053/j.ro.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 11/05/2024]
Affiliation(s)
- Holden Archer
- UT Southwestern Medical Center, Department of Orthopaedic Surgery, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Shuda Xia
- UT Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390
| | | | - Christoph Götz
- ImageBiopsy Lab, Inc., Zehetnergasse 6/2/2, 1140, Wien, Vienna, Austria
| | - Avneesh Chhabra
- UT Southwestern Medical Center, Department of Orthopaedic Surgery, 5323 Harry Hines Blvd, Dallas, TX 75390; UT Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX 75390; Adjunct Faculty Johns Hopkins University, Department of Radiology, Maryland, USA; Department of Radiology, Walton Center of Neurosciences, Liverpool, UK.
| |
Collapse
|
|
8
|
Boel F, Riedstra NS, Tang J, Hanff DF, Ahedi H, Arbabi V, Arden NK, Bierma-Zeinstra SMA, van Buuren MMA, Cicuttini FM, Cootes TF, Crossley K, Eygendaal D, Felson DT, Gielis WP, Heerey J, Jones G, Kluzek S, Lane NE, Lindner C, Lynch J, van Meurs J, Nelson AE, Mosler AB, Nevitt MC, Oei EH, Runhaar J, Weinans H, Agricola R. Reliability and agreement of manual and automated morphological radiographic hip measurements. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100510. [PMID: 39262611 PMCID: PMC11387701 DOI: 10.1016/j.ocarto.2024.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/01/2024] [Indexed: 09/13/2024] Open
Abstract
Objective To determine the reliability and agreement of manual and automated morphological measurements, and agreement in morphological diagnoses. Methods Thirty pelvic radiographs were randomly selected from the World COACH consortium. Manual and automated measurements of acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg center edge angle (WCEA), lateral center edge angle (LCEA), extrusion index (EI), neck-shaft angle (NSA), and triangular index ratio (TIR) were performed. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to test reliability. Agreement in diagnosing acetabular dysplasia, pincer and cam morphology by manual and automated measurements was assessed using percentage agreement. Visualizations of all measurements were scored by a radiologist. Results The Bland-Altman plots showed no to small mean differences between automated and manual measurements for all measurements except for ADR. Intraobserver ICCs of manual measurements ranged from 0.26 (95%-CI 0-0.57) for TIR to 0.95 (95%-CI 0.87-0.98) for LCEA. Interobserver ICCs of manual measurements ranged from 0.43 (95%-CI 0.10-0.68) for AA to 0.95 (95%-CI 0.86-0.98) for LCEA. Intermethod ICCs ranged from 0.46 (95%-CI 0.12-0.70) for AA to 0.89 (95%-CI 0.78-0.94) for LCEA. Radiographic diagnostic agreement ranged from 47% to 100% for the manual observers and 63%-96% for the automated method as assessed by the radiologist. Conclusion The automated algorithm performed equally well compared to manual measurement by trained observers, attesting to its reliability and efficiency in rapidly computing morphological measurements. This validated method can aid clinical practice and accelerate hip osteoarthritis research.
Collapse
Affiliation(s)
- F Boel
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - N S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - J Tang
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - D F Hanff
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - H Ahedi
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - V Arbabi
- Department of Orthopedics, UMC Utrecht, Utrecht, the Netherlands
- Orthopaedic-Biomechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - N K Arden
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - M M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - F M Cicuttini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - T F Cootes
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - K Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - D Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - D T Felson
- Boston University School of Medicine, Boston, MA, USA
| | - W P Gielis
- Department of Orthopedics, UMC Utrecht, Utrecht, the Netherlands
| | - J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - G Jones
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - S Kluzek
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - N E Lane
- Department of Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - C Lindner
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - J Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - J van Meurs
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - A E Nelson
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - E H Oei
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - J Runhaar
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - H Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, the Netherlands
| | - R Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| |
Collapse
|
|
9
|
Jang SJ, Driscoll DA, Anderson CG, Sokrab R, Flevas DA, Mayman DJ, Vigdorchik JM, Jerabek SA, Sculco PK. Radiographic Findings Associated With Mild Hip Dysplasia in 3869 Patients Using a Deep Learning Measurement Tool. Arthroplast Today 2024; 28:101398. [PMID: 38993836 PMCID: PMC11237356 DOI: 10.1016/j.artd.2024.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 07/13/2024] Open
Abstract
Background Hip dysplasia is considered one of the leading etiologies contributing to hip degeneration and the eventual need for total hip arthroplasty (THA). We validated a deep learning (DL) algorithm to measure angles relevant to hip dysplasia and applied this algorithm to determine the prevalence of dysplasia in a large population based on incremental radiographic cutoffs. Methods Patients from the Osteoarthritis Initiative with anteroposterior pelvis radiographs and without previous THAs were included. A DL algorithm automated 3 angles associated with hip dysplasia: modified lateral center-edge angle (LCEA), Tönnis angle, and modified Sharp angle. The algorithm was validated against manual measurements, and all angles were measured in a cohort of 3869 patients (61.2 ± 9.2 years, 57.1% female). The percentile distributions and prevalence of dysplastic hips were analyzed using each angle. Results The algorithm had no significant difference (P > .05) in measurements (paired difference: 0.3°-0.7°) against readers and had excellent agreement for dysplasia classification (kappa = 0.78-0.88). In 140 minutes, 23,214 measurements were automated for 3869 patients. LCEA and Sharp angles were higher and the Tönnis angle was lower (P < .01) in females. The dysplastic hip prevalence varied from 2.5% to 20% utilizing the following cutoffs: 17.3°-25.5° (LCEA), 9.4°-15.6° (Tönnis), and 41.3°-45.9° (Sharp). Conclusions A DL algorithm was developed to measure and classify hips with mild hip dysplasia. The reported prevalence of dysplasia in a large patient cohort was dependent on both the measurement and threshold, with 12.4% of patients having dysplasia radiographic indices indicative of higher THA risk.
Collapse
Affiliation(s)
- Seong Jun Jang
- Weill Cornell College of Medicine, New York, NY, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel A Driscoll
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Christopher G Anderson
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ruba Sokrab
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Dimitrios A Flevas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
|
10
|
Featherall J, Metz AK, Froerer DL, Rosenthal RM, O'Neill DC, Khalil AZ, Maak TG, Aoki SK. False-Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Correlate to Different Weightbearing Regions of the Acetabulum: A 3-Dimensional Analysis. Am J Sports Med 2024; 52:2603-2610. [PMID: 39135344 DOI: 10.1177/03635465241265679] [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: 08/23/2024]
Abstract
BACKGROUND The acetabular sourcil is commonly interpreted as a reliable radiographic representation of the weightbearing dome of the acetabulum, despite limited modern data. Assessment of weightbearing acetabular coverage has been described using both the sourcil edge and bone edge as anatomic landmarks, leading to confusion and potential misguidance in surgical decision-making and thus compromised patient outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to characterize the 3-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic measurements on false-profile radiographs. It was hypothesized that the sourcil edge would represent anterolateral coverage and the bone edge would represent anterior coverage. STUDY DESIGN Descriptive laboratory study. METHODS A total of 80 hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center-edge angles, based on upper and lower quartiles of discrepancy. Three-dimensional surface mesh models and digitally reconstructed radiographs were generated from hip computed tomography scans. Sourcil-edge and bone-edge anterior center-edge angles were identified on digitally reconstructed radiographs and registered to the 3D models with fiducial markers. Intersections of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models. RESULTS The bone-edge and sourcil-edge projections intersected the acetabular rim at clockface means of 2:05 ± 0:22 and 1:12 ± 0:25, respectively. The 3D models consistently demonstrated that, in both large- and small-discrepancy groups, the sourcil edge corresponded to the acetabular area just posterior to the anterior inferior iliac spine (AIIS) projection, and the bone edge corresponded to the weightbearing region inferior to the AIIS. Additionally, in large-discrepancy hips, the bone edge corresponded to more prominent acetabular coverage in the region inferomedial to the AIIS when compared with the small-discrepancy hips. CONCLUSION On false-profile radiographs, the sourcil edge corresponds to superior femoral head coverage, and the bone edge corresponds to anterosuperior coverage. Radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate acetabular rim prominence in the region of the AIIS. CLINICAL RELEVANCE Characterizing the anatomic weightbearing regions of the acetabulum represented on false-profile radiographs facilitates improved clinical and intraoperative decision-making in hip preservation surgery, including acetabuloplasty and periacetabular osteotomy.
Collapse
Affiliation(s)
- Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Allan K Metz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Reece M Rosenthal
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Dillon C O'Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Ameen Z Khalil
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
|
11
|
Bischoff CJ, Woodard DR, Pringle LC, DeFroda SF. Imaging Modalities in the Preoperative Assessment of Femoroacetabular Impingement and Hip Dysplasia: Determining Best Practices. JBJS Rev 2024; 12:01874474-202407000-00006. [PMID: 38991089 DOI: 10.2106/jbjs.rvw.24.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
» In the last decade, significant progress has been made in understanding hip pain, especially related to femoroacetabular impingement (FAI) and hip dysplasia (HD), which collectively affect over 20% of the population.» Preoperative imaging, including plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), plays a pivotal role in diagnosing FAI and HD. Imaging precision, standardized techniques, and accurate interpretation are crucial for effective treatment planning.» The continual advancements in imaging techniques, especially seen in MRI (arthrograms, application of leg traction, and delayed gadolinium-enhanced MRI of cartilage), represent important strides in the precise assessment of pathology associated with FAI and HD.» By incorporating these advancements into routine imaging protocols, healthcare providers can ensure a comprehensive understanding of hip joint dynamics, enabling more accurate diagnosis and effective management strategies for patients with FAI and HD, ultimately leading to improved clinical outcomes.
Collapse
Affiliation(s)
- Caleb J Bischoff
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - David R Woodard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | | | - Steven F DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| |
Collapse
|
|
12
|
Kim DNW, Fong S, Park N, Simington J, Atadja L, Pettinelli N, Lee MS, Gillinov SM, Maldonado DR, Jimenez AE. Mid- to Long-Term Outcomes in Patients After Hip Arthroscopy With Labral Reconstruction: A Systematic Review. Orthop J Sports Med 2024; 12:23259671241232306. [PMID: 38831872 PMCID: PMC11144364 DOI: 10.1177/23259671241232306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 06/05/2024] Open
Abstract
Background There is a paucity of aggregate data documenting mid- to long-term outcomes of patients after hip arthroscopy with labral reconstruction. Purpose To report mid- to long-term outcomes in patients after undergoing either primary or revision hip arthroscopy with labral reconstruction for the treatment of irreparable labral tears. Study Design Systematic review; Level of evidence, 4. Methods A systematic review of the PubMed, Cochrane, and Scopus databases in May 2022 was conducted with the following keywords: "hip arthroscopy,""labral reconstruction,""irreparable,""labrum,""reconstruction,""five-year,""midterm,""5 year,""long-term,""10 year," ten-year," and "femoroacetabular impingement" using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Midterm was defined as mean 5-year follow-up, and long-term was defined as mean 10-year or longer follow-up. For each included article, the demographic, radiographic, intraoperative, and surgical variables, as well as patient-reported outcomes (PROs), psychometric thresholds, and secondary surgeries were recorded. Forest plots were created for PROs that were reported in ≥3 studies; heterogeneity was assessed using I2 values. Results Out of 463 initial articles, 5 studies including 178 hips with primary and 41 hips with revision surgeries were included. One study had an average 5-year follow-up, three studies had a minimum 5-year follow-up and one study had a minimum 10-year follow-up. The most common indications for hip arthroscopy with labral reconstruction were irreparable labral tears. The most common PRO was the modified Harris Hip Score (mHHS), which was reported in all 5 studies. The mean preoperative mHHS ranged from 58.9 to 66, and the mean postoperative mHHS at minimum 5-year follow-up ranged from 80.2 to 89. The preoperative and postoperative mHHSs for the single long-term follow-up study were 60 and 82, respectively. All 5 studies demonstrated significant improvements in reported PROs. All 5 studies reported secondary surgery rates, with 1 study reporting rates at both 5- and 10-year follow-up. Conversion to total hip arthroplasty ranged from 0% to 27%, while overall secondary surgery rates ranged from 0% to 36%. Conclusion Findings demonstrated that patients undergoing primary and revision hip arthroscopy with labral reconstruction experienced favorable outcomes and high rates of clinical benefit and survivorship at mid- to long-term follow-up.
Collapse
Affiliation(s)
- David Nam-Woo Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jacquelyn Simington
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Louise Atadja
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - David R. Maldonado
- Department of Orthopedic Surgery, McGovern Medical School, Houston, Texas, USA
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
|
13
|
Boel F, de Vos-Jakobs S, Riedstra NS, Lindner C, Runhaar J, Bierma-Zeinstra SMA, Agricola R. Automated radiographic hip morphology measurements: An open-access method. OSTEOARTHRITIS IMAGING 2024; 4:100181. [PMID: 39239618 PMCID: PMC7616415 DOI: 10.1016/j.ostima.2024.100181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Objective The aim of this study is to present a newly developed automated method to determine radiographic measurements of hip morphology on dual-energy x-ray absorptiometry (DXA) images. The secondary aim was to compare the performance of the automated and manual measurements. Design 30 DXA scans from 13-year-olds of the prospective population-based cohort study Generation R were randomly selected. The hip shape was outlined automatically using radiographic landmarks from which the acetabular depth-width ratio (ADR), acetabular index (AI), alpha angle (AA), Wiberg and lateral center edge angle (WCEA) (LCEA), extrusion index (EI), neck-shaft angle (NSA), and the triangular index (TI) were determined. Manual assessments were performed twice by two orthopedic surgeons. The agreement within and between observers and methods was visualized using Bland-Altman plots, and the reliability was studied using the intraclass correlation coefficient (ICC) with 95 % confidence intervals (CI). Results The automated method was able to perform all radiographic hip morphology measurements. The intermethod reliability between the automated and manual measurements ranged from 0.57 to 0.96 and was comparable to or better than the manual interobserver reliability, except for the AI. Conclusion This open-access, automated method allows fast and reproducible calculation of radiographic measurements of hip morphology on right hip DXA images. It is a promising tool for performing automated radiographic measurements of hip morphology in large population studies and clinical practice.
Collapse
Affiliation(s)
- F Boel
- Erasmus MC, Department of Orthopaedics and Sports Medicine, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - S de Vos-Jakobs
- Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - N S Riedstra
- Erasmus MC, Department of Orthopaedics and Sports Medicine, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - J Runhaar
- Erasmus MC, Department of General Practice, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Erasmus MC, Department of Orthopaedics and Sports Medicine, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
- Erasmus MC, Department of General Practice, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - R Agricola
- Erasmus MC, Department of Orthopaedics and Sports Medicine, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| |
Collapse
|
|
14
|
Iwasaka-Neder J, Bedoya MA, Connors J, Warfield S, Bixby SD. Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children. Pediatr Radiol 2024; 54:743-757. [PMID: 38421417 DOI: 10.1007/s00247-024-05888-7] [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: 10/02/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND MRI-based synthetic CT (sCT) generates CT-like images from MRI data. OBJECTIVE To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients. MATERIALS AND METHODS We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue. Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard. RESULTS Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9-20.9; male = 5). cCT- and sCT-based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77 CONCLUSION sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.
Collapse
Affiliation(s)
- Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - James Connors
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Simon Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, 401 Park Drive, Boston, MA, 02215, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| |
Collapse
|
|
15
|
Sinha R, Morris WZ, Ellis HB, McGinley J, Podeszwa DA, Sucato DJ, Nepple JJ, Clohisy JC. Radiographic evaluation of the painful adolescent and young adult hip. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2024; 7:100039. [PMID: 40433291 PMCID: PMC12088303 DOI: 10.1016/j.jposna.2024.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 05/29/2025]
Abstract
Radiographic evaluation of hip pain in adolescents and young adults is an important component of the assessment to aid in the identification of the cause of pain, distinguish between etiologies of early hip degeneration such as acetabular dysplasia (instability) and femoroacetabular impingement, and guide further workup and management. Recent advances in radiographic assessment include the importance of obtaining a standing anterior-posterior radiograph to illustrate the functional position of the pelvis, the use of anterior and posterior wall indices to illustrate anterior and posterior wall coverage and the importance of interpreting radiographic measures in the context of a patient's sagittal balance. Advances in magnetic resonance imaging, computed tomography, and ultrasound have also occurred and can provide further diagnostic clarity. The purpose of this work is to review the literature to provide a systematic approach to the radiographic evaluation of hip pain in skeletally mature adolescents and young adults. Key Concepts (1)The standing AP pelvis, 45° Dunn, and false-profile views provide a preliminary comprehensive radiographic assessment of the symptomatic hip in the skeletally mature adolescent and young adult and help to distinguish between instability and impingement.(2)The Lateral Center Edge Angle (LCEA) should be augmented by the anterior center edge angle (ACEA), anterior wall index (AWI), and posterior wall index (PWI) to obtain a more complete understanding of 3-dimensional femoral head coverage from plain radiographs.(3)While the crossover and posterior wall signs on radiographs can be helpful in screening for acetabular retroversion and anteversion, CT should be used to confirm if considering reorientation or resection.(4)Cam morphology should be quantitatively assessed using the alpha angle and head-neck offset on the 45° Dunn view.(5)Dynamic ultrasound may be useful in illustrating the motion associated with impingement and instability in real-time but may be limited by the technician-dependent nature of this modality.
Collapse
Affiliation(s)
- Rishi Sinha
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Z. Morris
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry B. Ellis
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James McGinley
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A. Podeszwa
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel J. Sucato
- Scottish Rite for Children, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey J. Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
|
16
|
Mortensen AJ, Featherall J, Metz AK, Rosenthal RM, O’Neill DC, Froerer DL, Khalil AZ, Tomasevich KM, Aoki SK. The Role of the Hip Capsule in Restoring Stability in the Initial Phase of Hip Distraction: An In Vivo Analysis. Orthop J Sports Med 2024; 12:23259671241249719. [PMID: 38784788 PMCID: PMC11113053 DOI: 10.1177/23259671241249719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 05/25/2024] Open
Abstract
Background The labral suction seal has been shown to provide the majority of resistance in the initial phase of hip distraction. However, the effect of an unrepaired interportal capsulotomy and capsular repair on the initial phase of hip distractive stability in vivo is not well understood. Purpose To investigate the effect of capsular repair on the initial phase of distractive stability of hip joints in patients with femoroacetabular impingement (FAI) syndrome. Study Design Controlled laboratory study. Methods Patients undergoing primary hip arthroscopy for FAI between March and August 2020 were prospectively enrolled. Total joint space was measured on fluoroscopic images at the medial and lateral edges of the sourcil at 12.5-lb (5.7-kg) axial traction intervals (up to 100 lb [45.4 kg]) in 3 capsular states: (1) native capsule, (2) interportal capsulotomy, and (3) capsular repair. Distraction on anteroposterior radiographs was calculated as the difference between total joint space at each traction interval and baseline joint space at 0 lb, normalized to millimeters. The native, capsulotomy, and capsular repair states were compared using Wilcoxon signed-rank and McNemar tests. Results Included were 36 hips in 35 patients. The median force required to distract ≥3 mm was 75 lb (34.0 kg; 95% CI, 70-80 lb [31.8-36.3 kg]) in both the native and capsular repair states (P = .629), which was significantly greater than the median force required to distract ≥3 mm in the capsulotomy state (50 lb [22.7 kg]; 95% CI, 45-55 lb [20.4-24.9 kg]) (P < .001). The most rapid rates of change in joint space were observed at the traction interval at which hips first achieved ≥3 mm of distraction (n = 33 hips; 92%). Conclusion The traction force at which hips distracted ≥3 mm was 75 lb (34.0 kg) in both the native capsular and capsular repair states. Significantly less traction force (50 lb [22.7 kg]) distracted hips ≥3 mm in the capsulotomy state. Complete capsular closure after interportal capsulotomy resulted in restoration of initial distractive stability relative to the unrepaired capsulotomy state at time zero after primary hip arthroscopy. Clinical Relevance This study provides surgeons with an improved understanding of the additional stability to the hip joint from capsular repair after hip arthroscopy for FAI syndrome.
Collapse
Affiliation(s)
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Allan K. Metz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Reece M. Rosenthal
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Dillon C. O’Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Devin L. Froerer
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ameen Z. Khalil
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
|
17
|
Gonçalves BAM, Saxby DJ, Meinders E, Barrett RS, Diamond LE. Hip Contact Forces During Sprinting in Femoroacetabular Impingement Syndrome. Med Sci Sports Exerc 2024; 56:402-410. [PMID: 37882088 DOI: 10.1249/mss.0000000000003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE Sprinting often provokes hip pain in individuals with femoroacetabular impingement syndrome (FAIS). Asphericity of the femoral head-neck junction (cam morphology) characteristic of FAIS can increase the risk of anterior-superior acetabular cartilage damage. This study aimed to 1) compare hip contact forces (magnitude and direction) during sprinting between individuals with FAIS, asymptomatic cam morphology (CAM), and controls without cam morphology, and 2) identify the phases of sprinting with high levels of anteriorly directed hip contact forces. METHODS Forty-six recreationally active individuals with comparable levels of physical activity were divided into three groups (FAIS, 14; CAM, 15; control, 17) based on their history of hip/groin pain, results of clinical impingement tests, and presence of cam morphology (alpha angle >55°). Three-dimensional marker trajectories, ground reaction forces, and electromyograms from 12 lower-limb muscles were recorded during 10-m overground sprinting trials. A linearly scaled electromyogram-informed neuromusculoskeletal model was used to calculate hip contact force magnitude (resultant, anterior-posterior, inferior-superior, medio-lateral) and angle (sagittal and frontal planes). Between-group comparisons were made using two-sample t -tests via statistical parametric mapping ( P < 0.05). RESULTS No significant differences in magnitude or direction of hip contact forces were observed between FAIS and CAM or between FAIS and control groups during any phase of the sprint cycle. The highest anteriorly directed hip contact forces were observed during the initial swing phase of the sprint cycle. CONCLUSIONS Hip contact forces during sprinting do not differentiate recreationally active individuals with FAIS from asymptomatic individuals with and without cam morphology. Hip loading during early swing, where peak anterior loading occurs, may be a potential mechanism for cartilage damage during sprinting-related sports in individuals with FAIS and/or asymptomatic cam morphology.
Collapse
|
|
18
|
Lee SH, Alarcon Perico D, Hevesi M, Sierra RJ. A New Arthroscopic Classification for Chondrolabral Disease in Patients Undergoing Surgery for Developmental Dysplasia of the Hip. Am J Sports Med 2024; 52:643-652. [PMID: 38279831 DOI: 10.1177/03635465231221507] [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: 01/29/2024]
Abstract
BACKGROUND Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia. PURPOSE To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 hips underwent combined hip arthroscopy and PAO at our institution between September 2013 and December 2014, irrespective of symptoms or radiographic findings. PROMs were evaluated preoperatively and at 2 years postoperatively. At the time of hip arthroscopy, the chondrolabral junction was classified as normal without tear (1 hip, type 1); hypertrophic labrum without chondrolabral disruption (19 hips, type 2); chondrolabral disruption on the articular side, not extending into the capsular side (16 hips, type 3A); chondrolabral disruption extending through the capsular side (3 hips, type 3B); and exposed acetabular subchondral bone (7 hips, type 4). RESULTS There was a significant difference in postoperative modified Harris Hip Score (mHHS) (P = .020), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (P = .037), and WOMAC total scores (P = .049) between chondrolabral junction types. Post hoc analyses demonstrated significant differences between type 2 (84.9 ± 12.9) and type 3A (67.8 ± 20.7; P = .198), and between type 2 and type 4 (59.3 ± 24.3; P = .011) in postoperative mHHS scores; and between type 2 (83.9 ± 12.9) and type 3A (68.9 ± 23.7; P = .045) in postoperative WOMAC total scores. In multivariate analysis, chondrolabral type 3 or type 4, age >35 years, and previous surgery were significantly correlated with worse mHHS scores at 2 years. CONCLUSION This new chondrolabral classification is proposed to describe intra-articular pathology seen during combined hip arthroscopy and PAO, specifically in dysplastic hips. More advanced chondrolabral disease was associated with worse PROMs at 2 years.
Collapse
Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | | |
Collapse
|
|
19
|
Falgout DM, Bevan PJ, Grumet RC, Parvaresh KC. Femoroacetabular Impingement Measurements Obtained From Two-Dimensional Radiographs Versus Three-Dimensional-Reconstructed Computed Tomography Images Result in Different Values. Arthrosc Sports Med Rehabil 2024; 6:100833. [PMID: 38169873 PMCID: PMC10758706 DOI: 10.1016/j.asmr.2023.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose To compare the reliability and accuracy of radiographic measurements obtained from 2-dimensional (2D) radiographs and 3-dimensional (3D)-reconstructed computed tomography (CT) images in the assessment of femoroacetabular impingement syndrome (FAIS). Methods Consecutive patients with FAIS from January 2018 to December 2020 were identified and included in this study. Two fellowship-trained surgeons and 2 fellows performed blinded radiographic measurements. Lateral center-edge angle (LCEA) and Tönnis angles were measured on anteroposterior pelvic radiographs, and alpha angles were measured on frog lateral radiographs. Reliability coefficients for individual measurement accuracy were performed using the Cronbach alpha and intra- and inter-rater intraclass correlation coefficients (ICCs). Composite measurements for LCEA, Tönnis angle, and alpha angle were compared with the corresponding 3D value using paired sample t-tests. Results Fifty-three patients with FAIS with standardized 2D radiographic and 3D-reconstructed CT imaging were included. All reliability metrics met thresholds for internal reliability. Inter-rater ICCs for LCEA, Tönnis angle, and alpha angle were (0.928, 0.888, 0.857, all P < .001). When we compared 2D radiographic measurements with 3D-reconstructed CT values, there was a significant difference in the LCEA for 2 authors: surgeon 1 (mean [M] = -9.14, standard deviation [SD] = 5.7); t(52) = -11.6, P < .001, and surgeon 2 (M = -5.9°, SD = 4.7); t(52) = -9.2, P < .001. Significant differences were seen for Tönnis angle for 2 authors: fellow 2 (M = 3.9°, SD = 5.6); t(52) = 5.1, P < .001, and surgeon 2 (M = -2.6°, SD = 4.1); t(52) = -4.6, P < .001. Alpha angle measurements compared to the 3D-reconstructed alpha angle at 2 o'clock was significantly different for 3 authors: fellow 1 (M = 11.9°, SD = 16.2); t(52) = 5.3, P < .001; fellow 2 (M = 10.4°, SD = 18.6); t(52) = 4.1, P = .002; and surgeon 2 (M = -6.5°, SD = 16.2); t(52) = -2.9, P = .005. Positive mean values indicate 2D radiographic measurements overestimated 3D reconstruction values and negative mean values indicate underestimation. Conclusions The use of 2D radiographs alone for preoperative planning of FAIS may lead to inaccuracies in radiographic measurements. Level of Evidence Level, III retrospective cohort study.
Collapse
|
|
20
|
Cheng H, Ren N, Gu W, Zhang Z, Li Y, Sun W, Chai W, Luo D, Zhang H. Comparison of Anterior Center-Edge Angle Measured From the Acetabular Sourcil Versus the Anterior Bone-Edge of the Acetabulum: A Descriptive Laboratory Study. Orthop J Sports Med 2024; 12:23259671231221295. [PMID: 38304054 PMCID: PMC10832420 DOI: 10.1177/23259671231221295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background Measuring anterior hip coverage on false-profile (FP) radiographs is important for judging anterior hip coverage. Conventionally, the anterior center-edge angle (ACEA) is measured from the anterior edge of the acetabular sourcil (sourcil ACEA); however, the anterior bone edge is also used as the anterior landmark. Purpose To determine whether the sourcil ACEA or the bone-edge ACEA better represents the anterior coverage of the hip joint. Study Design Descriptive laboratory study. Methods We retrospectively observed 49 hips in 49 patients who underwent isolated periacetabular osteotomy. The sourcil ACEA was measured according to the standard procedure. Then, 3-dimensional (3D) volumetric models were made from computed tomographic data. The acetabular surface of the 3D model was labeled and projected onto a simulated FP radiograph, enabling the edge of the acetabulum to be identified. This simulated FP radiograph was used to measure the "true ACEA," as well as the sourcil ACEA and the bone-edge ACEA, and the 3 measurements were compared. Statistical analysis was performed-including testing for normal distribution, measuring interobserver agreement, evaluating differences between measurements, and validating correlation. Results The mean sourcil ACEA was 8.6° (range, -3.9° to 31.7°) smaller than that of the true ACEA (P < .001); there was a strong correlation (r = 0.81; P < .001) between the 2. The mean bone-edge ACEA was 16.8° (range, -1.7° to 45.4°) greater than that of the true ACEA (P < .001); there was a moderate correlation (r = 0.57; P < 0.001) between the 2. Conclusion Both the sourcil ACEA and bone-edge ACEA differed from the true ACEA. However, compared with the bone-edge ACEA, the sourcil ACEA was numerically closer to the true ACEA and had a stronger correlation with it . Clinical Relevance While the exact edge of the true bearing surface of the articular cartilage may not be visible on the FP radiograph, the sourcil ACEA can be effectively utilized as a reliable surrogate when evaluating the anterior acetabular coverage in hip preservation surgery.
Collapse
Affiliation(s)
- Hui Cheng
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Ningtao Ren
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wang Gu
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Zhendong Zhang
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Yong Li
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wei Sun
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Dianzhong Luo
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| | - Hong Zhang
- Senior Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medical and Rehabilitation, Beijing, China
| |
Collapse
|
|
21
|
Alghamdi A, Madan S, Shuweihdi F, Offiah AC. "The accuracy of the EOS imaging system to assess hip abnormalities in adolescents and adults:" a systematic review and meta-analysis. Skeletal Radiol 2024; 53:29-42. [PMID: 37338589 PMCID: PMC10661804 DOI: 10.1007/s00256-023-04351-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To determine the accuracy of the EOS imaging system compared to the gold standard computed tomography (CT) scan, for the measurement of native and postoperative/prosthetic hip parameters in adolescents and adults. METHODS Medline, Cochrane Systematic Review, and Web of Science databases were searched to obtain relevant articles published between January 1964 and February 2021. All articles published in English. Inclusion and exclusion criteria were developed according to the Population, Intervention, Comparator, Outcome (PICO) framework. Three reviewers independently assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. A narrative synthesis of the articles and a meta-analysis were conducted. The heterogeneity exhibited by the effect sizes was obtained using a forest plot, the Q statistic and the I2 index. Reliability coefficients were transformed into Fisher's Z to normalise their distribution and stabilise the variances. For each meta-analysis, an effect size (average reliability coefficient) and a 95% confidence interval were calculated and presented in a forest plot. The amount of radiation dose between modalities was compared. RESULTS The search retrieved 75 articles, six of which met inclusion and exclusion criteria. The meta-analysis included five of these six studies (sample size from 20 to 90). Comparing EOS and CT, the estimated average correlation (effect size) for combined studies was significantly high (r = 0.84, 95% CI = 0.78 to 0.88, p-value < 0.001). With respect to Pearson's correlation between EOS and CT, the estimated average correlation for combined studies was significantly high (r = 0.86, 95% CI = 0.80 to 0.90, p-value < 0.001). Average radiation dose for EOS was 0.18 ± 0.05 mGy for the anteroposterior view (AP) and 0.45 ± 0.08 mGy for the lateral view; and for CT was 8.4 to 15.6 mGy. CONCLUSION The EOS imaging system has a high correlation with CT for preoperative and postoperative/prosthetic hip measurements, with considerably lower irradiation of patients.
Collapse
Affiliation(s)
- Ahmed Alghamdi
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
- Diagnostic Radiology Department, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sanjeev Madan
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
- Doncaster &, Bassetlaw Teaching Hospitals, Doncaster, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amaka C Offiah
- Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, UK
| |
Collapse
|
|
22
|
Ukai T, Katoh H, Yokoyama K, Sato M, Watanabe M. Effect of spinal fusion on joint space narrowing of the hip: comparison among non-fusion, short fusion, and middle or long fusion. J Orthop Traumatol 2023; 24:1. [PMID: 36622495 PMCID: PMC9829947 DOI: 10.1186/s10195-022-00682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lumbar fusion corrects spinal deformities and improves spinal complications. Hip osteoarthritis (OA) is strongly correlated with spinal mobility, and joint space narrowing of the hip after spinal fusion has gained attention. This study aimed to elucidate the effect of spinal fusion on hip joint space narrowing. MATERIALS AND METHODS We retrospectively examined 530 hips of 270 patients who underwent spinal surgery. All the patients underwent whole-spine radiography before and at the final follow-up. Patients were divided into three groups (N group: non-spinal fusion, S group: up to three interbody fusions, and L group: more than four interbody fusions). The rates of joint space narrowing, spinal parameters (sagittal vertical axis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence), and limb length discrepancy at the final follow-up were compared. A multilinear regression analysis was performed to identify the risk factors for the rate of joint space narrowing. RESULTS The rate of joint space narrowing was significantly higher in the L group than in the N and S groups (P < 0.001). No significant difference in the rate of joint space narrowing was observed between the N and S groups. Multiple linear regression analysis revealed that the number of fusion levels (p < 0.05) and follow-up period (p < 0.001) were independent risk factors for joint space narrowing. Spinal parameters at the final follow-up were not independent risk factors. CONCLUSIONS Long spinal fusion (more than four levels) led to significantly greater joint space narrowing of the hip than short (up to three levels) or no fusion. Spinal alignment did not affect joint space narrowing of the hip. Surgeons should be aware that more than four interbody fusions may result in worse joint space narrowing of the hip. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Taku Ukai
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Hiroyuki Katoh
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Katsuya Yokoyama
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Tokai University School of Medicine Oiso Hospital, 21-1 Gakkyo, Oiso, Kanagawa 259-0198 Japan
| | - Masato Sato
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Masahiko Watanabe
- grid.265061.60000 0001 1516 6626Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| |
Collapse
|
|
23
|
Dornacher D, Lutz B, Sgroi M, Caffard T, Reichel H. Age and magnitude of acetabular correction impair bone healing after triple pelvic osteotomy. Arch Orthop Trauma Surg 2023; 143:6599-6607. [PMID: 37421516 PMCID: PMC10541840 DOI: 10.1007/s00402-023-04966-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION The aim of this examination was to assess, which risk factors impair bone healing after triple pelvic osteotomy (TPO) in the treatment of symptomatic hip dysplasia. METHODS A consecutive series of 241 TPO was reviewed retrospectively. Of these, a set of five postoperative radiographs was available, performed in a standardized regimen in the first year after surgery. Two experienced observers had to agree on the existence of a non-union on the radiographs obtained 1 year after TPO. Both observers measured the lateral center edge angle (LCEA) and acetabular index (AI) on all radiographs. Besides patient-specific risk factors, the magnitudes of acetabular correction and the amounts of a detectable slight change in acetabular correction were assessed. Binary logistic regression analysis and chi-squared test were used to detect the impact of the risk factor on bone healing. RESULTS A total of 222 cases were left for further examination. In 19 of these, at least one osteotomy was not healed completely one year after surgery. Binary logistic regression showed a significant relationship between the risk factors "age" (p < 0.001; odds ratio (OR) 1.109 (95% CI 1.05-1.18)) as well as "magnitude of acetabular correction (LCEA)" (p = 0.01; OR 1.087 (95% CI 1.02-1.16)) and non-union. Pearson's chi-square test showed a relationship between the risk factor "wound healing disorder" and non-union (p < 0.001). LCEA and AI showed a slight increase from the first to the last follow-up (observer 1: 1.6° and 1.3°, resp.), but regression analysis for the risk factor "amount of postoperative change of acetabular correction (LCEA, AI)" did not show statistically significant values. CONCLUSION The age at surgery and the magnitude of acetabular correction negatively influenced the healing progress of the osteotomy sites. The amount of a slight postoperative change of LCEA and AI did not correlate with a non-union.
Collapse
Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Thomas Caffard
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| |
Collapse
|
|
24
|
Dornacher D, Lutz B, Fuchs M, Zippelius T, Reichel H. Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection. Arch Orthop Trauma Surg 2023; 143:6139-6146. [PMID: 37272987 PMCID: PMC10491512 DOI: 10.1007/s00402-023-04920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION After pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthritis. There is evidence that acetabula in the borderline range, defined by a lateral center edge angle (LCEA) between 18° and 25°, are more delicate to be orientated physiologically. The aim of this study was to assess the quality of acetabular orientation by triple pelvic osteotomy (TPO), established by Tönnis and Kalchschmidt, especially with respect to acetabular overcorrection. MATERIALS AND METHODS A retrospective examination on 368 consecutive hips treated with TPOs was conducted. On the preoperative pelvic radiograph and the radiographic control 5 days after surgery, LCEA, acetabular index (AI), and anterior (AWI) and posterior wall index (PWI) were measured. According to the above-mentioned definition, the hips were divided into a borderline (n = 196) and a dysplastic (n = 172) group. Acetabular overcorrection was defined as when LCEA exceeded 35°, AI was below 0° and AWI exceeded 0.60, postoperatively. The postoperative occurrence of a relevant femoroacetabular impingement was correlated to these thresholds. Statistics comprised a priori power analysis, correlation analyses and receiver operating characteristics (ROC). RESULTS In the borderline group, in 64 hips (32.7%), LCEA and AI indicated lateral overcorrection. In the dysplastic group, in 14 hips (8.1%), solely AI indicated overcorrection. In none of the hips, relevant anterior overcorrection was detected since AWI never exceeded 0.60. Chi-square test demonstrated a significant correlation between the occurrence of a postoperative femoroacetabular impingement and LCEA exceeding 35°, as well as AI below 0° (p < 0.001, resp.). Bravais-Pearson's analysis showed a significant correlation between the pre- and postoperative values of all parameters in the borderline and the dysplasia group (p < 0.001). Thus, ROC analysis could be performed and provided preoperative cutoff values for LCEA (23°) and AI (12.5°), hinting at postoperative overcorrection. CONCLUSION The comparison of radiographic parameters after TPO showed a considerably greater percentage of laterally overcorrected acetabula in the borderline hips than in the dysplastic hips. According to the wall indices, anterior overcorrection was not observed. ROC analysis anticipated unfavorable lateral overcorrection when preoperative LCEA was above 23° and AI below 12.5°. These findings should sensitize the surgeon to the delicate acetabular correction in borderline dysplastic hips.
Collapse
Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Michael Fuchs
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Timo Zippelius
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| |
Collapse
|
|
25
|
Zhang J, Li C, Zhang J, Zhao G, Liu Y. Lateral Center-edge Angle of 18° (Bone-Edge): Threshold for Hip Arthroscopy Treatment in Patients with Borderline Developmental Dysplasia of the Hip? Orthop Surg 2023; 15:2665-2673. [PMID: 37641583 PMCID: PMC10549843 DOI: 10.1111/os.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Hip arthroscopy for the treatment of symptomatic borderline developmental dysplasia of the hip (BDDH) has been controversial. The purpose of this study was to retrospectively analyze minimum 2-year outcomes of BDDH after arthroscopic surgery and explore the criteria and thresholds of the lateral center-edge angle (LCEA) in arthroscopic surgery for BDDH. METHODS Data were retrospectively collected from patients aged 18-50 who underwent arthroscopic surgery for BDDH and had an LCEA 18-25° between September 2016 and June 2020. The consistency of interobserver and intraobserver measurements of bone-edge LCEA was analyzed. Patients were divided into two groups based on LCEA (18-20°and 20-25°) and the results of arthroscopy compared between groups. Patient-reported outcome (PRO) scores, consisting of the modified Harris hip score (mHHS), the visual analogue scale (VAS) and the international hip outcome tool-12 (IHOT-12), the minimal clinically important difference (MCID) and patient acceptable symptom status (PASS) were calculated. RESULTS In 52 patients with ≥2-year follow-up, female patients accounted for 71.2% and the mean age was 30.8 ± 8.4 years (range: 18 to 49 years). There was a high level of agreement when measuring the bone-edge LCEA definition of BDDH (Kappa = 0.921). Interobserver repeatability (ICC = 0.909, 95%CI: 0.847-0.947) and intraobserver repeatability (ICC = 0.944, 95%CI: 0.905-0.968) were excellent for bone-edge LCEA measurements. In addition to LCEA and Tönnis angle, there were no significant differences in α angle, neck stem angle, femoral anteversion angle, medial joint space, Tönnis grade of osteoarthritis, acetabular retroversion (8 sign), Cam deformity and anterior inferior iliac spine (AIIS) morphology between the two groups (p > 0.05). Intraoperative findings and procedures showed no statistical difference between groups (p > 0.05). The mean follow-up time was 44.4 ± 11.0 months (range: 25 to 64 months). Postoperative VAS, mHHS and IHOT-12 scores in the LCEA 18-20° group and the LCEA 20-25° group were significantly improved compared with those before surgery, and there was no statistically significant difference in the percentage of MCID and PASS (mHHS and iHOT-12) between the groups (p > 0.05). CONCLUSION Patients in the LCEA 18-20° group and the LCEA 20-25° group achieved favorable outcomes after arthroscopic surgery. LCEA 18° (bone-edge) should be the threshold for hip arthroscopic surgery in BDDH patients without obvious hip instability.
Collapse
Affiliation(s)
- Jia Zhang
- Department of Orthopedicsthe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Chunbao Li
- Department of Orthopedicsthe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jianping Zhang
- Department of Orthopedics920 Hospital of Joint Logistics Support ForceKunmingChina
| | - Gang Zhao
- Department of Orthopedicsthe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yujie Liu
- Department of Orthopedicsthe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| |
Collapse
|
|
26
|
Dornacher D, Kelsch M, Sgroi M, Reichel H, Lutz B. Screw fixation after tripe pelvic osteotomy is reliable: changes of acetabular correction are rare and do not correlate with risk factors. J Orthop Surg Res 2023; 18:709. [PMID: 37735695 PMCID: PMC10512489 DOI: 10.1186/s13018-023-04186-6] [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: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE The aim of this examination was to assess whether there is a change of acetabular correction after triple pelvic osteotomy (TPO) and if so, whether there is a correlation with patient-specific risk factors or with certain periods in the postoperative course. METHODS A consecutive series of 241 TPO was reviewed retrospectively. The close-meshed radiographic follow-up of the first 12 weeks comprised pelvic radiographs performed immediately after the procedure, 5 days, 6 and 12 weeks after TPO. Three observers measured the lateral center edge angle, acetabular index and the craniocaudal offset of the pubic osteotomy. Patient-specific risk factors (e. g. age, gender, body mass index, nicotine abuse) and certain periods in the postoperative course were correlated with a change of acetabular correction. RESULTS After application of the exclusion criteria, 225 hips were available for further examination. Intraclass correlation coefficient resulted in predominantly excellent agreement between the measurements of the three observers (0.74-0.91). In 27 cases (12%), the three observers agreed on a change of acetabular correction. In 18 cases (8%), there was a slight change, in 9 cases (4%), a relevant change. The latter entailed consequences in the postoperative aftercare. General equation estimation did not show any correlation between a change of acetabular correction and patient-specific risk factors or certain periods in the postoperative course (p = 0.79-0.99). CONCLUSION Every once treated hip should be followed-up with the same attention, irrespective of the apparent risk profile. There is no rationale to skip a radiographic follow-up in the first 12 weeks after TPO.
Collapse
Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Maximilian Kelsch
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| |
Collapse
|
|
27
|
Dornacher D, Sgroi M, Freitag T, Reichel H, Lutz B. Acetabular orientation in triple pelvic osteotomy: is intraoperative fluoroscopy reliable? Arch Orthop Trauma Surg 2023; 143:3715-3723. [PMID: 35947170 PMCID: PMC10293451 DOI: 10.1007/s00402-022-04568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE In pelvic osteotomies, unfavorable balancing of the anterior and posterior acetabular wall can affect the longevity of the natural joint. This raises the question, whether intraoperative fluoroscopy is sufficiently accurate. The objective was to assess the correlation between acetabular parameters [lateral center edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI)] acquired on intraoperative fluoroscopic images and postoperative pelvic radiographs and to analyze intra- and interobserver reliability of these parameters. METHODS A retrospective examination was conducted on 206 consecutive cases (176 patients) after triple pelvic osteotomy (TPO). Every patient received a pre- and postoperative pelvic radiograph in supine position in exactly the same technique. A highly standardized surgical sequence allowed consistent intraoperative fluoroscopic imaging. LCAE, AI, PWI and AWI were measured by an experienced orthopedic surgeon and an orthopedic surgeon in training. Statistics comprised a priori power analysis, Bland-Altman analysis and intraclass correlation coefficient (ICC). RESULTS A total of 165 cases were included. ICC between the parameters of the fluoroscopic images and postoperative radiographs was for LCEA: 0.935, AI: 0.936, AWI: 0.725 and PWI: 0.878. Intraobserver ICC for all parameters ranged from 0.953 to 0.989, interobserver ICC from 0.798 to 0.968, respectively. CONCLUSION In the surgical treatment of hip dysplasia by means of TPO, intraoperative fluoroscopic imaging has proven to be reliable and accurate. Intraobserver correlation was excellent for all parameters. The correlation between the intraoperative fluoroscopic images and postoperative radiographs ranged from good to excellent, with the lowest values for the acetabular wall indices (AWI and PWI).
Collapse
Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Tobias Freitag
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| |
Collapse
|
|
28
|
Dornacher D, Lutz B, Fuchs M, Zippelius T, Reichel H. Acetabular deficiency in borderline hip dysplasia is underestimated by lateral center edge angle alone. Arch Orthop Trauma Surg 2023; 143:3937-3944. [PMID: 36271941 PMCID: PMC10293430 DOI: 10.1007/s00402-022-04652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION In hip preservation surgery, the term "borderline hip dysplasia" was used when the lateral center edge angle (LCEA), historically described by Wiberg, measured 18-25°. In recent years, several radiographic parameters have been described to assess the antero posterior coverage of the femoral head, for example, the anterior and posterior wall index (AWI and PWI). This allowed an increasingly comprehensive understanding of acetabular morphology and a questioning of the borderline definition. MATERIAL AND METHODS A retrospective review of 397 consecutive hips was performed, all treated with triple pelvic osteotomy (TPO) due to symptomatic hip dysplasia. On all preoperative pelvic radiographs with a LCEA of 18-25°, acetabular index (AI), AWI and PWI were measured. With these values, the hips were categorized into laterally, antero-laterally and postero-laterally dysplastic and stratified by gender. Intra- and interobserver correlation of the parameters was analyzed by intraclass correlation coefficient (ICC). RESULTS According to LCEA, 192 hips were identified as "borderline dysplastic". Based on AWI and PWI, the categorization resulted in 116 laterally dysplastic (60.4%), 33 antero-laterally (17.2%) and 43 postero-laterally dysplastic hips (22.4%). Gender stratification revealed that male acetabula seemed to be slightly more postero-laterally deficient than female (mean PWI 0.80 vs 0.89; p = 0.017). ICC confirmed highly accurate and reproducible readings of all parameters. CONCLUSION The rather high proportion of symptomatic hips labelled borderline dysplastic suggested, that there might be substantial acetabular deficiency not recognizable by LCEA. Comprehensive deformity analysis using LCEA, AI, AWI and PWI showed, that 40% of these hips were deficient either antero-laterally or postero-laterally. Male acetabula were more deficient postero-laterally than female.
Collapse
Affiliation(s)
- Daniel Dornacher
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Bernd Lutz
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Michael Fuchs
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Timo Zippelius
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedics, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| |
Collapse
|
|
29
|
Heinz T, Vasilev H, Anderson PM, Stratos I, Jakuscheit A, Horas K, Holzapfel BM, Rudert M, Weißenberger M. The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases. J Clin Med 2023; 12:3941. [PMID: 37373635 DOI: 10.3390/jcm12123941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. METHODS A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. RESULTS In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. CONCLUSION The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity.
Collapse
Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Hristo Vasilev
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Philip Mark Anderson
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Konstantin Horas
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| |
Collapse
|
|
30
|
Mortensen AJ, Metz AK, Featherall J, O’Neill DC, Rosenthal RM, Aoki SK. Hip Joint Venting Decreases the Traction Force Required to Access the Central Compartment During Hip Arthroscopy. Arthrosc Sports Med Rehabil 2023; 5:e589-e596. [PMID: 37388887 PMCID: PMC10300549 DOI: 10.1016/j.asmr.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To investigate the effect of hip joint venting on the magnitude of traction force required to arthroscopically access the central compartment of the hip. Methods Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome prospectively underwent an intraoperative traction protocol. Joint space was measured on fluoroscopic images obtained at 50 and 100 lbs of axial traction in the prevented and vented state, and joint space values were normalized to millimetric values using preoperative anteroposterior pelvis radiographs. Venting was performed by inserting a large gauge spinal needle into the hip joint through the hip capsule and removing the stylet. Joint space differences were compared with paired t-tests, Wilcoxon signed-rank tests, and McNemar tests. Results Fifty hips in 46 patients were included. Mean joint space before venting was 7.4 ± 2.6 mm and 13.3 ± 2.8 mm at 50 and 100 lbs of traction, respectively. Mean joint space after venting was 13.9 ± 2.3 mm and 15.5 ± 2.4 mm at 50 and 100 lbs of traction, respectively. Mean differences in joint space at 50 and 100 lbs were 6.5 mm (P < .001) and 2.2 mm (P < .001), respectively. Mean joint space at 50 lbs in the vented state was significantly greater than in the pre-vented state at 100 lbs (13.9 mm vs. 13.3 mm; P = .002). The increase in joint space between 50 and 100 lbs of traction was significantly greater in the prevented state than in the vented state (5.9 mm vs 1.6 mm; P = .021). Conclusions Venting the hip reduces the traction force necessary to arthroscopically visualize and instrument the central compartment of the hip by at least 50%. Further, residual negative pressurization of the hip joint remains after breaking the labral suction seal and venting effectively eliminates this phenomenon to aid in hip joint distraction at lower traction force. Level of Evidence Level IV, case series.
Collapse
Affiliation(s)
| | | | | | | | | | - Stephen K. Aoki
- Address correspondence to Stephen K. Aoki, M.D., Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| |
Collapse
|
|
31
|
Kokubu Y, Kawahara S, Kitamura K, Hamai S, Motomura G, Ikemura S, Sato T, Yamaguchi R, Hara D, Fujii M, Nakashima Y. Evaluation of the anterior acetabular coverage with a false profile radiograph considering appropriate range of positioning. Sci Rep 2023; 13:8288. [PMID: 37217756 PMCID: PMC10203119 DOI: 10.1038/s41598-023-35514-9] [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: 12/10/2022] [Accepted: 05/19/2023] [Indexed: 05/24/2023] Open
Abstract
This study aimed to (1) set a reference value for anterior center edge angle (ACEA) for preoperative planning of periacetabular osteotomy (PAO), (2) investigate the effects of pelvic rotation and inclination from false profile (FP) radiographs on the measured ACEA, and (3) determine the "appropriate range of positioning" for FP radiograph. This single-centered, retrospective study analyzed 61 patients (61 hips) who underwent PAO from April 2018 and May 2021. ACEA was measured in each digitally reconstructed radiography (DRR) image of the FP radiograph reconstructed in different degrees of pelvic rotation. Detailed simulations were performed to determine the "appropriate range of positioning" (0.67 < ratio of the distance between the femoral heads to the diameter of the femoral head < 1.0). The vertical-center-anterior (VCA) angle was measured on the CT sagittal plane considering the patient-specific standing positions, and its correlation with the ACEA was investigated. The reference value of ACEA was determined by receiver operating characteristic (ROC) curve analysis. The ACEA measurement increased by 0.35° for every 1° pelvic rotation approaching the true lateral view. The pelvic rotation with the "appropriate range of positioning" was found at 5.0° (63.3-68.3°). The ACEA on the FP radiographs showed a good correlation with the VCA angle. The ROC curve revealed that an ACEA < 13.6° was associated with inadequate anterior coverage (VCA < 32°). Our findings suggest that during preoperative PAO planning, an ACEA < 13.6° on FP radiographs indicates insufficient anterior acetabular coverage. Images with the "appropriate positioning" can also have a measurement error of 1.7° due to the pelvic rotation.
Collapse
Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, 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
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
|
32
|
Nishimura T, Watanabe H, Taki N, Kikkawa I, Takeshita K. Standard radiographic values for the acetabulum in Japanese adolescents: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:257. [PMID: 37013503 PMCID: PMC10069018 DOI: 10.1186/s12891-023-06368-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Most previous reports of normal acetabular radiographic values focused on adults or elderly people. Recent reports have described premature hip osteoarthritis in adolescents not caused by acetabular dysplasia. In addition, there is a certain failure rate of surgical treatment for young patients with borderline acetabular dysplasia. Accurate indices for treatment of adolescent hips are unclear because standard measurement values of the adolescent acetabulum have not been reported. METHODS This cross-sectional study involved 552 Japanese adolescents aged 12-18 years who had scoliosis or suspected scoliosis and asymptomatic hips. All persons underwent plain standing anteroposterior whole-spine radiography, and measurements were obtained using the pelvic part of the radiograph. We excluded persons who were unable to correctly perform measurements because of conditions such as pelvic rotation or lateral inclination and persons in whom closure of the triradiate cartilage or closure of the secondary ossification centers of the acetabulum had not yet occurred. In 1101 hips, we measured the lateral center-edge angle (LCEA), Tönnis angle, Sharp angle, acetabular head index (AHI), lateral subluxation (LS), vertical subluxation (VS), and peak-to-edge distance (PED). We evaluated the correlation coefficient and coefficient of determination between each parameter and age, height, body weight, and body mass index (BMI) and assessed the intra- and inter-rater reliability of each radiographic parameter. RESULTS Among all hips, the mean of each parameter was as follows: LCEA, 27.9° ± 4.8°; Tönnis angle, 5.0° ± 3.7°; Sharp angle, 44.1° ± 3.1°; AHI, 82.1% ± 5.5%; LS, 5.4 ± 1.4 mm; VS, 0.3 ± 1.2 mm; and PED, 14.0 ± 2.3 mm. The correlation between each parameter and age, height, body weight, and BMI was considerably low. Intra- and inter-rater reliability was moderate or good for almost all parameters. CONCLUSIONS The values for each radiographic parameter of the acetabulum in this study are considered standard for the adolescent acetabulum without age-related changes. Some parameters differ slightly from the normal values for adults or elderly people in previous reports; thus, we suggest careful evaluation of these parameters for adolescents.
Collapse
Affiliation(s)
- Takahiro Nishimura
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi Prefecture, 329-0498, Japan.
| | - Hideaki Watanabe
- Department of Paediatric Orthopaedics and Orthopaedic Surgery, Jichi Children's Medical Center, 3311-1 Yakushiji, Shimotsuke, Tochigi Prefecture, 329-0498, Japan
| | - Naoya Taki
- Department of Paediatric Orthopaedics and Orthopaedic Surgery, Jichi Children's Medical Center, 3311-1 Yakushiji, Shimotsuke, Tochigi Prefecture, 329-0498, Japan
| | - Ichiro Kikkawa
- Department of Orthopaedic Surgery, Nasu Central Hospital, 1453 Shimoishigami, Otawara, Tochigi Prefecture, 324-0036, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi Prefecture, 329-0498, Japan
| |
Collapse
|
|
33
|
Owens JS, Jimenez AE, Lee MS, Monahan PF, Maldonado DR, Domb BG. High-Level Athletes With Borderline Hip Dysplasia Achieve Favorable Outcomes and Return to Sport Rates Following Primary Hip Arthroscopy: Minimum 5-Year Outcomes Comparison to a Propensity-Matched Control Group. Arthroscopy 2023; 39:271-282. [PMID: 36055477 DOI: 10.1016/j.arthro.2022.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To report minimum 5-year patient-reported outcomes (PROs) and return to sport (RTS) rates in high-level athletes with borderline hip dysplasia (BHD) following primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome and (2) to compare results to a propensity-matched control group of athletes with normal acetabular coverage. METHODS Data were reviewed for surgeries performed between February 2009 and February 2016. Patients were eligible if they underwent primary hip arthroscopy in the setting of BHD (lateral center-edge angle [LCEA] 18-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria were preoperative and minimum 5-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritis Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale for pain. Rates of achieving the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. BHD athletes were matched by age at the time of surgery, sex, body mass index, Tönnis grade, follow-up time, sport type, and competition level to a control group of 58 athletes with normal acetabular coverage (LCEA 25°-40°) for comparison. RESULTS A total of 34 BHD athletes were included with a mean follow-up of 73.6 ± 10.7 months. BHD athletes showed significant improvements in all PROs, demonstrated high RTS rates (90.0%), and achieved PASS/MCID/MOIST for mHHS (MCID: 80.0%, PASS: 93.3%, MOIST: 80.0%) and HOS-SSS (MCID: 76.7%, PASS: 73.3%) at high rates. When compared to a propensity-matched group with normal acetabular coverage, BHD athletes demonstrated similar postoperative PROs, rates of achieving psychometric thresholds, and RTS rates (P > .05). Additionally, by the latest follow-up, no athlete in either group required conversion to total hip arthroplasty. CONCLUSIONS High-level athletes with BHD undergoing primary hip arthroscopy for labral pathology and femoroacetabular impingement syndrome may expect favorable midterm outcomes and high RTS rates. These results were comparable to a control group of athletes with normal coverage. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A; American Hip Institute, Chicago, Illinois, U.S.A.
| |
Collapse
|
|
34
|
Cheng H, Zhang L, Luo D, Ren N, Zhang Z, Gu W, Hu Y, Zhang H. Determining anterior hip coverage in patients with hip dysplasia using the anterior center-edge angle on Lequesne's false-profile radiograph and on computed tomography. J Hip Preserv Surg 2023; 10:42-47. [PMID: 37275833 PMCID: PMC10234381 DOI: 10.1093/jhps/hnac048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/02/2022] [Accepted: 11/21/2022] [Indexed: 06/07/2023] Open
Abstract
Anterior hip coverage is important for hip stability. As a parameter of anterior hip coverage, the anterior center-edge angle on false-profile radiograph (ACEA FP) is associated with clinical outcomes. With the widespread application of computed tomography (CT), the anterior center-edge angle on CT (ACEA CT) has also been used to measure anterior hip coverage. Little is known about the reproducibility of the ACEA FP and ACEA CT in patients with hip dysplasia or the correlation between the ACEA CT and ACEA FP. In total, 49 hips of 49 patients who underwent periacetabular osteotomy in our center were included. The lateral center-edge angle, Tönnis angle, ACEA FP and ACEA CT were determined. We assessed the intraobserver and interobserver reliability of the ACEA FP and ACEA CT, the effect of the Tönnis angle on the reliability of the ACEA FP and ACEA CT and the correlation between the ACEA CT and ACEA FP. The intraobserver and interobserver interclass correlation coefficients of the ACEA FP were good, and those of the ACEA CT were very good. The Tönnis angle was weakly correlated with inconsistent ACEA FP measurements (P = 0.008) but not with inconsistent ACEA CT measurements (P = 0.600). No correlation between ACEA FP and ACEA CT measurements was observed (P = 0.213-0.665). The reproducibility of the ACEA CT is more consistent than that of the ACEA FP. The oblique acetabular roof had an effect on determining the ACEA FP but not on determining the ACEA CT. No correlation was observed between the measured ACEA FP and ACEA CT values, so the clinical evidence obtained from the ACEA FP cannot be directly applied to the ACEA CT.
Collapse
Affiliation(s)
| | | | - Dianzhong Luo
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Ningtao Ren
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Zhendong Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | - Wang Gu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| | | | - Hong Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, No. 51, Fucheng Road, Haidian District, Beijing, China
| |
Collapse
|
|
35
|
Metz AK, Featherall J, Froerer DL, Mortensen AJ, Tomasevich KM, Aoki SK. Female Patients and Decreased Hip Capsular Thickness on Magnetic Resonance Imaging Associated With Increased Axial Distraction Distance on Examination Under Anesthesia: An In Vivo Study. Arthroscopy 2022; 38:3133-3140. [PMID: 35550416 DOI: 10.1016/j.arthro.2022.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the relation of hip capsular thickness as measured on preoperative magnetic resonance imaging (MRI) and intraoperative hip joint axial distraction distance on an examination under anesthesia. METHODS A retrospective review of primary arthroscopic hip procedures performed between November 2018 and June 2021 was conducted. The inclusion criteria included a diagnosis of femoroacetabular impingement syndrome and preoperative radiographic imaging and MRI. Fluoroscopic images were obtained at 0 lb and 100 lb of axial traction force. Total distraction distance was calculated by comparing the initial joint space with the total joint space at 100 lb. Hip capsular thickness was measured on MRI. Analysis was conducted using multiple linear regression, independent-samples t tests, and Mann-Whitney U tests. RESULTS Eighty patients were included. Bivariable regression showed an association between an increased distraction distance and female sex (β = 4.303, R = 0.561, P < .001), as well as decreased anterior axial (β = -1.291, R = 0.365, P < .001) and superior coronal (β = -1.433, R = 0.501, P < .001) capsular thickness. Multivariable regression (R = 0.645) showed an association between an increased distraction distance and female sex (β = 3.175, P < .001), as well as decreased superior coronal capsular thickness (β = -0.764, P = .022). Independent-samples t tests showed that female patients had significantly decreased superior coronal capsular thickness (2.92 ± 1.14 mm vs 3.99 ± 1.15 mm, P < .001). CONCLUSIONS Female sex and decreased hip capsular thickness in the superior aspect of the coronal plane on magnetic resonance scans were found to be predictors of increased hip joint axial distraction distance on examination under anesthesia prior to hip arthroscopy, with anterior axial capsular thickness being a moderate predictor. Poor predictors of distraction distance were posterior axial and inferior coronal capsular thickness, age, body mass index, and lateral center-edge angle. Female patients were also found to have thinner hip capsules in the superior region, which may explain the association between female patients and increased distraction. These findings further characterize the relation between capsular thickness and hip laxity. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Allan K Metz
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Featherall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Devin L Froerer
- School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Kelly M Tomasevich
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
| |
Collapse
|
|
36
|
Archer H, Reine S, Alshaikhsalama A, Wells J, Kohli A, Vazquez L, Hummer A, DiFranco MD, Ljuhar R, Xi Y, Chhabra A. Artificial intelligence-generated hip radiological measurements are fast and adequate for reliable assessment of hip dysplasia. Bone Jt Open 2022; 3:877-884. [DOI: 10.1302/2633-1462.311.bjo-2022-0125.r1] [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] [Indexed: 11/16/2022] Open
Abstract
Aims Hip dysplasia (HD) leads to premature osteoarthritis. Timely detection and correction of HD has been shown to improve pain, functional status, and hip longevity. Several time-consuming radiological measurements are currently used to confirm HD. An artificial intelligence (AI) software named HIPPO automatically locates anatomical landmarks on anteroposterior pelvis radiographs and performs the needed measurements. The primary aim of this study was to assess the reliability of this tool as compared to multi-reader evaluation in clinically proven cases of adult HD. The secondary aims were to assess the time savings achieved and evaluate inter-reader assessment. Methods A consecutive preoperative sample of 130 HD patients (256 hips) was used. This cohort included 82.3% females (n = 107) and 17.7% males (n = 23) with median patient age of 28.6 years (interquartile range (IQR) 22.5 to 37.2). Three trained readers’ measurements were compared to AI outputs of lateral centre-edge angle (LCEA), caput-collum-diaphyseal (CCD) angle, pelvic obliquity, Tönnis angle, Sharp’s angle, and femoral head coverage. Intraclass correlation coefficients (ICC) and Bland-Altman analyses were obtained. Results Among 256 hips with AI outputs, all six hip AI measurements were successfully obtained. The AI-reader correlations were generally good (ICC 0.60 to 0.74) to excellent (ICC > 0.75). There was lower agreement for CCD angle measurement. Most widely used measurements for HD diagnosis (LCEA and Tönnis angle) demonstrated good to excellent inter-method reliability (ICC 0.71 to 0.86 and 0.82 to 0.90, respectively). The median reading time for the three readers and AI was 212 (IQR 197 to 230), 131 (IQR 126 to 147), 734 (IQR 690 to 786), and 41 (IQR 38 to 44) seconds, respectively. Conclusion This study showed that AI-based software demonstrated reliable radiological assessment of patients with HD with significant interpretation-related time savings. Cite this article: Bone Jt Open 2022;3(11):877–884.
Collapse
Affiliation(s)
- Holden Archer
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Seth Reine
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Joel Wells
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Kohli
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis Vazquez
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Yin Xi
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
|
37
|
Owens JS, Lee MS, Jimenez AE, Maldonado DR, Lall AC, Domb BG. Elite Female Athletes Demonstrate a Comparable Improvement in Midterm Patient-Reported Outcome Scores and Rate of Return to Sport Compared With Elite Male Athletes After Hip Arthroscopic Surgery: A Sex-Based Comparison in Professional and Collegiate Athletes. Am J Sports Med 2022; 50:3600-3609. [PMID: 36197056 DOI: 10.1177/03635465221123060] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have compared outcomes, return to sport (RTS), and continuation of sport (CTS) after primary hip arthroscopic surgery between matched groups of male and female athletes with a minimum 5-year follow-up. PURPOSE (1) To report minimum 5-year patient-reported outcome (PRO) scores as well as RTS and CTS rates for elite female athletes undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) and (2) to compare clinical results with those of a matched control group of elite male athletes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were prospectively collected and retrospectively reviewed for elite (collegiate or professional) female athletes who underwent primary hip arthroscopic surgery for FAIS between March 2009 and March 2016. Inclusion criteria were preoperative and minimum 5-year scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous ipsilateral hip surgery/conditions, and those unwilling to participate. Rates of achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. CTS was also recorded and defined as athletes reporting continued sport activity at a minimum 5-year follow-up after initially reporting returning to sport. Elite female athletes were propensity matched in a 1:1 ratio to elite male athletes for comparison. RESULTS A total of 81 hips in elite female athletes that underwent primary hip arthroscopic surgery met the inclusion criteria, and follow-up was available for 65 hips (80.2%) at a mean of 67.6 ± 6.5 months, with a mean age of 24.3 ± 6.8 years. Female athletes demonstrated significant improvements in all recorded PRO scores; achieved the MCID, PASS, and MOIST at high rates; returned to sport at a rate of 80.4%; and continued sport at a rate of 97.1%. Female athletes demonstrated lower preoperative PRO scores compared with male athletes, but postoperative PRO scores; improvements in scores; rates of achieving the MCID, PASS, MOIST; and RTS and CTS rates were similar between female and male athletes. CONCLUSION Elite female athletes undergoing primary hip arthroscopic surgery for FAIS demonstrated favorable PRO scores and high RTS and CTS rates at a minimum 5-year follow-up. These results were comparable with those of a propensity-matched control group of elite male athletes.
Collapse
Affiliation(s)
- Jade S Owens
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Michael S Lee
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| |
Collapse
|
|
38
|
Jensen J, Graumann O, Overgaard S, Gerke O, Lundemann M, Haubro MH, Varnum C, Bak L, Rasmussen J, Olsen LB, Rasmussen BSB. A Deep Learning Algorithm for Radiographic Measurements of the Hip in Adults-A Reliability and Agreement Study. Diagnostics (Basel) 2022; 12:2597. [PMID: 36359441 PMCID: PMC9689405 DOI: 10.3390/diagnostics12112597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 08/04/2023] Open
Abstract
Hip dysplasia (HD) is a frequent cause of hip pain in skeletally mature patients and may lead to osteoarthritis (OA). An accurate and early diagnosis may postpone, reduce or even prevent the onset of OA and ultimately hip arthroplasty at a young age. The overall aim of this study was to assess the reliability of an algorithm, designed to read pelvic anterior-posterior (AP) radiographs and to estimate the agreement between the algorithm and human readers for measuring (i) lateral center edge angle of Wiberg (LCEA) and (ii) Acetabular index angle (AIA). The algorithm was based on deep-learning models developed using a modified U-net architecture and ResNet 34. The newly developed algorithm was found to be highly reliable when identifying the anatomical landmarks used for measuring LCEA and AIA in pelvic radiographs, thus offering highly consistent measurement outputs. The study showed that manual identification of the same landmarks made by five specialist readers were subject to variance and the level of agreement between the algorithm and human readers was consequently poor with mean measured differences from 0.37 to 9.56° for right LCEA measurements. The algorithm displayed the highest agreement with the senior orthopedic surgeon. With further development, the algorithm may be a good alternative to humans when screening for HD.
Collapse
Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, 5000 Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
| | | | - Martin Haagen Haubro
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, 5000 Odense, Denmark
- Department of Orthopedic Surgery, Lillebaelt Hospital—Vejle, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Lene Bak
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Janne Rasmussen
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
| | - Lone B. Olsen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | - Benjamin S. B. Rasmussen
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, 5230 Odense, Denmark
- Department of Radiology, Odense University Hospital, 5700 Svendborg, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence), Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark
| |
Collapse
|
|
39
|
Jo C, Hwang D, Ko S, Yang MH, Lee MC, Han HS, Ro DH. Deep learning-based landmark recognition and angle measurement of full-leg plain radiographs can be adopted to assess lower extremity alignment. Knee Surg Sports Traumatol Arthrosc 2022; 31:1388-1397. [PMID: 36006418 DOI: 10.1007/s00167-022-07124-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Evaluating lower extremity alignment using full-leg plain radiographs is an essential step in diagnosis and treatment of patients with knee osteoarthritis. The study objective was to present a deep learning-based anatomical landmark recognition and angle measurement model, using full-leg radiographs, and validate its performance. METHODS A total of 11,212 full-leg plain radiographs were used to create the model. To train the data, 15 anatomical landmarks were marked by two orthopaedic surgeons. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and hip-knee-ankle angle (HKAA) were then measured. For inter-observer reliability, the inter-observer intraclass correlation coefficient (ICC) was evaluated by comparing measurements from the model, surgeons, and students, to ground truth measurements annotated by an orthopaedic specialist with 14 years of experience. To evaluate test-retest reliability, all measurements were made twice by each measurer. Intra-observer ICCs were then derived. Performance evaluation metrics used in previous studies were also derived for direct comparison of the model's performance. RESULTS Inter-observer ICCs for all angles of the model were 0.98 or higher (p < 0.001). Intra-observer ICCs for all angles were 1.00, which was higher than that of the orthopaedic specialist (0.97-1.00). Measurements made by the model showed no significant systemic variation. Except for JLCA, angles were precisely measured with absolute error averages under 0.52 degrees and proportion of outliers under 4.26%. CONCLUSIONS The deep learning model is capable of evaluating lower extremity alignment with performance as accurate as an orthopaedic specialist with 14 years of experience. LEVEL OF EVIDENCE III, retrospective cohort study.
Collapse
Affiliation(s)
- Changwung Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Doohyun Hwang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sunho Ko
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Myung Ho Yang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea. .,CONNECTEVE Co., Ltd, Seoul, South Korea.
| |
Collapse
|
|
40
|
Laboudie P, Dymond T, Kreviazuk C, Grammatopoulos G, Beaulé PE. Hip arthroscopy after periacetabular osteotomy for acetabular dysplasia - incidence and clinical outcome. BMC Musculoskelet Disord 2022; 23:659. [PMID: 35820874 PMCID: PMC9275150 DOI: 10.1186/s12891-022-05625-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background The periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia and has demonstrated improvement in patient reported outcomes measures (PROMs) as well as acceptable long-term survival. However, acetabular dysplasia is also associated with intra-articular lesions that can negatively impact clinical outcome. This study aimed to analyse the incidence, operative findings, and outcomes of hip arthroscopy after PAO. Methods This is a single center retrospective study by querying our hip preservation prospectively collected database from 2006 to 2020. All patients having undergone hip arthroscopy after a PAO, with a minimal follow-up of one year, were identified. 202 PAOs were done with a mean age of 28.3 years (12.7 – 53.6) including 39 males and 167 females. Failure was defined as conversion to hip replacement. Demographics, surgical findings, reoperations, and PROMs (pre and post operatively at the last follow-up point only for hips not converted to hip replacement). Results Fifteen hips in 15 patients (7.4%) out of 202 PAOs underwent a hip arthroscopy at a mean time of 3.9 years (0.3–10.3) after PAO. There were 2 males, 13 females and the mean age was 29.8 years (18.5–45). 12 hips had no radiological osteoarthritis (Tönnis 0) and 3 hips had early osteoarthritis (Tönnis 1). At time of arthroscopy, all hips had a labral tear, 9 had a chondral damage ≥ Beck 4. Eight hips had labral debridement, 7 had labral repair, 2 had resection of adhesions and 4 underwent a femoral osteochondroplasty. Four hips (27%) were converted to a hip replacement at a mean time of 1.8 years(0.5–3.2) after hip arthroscopy. Patients converted to hip replacement were significantly older (p = 0.01), had a lower post-PAO LCEA (p = 0.01) and a higher post-PAO Tönnis angle (p = 0.02). There were no significant improvements in PROMs. Conclusion This study reports a hip arthroscopy reoperation rate after PAO of 7.4%. All three types of dysplasia (uncovered anteriorly, posteriorly, or globally) were present in this cohort. Twenty seven percent of patients were converted to hip replacement and PROMs were not significantly improved by hip arthroscopy. Therefore, this procedure should be approached with some caution.
Collapse
Affiliation(s)
- Pierre Laboudie
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada.,Orthopaedic surgery department, Cochin hospital, Paris, France
| | - Thomas Dymond
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital (TOH), General Campus, 501 Smyth Road, CCW 1640, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, The University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| |
Collapse
|
|
41
|
Aoki SK, Mozingo JD, Schuring LL, Anderson AE, Rosenthal RM. Using Sourcil vs Bone Margin as Anatomic Landmark on False-Profile Radiographs Yields Different ACEA Values: Response. Orthop J Sports Med 2022; 10:23259671221112438. [PMID: 35912385 PMCID: PMC9326831 DOI: 10.1177/23259671221112438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
42
|
Mortensen AJ, Tomasevich KM, Ohlsen SM, O'Neill DC, Featherall J, Aoki SK. Previous Arthroscopic Hip Surgery Increases Axial Distractibility Compared to the Native Contralateral Hip and May Suggest Instability. Arthroscopy 2022; 38:1466-1477. [PMID: 34582993 DOI: 10.1016/j.arthro.2021.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare intraoperative hip joint distractibility between hips that previously underwent arthroscopic surgery and the contralateral hip with no history of surgical manipulation. METHODS Patients undergoing revision hip arthroscopy between April 2019 and December 2020, who previously underwent arthroscopic hip surgery for femoroacetabular impingement syndrome, were prospectively enrolled. Exclusion criteria were any contralateral hip surgery. Before instrumentation, fluoroscopic images of both hips were obtained at 25 lbs traction intervals up to 100 lbs. Total joint space was measured at each traction interval. Distraction was calculated as the difference between the baseline joint space and the total joint space at each subsequent traction interval. Wilcoxon signed ranks tests and McNemar tests were used to compare distraction between revision and native contralateral hips. RESULTS Forty-seven patients were included. Mean distraction of operative hips was significantly greater than mean distraction of nonoperative hips at traction intervals of 50 lbs (2.13 vs 1.04 mm, P = .002), 75 lbs (6.39 vs 3.70 mm, P < .001), and 100 lbs (8.24 vs 5.39, P < .001). Mean total joint space of operative hips was significantly greater than mean total joint space of nonoperative hips at traction intervals of 50 lbs (6.60 vs 5.39 mm, P < .001), 75 lbs (10.86 vs 8.05 mm, P < .001), and 100 lbs (12.73 vs 9.73, P < .001). A greater percentage of operative hips achieved all distraction thresholds, in 2-mm intervals up to 10-mm, at each traction interval. CONCLUSIONS In the majority of patients undergoing revision hip arthroscopy, previous arthroscopic hip surgery increases axial distractibility of the hip joint compared with the native contralateral hip at axial traction forces of 50-100 lbs. Increased axial distractibility following hip arthroscopy may be suggestive of hip instability and can be assessed on a stress examination with the patient under anesthesia. LEVEL OF EVIDENCE III, case-control study.
Collapse
Affiliation(s)
| | - Kelly M Tomasevich
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Suzanna M Ohlsen
- School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | - Dillon C O'Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
| |
Collapse
|
|
43
|
Radiographic Outcomes of Ganz versus Modified Triple Osteotomies in Femoral Head Medialization and Coverage in Acetabular Dysplasia. J Clin Med 2022; 11:jcm11071924. [PMID: 35407532 PMCID: PMC9000010 DOI: 10.3390/jcm11071924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy.
Collapse
|
|
44
|
Laboudie P, Gauthier P, Kreviazuk C, Beaulé PE. Does labral treatment technique influence the outcome of FAI surgery? A matched-pair study of labral reconstruction versus repair and debridement with a follow-up of 10 years. J Hip Preserv Surg 2022; 9:95-101. [PMID: 35854806 PMCID: PMC9291390 DOI: 10.1093/jhps/hnac017] [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: 12/07/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to analyze the long-term clinical outcomes of labral reconstruction in patients undergoing femoro-acetabular impingement (FAI) surgery and compare them with labral repair and debridement. This is a single-center, single-surgeon, retrospective match-paired study from a prospectively collected hip preservation database. All patients underwent a hip surgical dislocation for FAI surgery. Eight patients underwent labral reconstruction with the ligamentum teres and were matched on sex, age and body mass index with 24 labral repair and 24 labral debridement (1:3). Failure was defined as conversion to total hip replacement (THR) and patient-reported outcome measures (PROMs) were collected. Mean follow-up was 9.8 years ±2.6 (5.2–13.9). There was a significant improvement in postoperative PROMs in the three groups regarding the WOMAC total, WOMAC function, HOOS-QoL, HOOS-ADL and HOOS-SRA (P < 0.05). There was no statistical difference between the three groups regarding postoperative PROMs and change in PROMs (P > 0.05). A total of 10 hips underwent joint replacement surgery at a mean time of 7.9 ± 3.5 years (2.4–12). There was no statistically significant difference between the three groups regarding the conversion rate to THR (P = 0.64) or time between surgery and conversion to THR (P = 0.15). Compared to a match-pair group of labral repair and debridement, labral reconstruction with ligamentum teres provides similar survival with conversion to a THR as an endpoint, as well as similar improvement in PROMs. Labral treatment can be safely adapted at the nature of the labral lesion with a treatment ‘à la carte’.
Collapse
Affiliation(s)
- Pierre Laboudie
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Paul Gauthier
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
| | - Cheryl Kreviazuk
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopedic Surgery, The Ottawa Hospital (TOH), 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Faculty of Medicine, The University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| |
Collapse
|
|
45
|
Mozingo JD, Schuring LL, Mortensen AJ, Anderson AE, Aoki SK. Effect of Patient Positioning on Measurement of the Anterior Center-Edge Angle on False-Profile Radiographs and Its 3-Dimensional Mapping to the Acetabular Rim. Orthop J Sports Med 2022; 10:23259671211073834. [PMID: 35141341 PMCID: PMC8819774 DOI: 10.1177/23259671211073834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The anterior center-edge angle (ACEA) is used to quantify anterior coverage of the femoral head by the acetabulum. However, its measurement has not been evaluated in a manner consistent with routine use, and the precise 3-dimensional (3D) anatomic location where it measures coverage is not known. Purpose: To determine the effect of patient positioning on ACEA measurement reliability, magnitude, and 3D location. Study Design: Descriptive laboratory study. Methods: Included were 18 adults; 7 participants had cam morphology and femoroacetabular impingement syndrome, and 11 participants had no radiographic evidence of hip abnormalities and no history of hip pain or injuries. Ultimately, 3D femur and pelvis models were generated from computed tomography images. Radiographs were generated with the models in different degrees of pelvic rotation, tilt, and obliquity relative to the standard false-profile view. The ACEA was measured by 2 raters by selecting the location of the bone edge on each radiograph. Selections were projected onto the pelvis model and expressed as a clockface location on the acetabular rim. The clockface was mirrored on left hips to allow a direct comparison of locations between hips. Interrater and intrarater reliability were quantified via the intraclass correlation coefficient (ICC). The effect of position on ACEA measurements and clockface locations was determined via linear regression. Results: Intrarater and interrater reliability were excellent (ICC ≥0.97 for all). For every degree increase in rotation, tilt, and obliquity, the ACEA changed by +0.53°, +0.93°, and –0.04°, respectively. The mean clockface location (hour:minute:second) in the false-profile view was 2:09:32 ± 0:12:00 and changed by +0:02:08, –0:00:35, and –0:00:05 for every degree increase in rotation, tilt, and obliquity, respectively. Conclusion: ACEA measurements were reliable even with differences in patient positioning. Rotation and tilt were associated with notable changes in ACEA measurements. ACEA bone edge measurements mapped to the anterosuperior acetabular rim, typically in proximity to the anterior inferior iliac spine. Mapped location was most sensitive to rotation. Clinical Relevance: Pelvic rotation and tilt affected ACEA measurements, which could alter the clinical classification and treatment of borderline abnormalities. Rotation in particular must be well controlled during patient imaging to preserve measurement reliability and accuracy and to describe coverage from the intended 3D rim location.
Collapse
Affiliation(s)
- Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Lindsay L. Schuring
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
|
46
|
Kuroda Y, Hashimoto S, Saito M, Matsumoto T, Nakano N, Kuroda R, Hayashi S. Femoro-Epiphyseal Acetabular Roof (FEAR) Index and Anterior Acetabular Coverage Correlate With Labral Length in Developmental Dysplasia of the Hip. Arthroscopy 2022; 38:374-381. [PMID: 33964382 DOI: 10.1016/j.arthro.2021.04.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the association between labral length and radiographic parameters of lateral and anterior acetabular coverage and the femoro-epiphyseal acetabular roof (FEAR) index in patients with developmental dysplasia of the hip (DDH). METHODS We retrospectively analyzed data from patients with DDH who visited our hip joint clinic for the first time due to hip symptoms. DDH presence was defined as a lateral center-edge angle (LCEA) of ≤25°. The labral lengths on the anterior and lateral sides were measured on central axial and central coronal slices of T1-weighted magnetic resonance imaging, respectively. The Pearson correlation coefficients (r) and simple linear regression analyses were performed to determine the association of the lateral and anterior labral lengths with the radiographic parameters, including the LCEA, acetabular roof obliquity, FEAR index, anterior wall index, and vertical center anterior angle. RESULTS This study included 88 patients, with a mean age of 39.6 ± 11.8 years. There were 65 women and 23 men. The lateral and anterior labral lengths correlated with all parameters of dysplasia. Specifically, the lateral labral length had a strong positive correlation with the FEAR index (R = 0.65, P < .001). The anterior labral length had a strong negative correlation with the anterior wall index (R = -0.66, P < .001). CONCLUSIONS The lateral labral length had a strong positive correlation with the FEAR index. Furthermore, the anterior labral length had a correlation with the anterior dysplasia. LEVEL OF EVIDENCE Level III, retrospective cross-sectional study.
Collapse
Affiliation(s)
- Yuichi Kuroda
- 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
| | - Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoyuki Matsumoto
- 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
| | - Ryosuke Kuroda
- 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.
| |
Collapse
|
|
47
|
Saks BR, Fox JD, Owens JS, Maldonado DR, Jimenez AE, Ankem HK, Lall AC, Domb BG. One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy. Am J Sports Med 2021; 49:3906-3914. [PMID: 34694159 DOI: 10.1177/03635465211043510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sex-based differences have been largely uncharacterized for patients with borderline hip dysplasia (BHD) undergoing hip arthroscopy. PURPOSE To evaluate for sex-based differences in clinical and pathologic characteristics as well as surgical outcomes in patients with BHD undergoing hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between January 2011 and December 2018, data were prospectively collected on all patients with BHD undergoing primary hip arthroscopy. Patients were included if they had preoperative and minimum 2-year postoperative scores for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale for pain. Patients with previous ipsilateral hip conditions or surgery, Tönnis grade >1, lateral center-edge angle <18° or >25°, or workers' compensation status were excluded. Patients were then divided by sex and propensity score matched in a 1:1 ratio for body mass index, age, and Tönnis grade. The rates of patients who achieved the minimal clinically important difference were recorded for the mHHS and NAHS. The rates of achieving the patient acceptable symptomatic state for the mHHS were calculated. RESULTS A total of 344 hips met the inclusion criteria, and 317 hips (92%) had adequate follow-up. Propensity score matching created cohorts of 109 male and 109 female patients. Male patients had significantly higher preoperative average alpha angles (69.79° vs 58.17°, P < .001), more often requiring a femoroplasty (97.2% vs 83.5%, P < .001), and had higher rates of complex labral tearing (50.5% vs 33.0%, P < .001). Male patients also had higher rates of grade 3 and 4 acetabular labral articular disruption (62.4% vs 19.3%, P < .001) and higher rates of grade 3 and 4 acetabular cartilage injury (59.6% vs 20.2%, P < .001) requiring a microfracture more frequently (32.1% vs 7.3%, P < .001). Female patients more typically had painful internal snapping requiring iliopsoas fractional lengthening (60.6% vs 32.1%, P < .001). Female patients also underwent capsular plication more regularly to address hip instability (79.8% vs 45.9%, P < .001). Male and female patients showed significant improvements in all outcome scores after surgery (P < .001). Female patients achieved the minimal clinically important difference for the NAHS at higher rates (85.3% vs 71.6%, P = .020). CONCLUSION Female and male patients with BHD who underwent hip arthroscopy achieved favorable outcomes but had notably dissimilar pathology. Hence, although they share similar acetabular bony morphology, male and female patients with BHD may represent 2 very different pathologic entities.
Collapse
Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - James D Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
|
48
|
Tan SHS, Tan JHI, Lim AKS, Hui JH. Periacetabular osteotomy for acetabular retroversion: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107:103078. [PMID: 34583014 DOI: 10.1016/j.otsr.2021.103078] [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: 10/02/2020] [Revised: 04/17/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The evidence for periacetabular osteotomy (PAO) when used in the management of acetabular retroversion remain limited. The review aims to answer the following questions: (1) What are the indications for an anteverting PAO for acetabular retroversion? (2) When are other concomitant procedures required when performing anteverting PAO for acetabular retroversion? (3) To what extent is an anteverting PAO able to correct acetabular retroversion? (4) What are the clinical outcomes for an anteverting PAO when used in acetabular retroversion? (5) What is the estimated survival for anteverting PAO when used in the treatment of acetabular retroversion, before other procedures need to be performed? (6) What are the complications and the complication rates when an anteverting PAO is performed? (7) How do the outcomes of an anteverting PAO compare to other surgical procedures used in the management of acetabular retroversion? MATERIAL AND METHODS The systematic review was conducted using the PRISMA guidelines. The search was conducted using PubMed Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception through 1 May 2020. The keywords used were "periacetabular osteotomy". All studies that reported the outcomes of periacetabular osteotomy for acetabular retroversion were included. Each study's data was then retrieved individually. The study design, surgical technique, indications, outcomes and complications of each study were analysed. RESULTS Seven studies with 225 hips were included. The pooled odds ratio (OR) for a positive crossover sign and posterior wall sign preoperatively as compared to postoperatively were 456.31 (95% CI: 99.57 to 2091.28) and 53.45 (95% CI: 23.05 to 123.93) respectively. The pooled weighted mean difference (WMD) for studies with their mean preoperative LCEA and AI in the dysplastic range were 12.61 (95% CI: 6.54 to 18.68) and-15.0 (95% CI: -19.40 to -11.80) respectively, while the pooled WMD for studies with their mean preoperative LCEA and AI in the normal range were 3.43 (95% CI: 1.08 to 5.77) and -3.56 (95% CI: -5.29 to -1.83) respectively. Other indicators for acetabular retroversion correction, hip dysplasia correction, functional outcomes and range of motion were also significantly improved and sustained up till 11 years postoperatively. Only 7.1% of the hips required subsequent surgical procedures for impingement symptoms or progression of osteoarthritis, and the mean estimate for survival time across the studies was 123.90 months (95% CI: 119.94 to 127.86). The complication rates for low-grade complication were 31.6% while the rate for high-grade complications was 12.0%. DISCUSSION Anteverting PAO is indicated for symptomatic acetabular retroversion, and when performed, leads to good deformity correction for both acetabular retroversion and hip dysplasia, positive improvement in clinical outcomes sustainable till 11 years postoperatively and a mean estimated survival time of more than 10 years. LEVEL OF EVIDENCE IV; Systematic review and meta-analysis.
Collapse
Affiliation(s)
- Si Heng Sharon Tan
- National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Joelle Hwee Inn Tan
- National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | | | - James Hoipo Hui
- National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| |
Collapse
|
|
49
|
Dittmer Flemig AJ, Essilfie A, Schneider B, Robustelli S, Sink EL. The use of image analysis software increases the accuracy of the periacetabular osteotomy fragment placement. J Hip Preserv Surg 2021; 8:325-330. [PMID: 35505798 PMCID: PMC9052410 DOI: 10.1093/jhps/hnab085] [Citation(s) in RCA: 3] [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: 05/28/2021] [Revised: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to report on the use of image analysis technology to enhance accuracy of intra-operative imaging and evaluation of periacetabular osteotomy (PAO) correction. This was a retrospective study reporting on the first 25 cases of PAO performed with the use of an image analysis tool. This technology was used intra-operatively to assess the position of the supine coronal image in comparison to pre-operative standing images using a ratio of pelvic tilt (PT). Intra-operative PT, Tönnis angle, lateral center–edge angle (LCEA) and anterior wall index were compared to post-operative images. Post-operative radiographic parameters in the study group were compared with a control group of PAO cases performed prior to the implementation of the new software. The image analysis software was able to obtain intra-operative supine imaging that was equivalent to pre-operative standing imaging. When comparing the PAOs performed with the use of the software versus those without, the study group trended toward being more likely within the surgeon’s defined target range of radiographic values, which was statistically significant for LCEA. This tool can be used to assure the surgeon that the intra-operative image being used for surgical decision-making is representative of the functional radiograph. PAOs performed with the use of this technology showed enhanced accuracy of surgical correction for the parameters within our defined target ranges. This may increase the ability of the surgeon to place the acetabular fragment more precisely within his or her goal parameters for acetabular reorientation correction.
Collapse
Affiliation(s)
- Alison J Dittmer Flemig
- Department of Orthopedic Surgery, Gillette Children’s Specialty Healthcare, 200 University Avenue East, St. Paul, MN 55101, USA
| | - Anthony Essilfie
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Brandon Schneider
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Stacy Robustelli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Ernest L Sink
- Department of Hip Preservation, Hospital for Special Surgery, 535 East 70th Street, NY, NY 10021, USA
| |
Collapse
|
|
50
|
DeFroda SF, Alter TD, Lambers F, Malloy P, Clapp IM, Chahla J, Nho SJ. Quantification of Acetabular Coverage on 3-Dimensional Reconstructed Computed Tomography Scan Bone Models in Patients With Femoroacetabular Impingement Syndrome: A Descriptive Study. Orthop J Sports Med 2021; 9:23259671211049457. [PMID: 34820460 PMCID: PMC8607491 DOI: 10.1177/23259671211049457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accurate assessment of osseous morphology is imperative in the evaluation of patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. Through use of computed tomography (CT), 3-dimensional (3D) reconstructed hip models may provide a more precise measurement for overcoverage and undercoverage and aid in the interpretation of 2-dimensional radiographs obtained in the clinical setting. Purpose To describe new measures of acetabular coverage based on 3D-reconstructed CT scan bone models. Study Design Cross-sectional study; Level of evidence, 3. Methods Preoperative CT scans were acquired on the bilateral hips and pelvises of 30 patients before arthroscopic surgical intervention for FAIS. Custom software was used for semiautomated segmentation to generate 3D osseous models of the femur and acetabulum that were aligned to a standard coordinate system. This software calculated percentage of total acetabular coverage, which was defined as the surface area projected onto the superior aspect of the femoral head. The percentage of coverage was also quantified regionally in the anteromedial, anterolateral, posteromedial, and posterolateral quadrants of the femoral head. The acetabular clockface was established by defining 6 o'clock as the inferior aspect of the acetabular notch. Radial coverage was then calculated along the clockface from the 9-o'clock to 5-o'clock positions. Results The study included 20 female and 10 male patients with a mean age of 33.6 ± 11.7 years and mean body mass index of 27.8 ± 6.3. The average percentage of total acetabular coverage for the sample was 57% ± 6%. Acetabular coverages by region were as follows: anteromedial, 78% ± 7%; anterolateral, 18% ± 7%, posterolateral, 33% ± 13%, and posteromedial, 99% ± 1%. The acetabular coverage ranged from 23% to 69% along the radial clockface from 9 to 5 o'clock. Conclusion This study demonstrated new 3D measurements to characterize acetabular coverage in patients with FAIS and elucidated the distribution of acetabular coverage according to these measurements.
Collapse
Affiliation(s)
- Steven F DeFroda
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA.,Arcadia University, Montgomery, Pennsylvania, USA
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|