Pelvic morphology medial to the femoral head center predicts anterior coverage and range of motion after curved periacetabular osteotomy

2020 ◽  
Vol 38 (9) ◽  
pp. 2031-2039 ◽  
Author(s):  
Tomoyuki Kamenaga ◽  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
Koji Fukuda ◽  
Koji Takayama ◽  
...  
Keyword(s):  
Femoral Head ◽  
Range Of Motion ◽  
Periacetabular Osteotomy ◽  
Pelvic Morphology ◽  
Curved Periacetabular Osteotomy ◽  
Femoral Head Center

scholarly journals Acetabular- and femoral orientation after periacetabular osteotomy as a predictor for outcome and osteoarthritis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jens Goronzy ◽  
Lea Franken ◽  
Albrecht Hartmann ◽  
Falk Thielemann ◽  
Sophia Blum ◽  
...  
Keyword(s):  
Femoral Head ◽  
Functional Outcome ◽  
Periacetabular Osteotomy ◽  
Acetabular Version ◽  
Femoral Torsion ◽  
Combined Anteversion ◽  
Femoral Version ◽  
Acetabular Fragment ◽  
Femoral Head Center

Abstract Background Periacetabular osteotomy is a successful treatment for hip dysplasia. The results are influenced, however, by optimal positioning of the acetabular fragment, femoral head morphology and maybe even femoral version as well as combined anteversion have an impact. In order to obtain better insight on fragment placement, postoperative acetabular orientation and femoral morphology were evaluated in a midterm follow-up in regard to functional outcome and osteoarthritis progression. Methods A follow-up examination with 49 prospectively documented patients (66 hips) after periacetabular osteotomy (PAO) was performed after 62.2 ± 18.6 months. Mean age of patients undergoing surgery was 26.7 ± 9.6 years, 40 (82%) of these patients were female. All patients were evaluated with an a.p. pelvic x-ray and an isotropic MRI in order to assess acetabular version, femoral head cover, alpha angle, femoral torsion and combined anteversion. The acetabular version was measured at the femoral head center as well as 0.5 cm below and 0.5 and 1 cm above the femoral head center and in addition seven modified acetabular sector angles were determined. Femoral torsion was assessed in an oblique view of the femoral neck. The combined acetabular and femoral version was calculated as well. To evaluate the clinical outcome the pre- and postoperative WOMAC score as well as postoperative Oxford Hip Score and Global Treatment Outcome were analyzed. Results After PAO acetabular version at the femoral head center (31.4 ± 9.6°) was increased, the anterior cover at the 15 o’clock position (34.7 ± 15.4°) was reduced and both correlated significantly with progression of osteoarthritis, although not with the functional outcome. Combined acetabular and femoral torsion had no influence on the progression of osteoarthritis or outcome scores. Conclusion Long-term results after PAO are dependent on good positioning of the acetabular fragment in all 3 planes. Next to a good lateral coverage a balanced horizontal alignment without iatrogenic pincer impingement due to acetabular retroversion, or insufficient coverage of the anterior femoral head is important.

scholarly journals Change in 2D and 3D femoral head coverage after curved periacetabular osteotomy

10.29007/jt57 ◽  
2020 ◽  
Author(s):  
Keisuke Uemura ◽  
Masashi Okamoto ◽  
Kunihiko Tokunaga ◽  
Andrew Anderson
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Head Region ◽  
Edge Angle ◽  
Center Edge ◽  
Curved Periacetabular Osteotomy ◽  
2D And 3D ◽  
Center Edge Angle ◽  
3D Coverage

Femoral head coverage in patients with hip dysplasia (DDH) is often quantified using 2D parameters, including the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, only moderate correlations have been observed between the 2D coverage and 3D coverage. The purposes of this study were to: 1) quantify the change in 3D head coverage after curved periacetabular osteotomy (CPO), and 2) analyze the relationship between 2D and 3D head coverage preoperatively and postoperatively. Forty-three hips of 39 female cases (age: 37±10 years) who underwent CPO were analyzed. 2D coverage was quantified using the LCEA and ACEA from CT images. 3D coverage was quantified in the anterior, superior, posterior, inferior head regions. 3D measurements were performed both pre- and post-operatively and were correlated to the measurements of 2D coverage to study interactions. Preoperative 3D percent coverage in each head region was 17.8±6.7%, 36.2±7.7%, 57.6±10.2%, and 15.3±6.4% for the anterior, superior, posterior, and inferior region, respectively. Postoperatively, 3D coverage in the anterior and superior regions increased to 23.4% and 53.7%, respectively while a significant decrease was found for the posterior and inferior regions (all p<0.01). When 3D and 2D coverage was correlated, significant positive correlation was found between the 3D superior coverage and the LCEA both preoperatively (r=0.72, p<0.01) and postoperatively (r=0.67, p<0.01). However, no correlation was found between the 3D anterior coverage and the ACEA, which became significant in the postoperative period (r=0.69, p<0.01). Results indicate that preoperative anterior coverage for patients with DDH should be evaluated three-dimensionally.

scholarly journals LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Clarabelle DeVries ◽  
Jeffrey J Nepple ◽  
Lucas Fowler ◽  
Sean Akers ◽  
Gail Pashos ◽  
...  
Keyword(s):  
Femoral Head ◽  
Normative Data ◽  
Low Dose ◽  
Periacetabular Osteotomy ◽  
Femoral Head Coverage ◽  
Edge Angle ◽  
Center Edge ◽  
Two Sectors ◽  
Posterior Sector ◽  
Center Edge Angle

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

scholarly journals Periacetabular Osteotomy Restores the Typically Excessive Range of Motion in Dysplastic Hips With a Spherical Head

2014 ◽  
Vol 473 (4) ◽  
pp. 1404-1416 ◽  
Author(s):  
Simon D. Steppacher ◽  
Corinne A. Zurmühle ◽  
Marc Puls ◽  
Klaus A. Siebenrock ◽  
Michael B. Millis ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Periacetabular Osteotomy ◽  
Spherical Head

Curved Periacetabular Osteotomy for Treatment of Dysplastic Hip

2005 ◽  
Vol &NA; (433) ◽  
pp. 129-135 ◽  
Author(s):  
Masatoshi Naito ◽  
Kei Shiramizu ◽  
Yuichiro Akiyoshi ◽  
Masamitsu Ezoe ◽  
Yoshinari Nakamura
Keyword(s):  
Periacetabular Osteotomy ◽  
Curved Periacetabular Osteotomy ◽  
Dysplastic Hip

scholarly journals Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system

Medicine ◽  
2018 ◽  
Vol 97 (48) ◽  
pp. e13519
Author(s):  
Ariha Goshi ◽  
Shigeo Fukunishi ◽  
Shohei Okahisa ◽  
Taishi Okada ◽  
Shinichi Yoshiya
Keyword(s):  
Computed Tomography ◽  
Real Time ◽  
Periacetabular Osteotomy ◽  
3 Dimensional ◽  
Curved Periacetabular Osteotomy

scholarly journals Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia

2020 ◽  
Author(s):  
Yoshiki Takahashi ◽  
Naonobu Takahira ◽  
Katsufumi Uchiyama ◽  
Kensuke Fukushima ◽  
Mitsutoshi Moriya ◽  
...  
Keyword(s):  
Physical Function ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Weight Bearing ◽  
Activity Participation ◽  
Full Weight Bearing ◽  
Sports Activity ◽  
Before And After ◽  
Curved Periacetabular Osteotomy ◽  
Sports Activities

Abstract Background: Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO.Methods: A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO.Results: The pre- and post-operative sports activity participation rates were 55.8% and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier.Conclusions: Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

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