Introduction: Osteonecrosis of the femoral head with joint space narrowing in young patients aged less than fifty years old was treated with posterior rotational osteotomy. Changes of the acetabular roof were observed after operation. Early remodeling of the acetabular roof after operation was studied radiographically. Materials and Methods: Eighteen hips in 15 patients treated by posterior rotational osteotomy were subjects for this study. The age of the patients ranged from 15 to 50 (mean of 36 years). Eleven patients were women, 4 were men. The etiologic factors were steroid administration in 9 patients, alcoholic abuse in 1 patient, trauma in 7 patients, and no apparent factor in 1 patient. Changes of the acetabular roof on antero-posterior radiographs were observed at 6 months, 1 year, and 2 years postoperatively. Atrophic change and uniform shape of the acetabular roof was studied in each period. Results: At 6 months after operation, atrophic change was noted on all 18 hips. None of uniform shape was found. Atrophic change of 10 hips (56%) was found 1 year postoperatively. Shape of acetabular roof was improved and uniformed in 8 hips. In all 18 hips 2 years after operation, shape of acetabular roof was remodeled and uniformed. Discussion: From these results, we thought acetabular roof of femoral head involving necrosis with joint narrowing was remodeled at an early period postoperatively

To propose a modified approach to measuring femoro-epiphyseal acetabular roof (FEAR) index while still abiding by its definition and biomechanical basis, and to compare the reliabilities of the two methods. To propose a classification for medial sourcil edges. We retrospectively reviewed a consecutive series of patients treated with periacetabular osteotomy and/or hip arthroscopy. A modified FEAR index was defined. Lateral center-edge angle, Sharp's angle, Tonnis angle on all hips, as well as FEAR index with original and modified approaches were measured. Intra- and inter-observer reliability were calculated as intraclass correlation coefficients (ICC) for FEAR index with both approaches and other alignments. A classification was proposed to categorize medial sourcil edges. ICC for the two approaches across different sourcil groups were also calculated. After reviewing 411 patients, 49 were finally included. Thirty-two patients (40 hips) were identified as having borderline dysplasia defined by an LCEA of 18 to 25 degrees. Intra-observer ICC for the modified method were good to excellent for borderline hips; poor to excellent for DDH; moderate to excellent for normal hips. As for inter-observer reliability, modified approach outperformed original approach with moderate to good inter-observer reliability (DDH group, ICC=0.636; borderline dysplasia group, ICC=0.813; normal hip group, ICC=0.704). The medial sourcils were classified to 3 groups upon its morphology. Type II(39.0%) and III(43.9%) sourcils were the dominant patterns. The sourcil classification had substantial intra-observer agreement (observer 4, kappa=0.68; observer 1, kappa=0.799) and moderate inter-observer agreement (kappa=0.465). Modified approach to FEAR index possessed greater inter-observer reliability in all medial sourcil patterns. The modified FEAR index has better intra- and inter-observer reliability compared with the original approach. Type II and III sourcils accounts for the majority to which only the modified approach is applicable

Aims: A main condition in succesfull rearthroplasty of acetabular component is the way of stabilizing this component in physiological site, with a full support on bone. Segmental and cavitary acetabular defect are often caused by aseptic loosening of the implants. The use of bulky corticocancellous grafts, which would be loaded is recommended. Methods: Acetabular roof reconstruction technique for revision cemented THA, according to Zuk is presented in a series 42 patients (19 male and 23 female aged 56– 68 yr). No screws and bone pins were used for cortico-cancellous graft þxation. Results: In 22 patients autogenic graft was sufþciently remodeled within 12 months, in 16 cases with frozen allogenic graft it lasted 20 months on average. Longer remodeling time depended on the size of acetabular defect, coexisting conditions and postoperative complication. In 2 cases an autolysis of the graft occurred; one patient underwent prolonged corticosteroid therapy before; the other one was exposed extensively to chemical substances prior to surgery. Aseptic loosening of the acetabular roof in this cases followed. Conclusions: Reconstruction of acetabular roof defect in this method is relatively simple and can diminish complication rate bounded with potential electrolysis harmfull effect. A mean remodeling time of reconstructed acetabular bone roof with this method was equal as with stabilized graft (pins and screws)

The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making specifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. The aims of this study were:. (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral centre-edge angle (LCEA) and acetabular index (AI), with respect to intra- and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received instable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7–35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95%CI, 25.5–38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2–35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic femoroacetabular impingement procedure. The association of received treatment categories with the variables AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index were evaluated first using Wilcoxon two-sample tests (two-sided) followed by stepwise multiple logistic regression analysis to identify the potential associated variables in a combined setting. Sensitivity, specificity, and receiver operator curves were calculated. The primary endpoint was the association between the FEAR index and instability, which we defined as migration of the femoral head either already visible on conventional radiographs or recentering of the head on AP abduction views, a break of Shenton's line, or the appearance of a crescent-shaped accumulation of gadolinium in the posteroinferior joint space at MR arthrography. The FEAR index showed excellent intra- and interobserver reliability, superior to the AI and LCEA. The FEAR index was lower in the stable borderline group (mean, −2.1 ± 8.4; 95% CI, −6.3 to 2.0) compared with the unstable borderline group (mean, 13.3 ± 15.2; 95% CI, 6.2–20.4) (p < 0.001) and had the highest association with treatment received. A FEAR index less than 5° had a 79% probability of correctly assigning hips as stable and unstable, respectively (sensitivity 78%; specificity 80%). A painful hip with a LCEA of 25° or less and FEAR index less than 5° is likely to be stable, and in such a situation, the diagnostic focus might more productively be directed toward femoroacetabular impingement

We wanted to evaluate the clinical and radiological results of acetabular revision using the acetabular reinforcement ring and allograft impaction in patients with severe acetabular bony defect.

41 hips revision arthroplasty using reinforcement ring were performed between April 1997 and October 2005 and were followed up for more than two years. The cause of primary arthroplasty was AVN in 18 cases, secondary osteoarthritis (OA) in 17 cases, fracture in cases and primary OA in 1 case. The cause of revision arthroplasty was acetabular cup loosening in 20 cases, massive osteolysis in 14 cases, infection in 4 cases, liner dissociation in 2 cases, and recurrent dislocation in 1 case. The average period between primary and revision arthroplasty was 11.4 years (range 0.6 to 29.1 years). Acetabular defects were classified based on the AAOS classification and Paprosky classification system. All were treated with autografts or allografts. Muller ring was used in 18 cases, Burch-Schneider ring was used in 14 cases, and Ganz ring in 9 cases. Clinical evaluations were performed according to the Harris hip score (HHS), and the radiographic results were evaluated by progression of acetabular component loosening, union of bone grafts, periacetabular osteolysis, and migration of the hip center.

The mean preoperative Harris hip score of 64.9 was improved to 91.8 points at the latest follow-up. There were 39 cases of type 3 defect, 2 cases of type 4 defect according to the AAOS classification and 8 cases of type 2B defect, 3 cases of type 2C defect, 28 cases of type 3A defect, and 2 cases of type 3B defect according to Paprosky classification.

Radiographically, the bone grafts were well united except one case. The mean preoperative hip center of rotation which was vertically 32.3mm, horizontally 33.2 mm migrated to vertically 26 mm, horizontally 33.2 mm postoperatively and it was statistically significant.

The mean preoperative abductor lever arm of 41.7 mm changed to 45 mm postoperatively which was statistically insignificant. However the mean preoperatiave body lever arm of 89.4 mm changed to 96.9 mm postoperatively which was statistically significant. Postoperative complications were cup loosening in 1 case, dislocation in 2 cases, and recurrence of deep infection in 1 case.

Clinically and radiographically, acetabular reconstruction using reinforcement ring showed very promising short term result. We conclude that reinforcement ring can provide stable support for grafted bone in severe bone defect. But meticulous surgical technique to get initial firm stability of ring and optimal indication in mandactory for the successful result.

Satisfactory intermediate and long-term results of rotational acetabular osteotomy (RAO) for the treatment of early osteoarthritis secondary to developmental dysplasia of the hip have been reported. The purpose of this study is to examine the 30-year results of RAO. Between 1987 and 1994, we treated 49 patients (55 hips) with RAO for diagnosis of pre- OA or early-stage OA. Of those patients, 35 patients (43 hips) were available at a minimum of 28 years. The follow-up rate was 78.2% and the mean follow-up was 30.5 years. The mean age at the time of surgery was 34 years. Clinical evaluation was performed with the Merle d'Aubigne and Postel rating scale, and radiographic analyses included measurements of the center-edge angle, acetabular roof angle, and head lateralization index on preoperative, postoperative AP radiographs of the pelvis. Postoperative joint congruency was classified into four grades. The radiographic evidence of progression of OA was defined as the minimum joint space less than 2.5mm. The mean preoperative clinical score was 14.0, which improved to a mean of 15.3 at the time of the latest follow-up. The mean center-edge angle improved from 0.6° preoperatively to 34° postoperatively, the mean acetabular roof angle improved from 28.4°preoperatively to 1.0°postoperatively, the mean head lateralization index improved from 0.642 preoperatively to 0.59 postoperatively. Postoperative joint congruency was excellent in 11 hips, good in 29 hips, and fair in 3 hips. Nineteen patients (20 hips) had radiographic OA progression, and 10 patients (11 hips) were converted to THA. Kaplan-Meier survivorship analysis, with radiographic OA progression as the end point, predicted survival of 75.6% at 20 years and 48.8% at 30 years, and with THA conversion as the end point, 90.2% at 20 years and 71.2% at 30 years. The RAO is an effective surgical procedure for symptomatic dysplastic hips of pre- and early-stage OA and could change the natural history of the dysplastic hip

Introduction: Operative treatment of secondary osteoarthritis due to congenital hip disease (CHD) in adults presents a challenging issue. Various classifications have been proposed for congenital hip disease in search for the best treatment option. Aim of this prospective study is to find measurements important in preoperative planning and their correlation with postoperative results. Materials and Methods: We have included 64 patients (70 hips) with CHD consecutively scheduled for operation. Preoperatively congenital hip disease was classified according to Crowe, Hartofilakidis and Eftekhar and center of rotation was determined using Ranawat’s method. Distance between ideal and actual center rotation was measured. Further, distance between medial acetabular wall and medial pelvic rim (medial bone bulk) in the line of ideal center of rotation was measured. Another measurement was distance between ideal acetabular roof point and medial pelvic rim. On the postoperative radiographs centre of the femoral head was recorded. Correlation between Crowe, Hartofilakidis and Eftekhar classifications with distance between ideal and postoperative center rotation and medial bone bulk were calculated using Pearson correlation. Correlation was also analyzed using information about distance between ideal acetabular roof point and medial pelvic rim. Results: Data analysis showed that there is the strongest connection between degree of CHD determined using Eftaker classification and distance between ideal and actual rotation center (r=0.417, p=0.011). Crowe and Hartofilakidis classifications also shows statistically significant connection, however not that strong (r= 0.384, p=0.021 for Crowe and r=0.373, p=0.025 for Hartofilakidis). Eftaker classification shows the strongest correlation with medial bone bulk r=0.425, a p=0.010. Similar is Crowe classification (r=0.341, p=0.042), while there is no statistically significant correlation with Hartofilakidis classification. Results also shows that when there is higher degree of congenital hip disease there is thinner bone bulk in line of ideal acetabular roof (for Crowe r= −0.360, p=0.031, for Hartofilakidis r= −0.354, p=0.34). Conclusion: Results show that severity of dysplasia according to Crowe, Hartofilakidis and Eftekhar correlates with postoperative position of rotation center. Eftekhar classification gives the best insight to how much medial bone bulk is available. For bone bulk on the acetabular roof predictions can be made using both Crowe and Hartofilakidis system. However, one classification still does not provide with all information we found important for correct endoprothesis placement in relation to center of rotation especially about acetabular depth, and bone mass on the medial acetabular wall and acetabular roof

In this paper operations are discussed that improve the dysplastic acetabular roof in developmental dislocation of the hip (DDH) of children up to 10 years. In the first year of life acetabular dysplasia can be treated successfully by flexion-abduction splints and plaster casts in „human position“. From the second year on, only slight dysplasias can heal spontaneously or be treated conservatively. Then the steep acetabular roof has to be osteotomized and levered down to a normal angle and coverage to avoid redislocation or residual dysplasia. Different procedures have been described in the course of time. Two osteotomies are chiseling in the anterior to posterior direction. Salters innominate osteotomy levers the whole acetabulum with the lower part of the pelvis in an anterolateral direction around an axis passing through the pubic symphysis and the posterior part of the osteotomy. In Pembertons osteotomy the hinge for turning down the acetabular roof is the last, posterior, transverse cortical segment over the tri-radiate cartilage, short before the sciatic notch. Osteotomies chiseling from lateral in medial direction have been described already by Albee (1915) and Jones (1920). Lance (1925) propagated this technique in Europe. Here the acetabular roof is partially osteotomized in a thickness of 5–7 mm. Only the lateral part of the acetabulum is brought into the horizontal position. Wiberg in 1939 used this technique, but in 1953 he was the first to publish a full osteotomy what Dega called 1973 a transiliac osteotomy. Dega had originally learned the technique of Lance, but in 1963 when he reduced high dislocations after the technique of Colonna, he performed also a full transiliac osteotomy. After the Symposium of Chapchal in Basel 1965 we started in Berlin also with the complete acetabular osteotomy. With the control of an image intensifier the blade of the osteotome is driven toward the posterior rim of the tri-radiate cartilage leaving only a small bony rim above. Anteriorly the blade passes through the ant. inf. iliac spine. Posteriorly it just enters the sciatic notch. Here we check the blade position by direct palpation. The acetabulum is bent down partly in the small rim of bone left and mainly in the triradiate cartilage. Angles up to 50° have been achieved, which you cannot reach by other techniques. In the beginning we have combined after Mittelmeier and Witt this acetabuloplasty with a varus osteotomy of the femur. In our long-time follow-up (Brüning et al. 1988,1990) however, we found in almost 50% a subcapital coxa valga or a so-called head-in-neck-position of the femoral head. Then we avoided varusosteotomies and had good results without it (Pothmann). To keep the acetabular roof in the new position we used first bone wedges from the varus osteotomy, then deproteinized bone wedges from animals, and today deep frozen wedges of human femoral heads of the bone bank, sterilized at 121 degrees C for 20 min. (Ekkernkamp, Katthagen). A firm layer of cortical bone laterally is necessary. Reinvestigations have proven the stability of this material too ( Pothmann). This type of acetabular osteotomy in our and other authors opinion is the best. Salters osteotomy is not as efficient in severe dysplasia. And in older children it produces a decrease in anteversion of the acetabulum, which may limit internal rotation of the hip and cause osteoarthritis if it does not improve. In Pembertons osteotomy one cannot use the image intensifier, which is of great help to perform the osteotomy exactly and also the levering of the acetabulum to the optimal coverage. Our first long-time follow-up of children with additional varus-osteotomies (Brüning et al.) reviewed 90 hip joints in 67 children. The age at operation was in average 3.6 years, the age at follow-up 15 years. Clinical results. 98% of the patients had no pain or only occasional, no limitation of movement and normal or almost normal gait. The Trendelenburg sign was negative in 71% of the cases, grade 1 in 15.5% and grade 3 in 13.5%. Radiological evaluation. The mean value of the AC-angle (acetabular index) preoperatively was 33.8°, postoperatively normal with 16.3°. The acetabular angle of the weightbearing zone was at follow-up 9.7°, which is normal too. At the age of less than 18 years the CE angle of 25,9° was normal too, as well the instability (protrusion) index of Reimers of 12.3 % and the distance femoral head to teardrop figure with 8.8 mm. In our study group of hip dysplasia we introduced a score of normal values of hip measurements and 3 grades of deviation from normal, slightly pathological, severely pathological and extremely. When we counted normal values and slightly pathological ones together as a good result, we found for the different measurements of the acetabulum percentages mainly between 82 and 93 %. Remarkable were two measurements of the femoral neck, the epiphyseal index with only 50 % of normal and slightly pathological angles and the head-neck index with 47.7% respectively. This was due to the head-in-neck position of the femoral neck after varus osteotomy as we have mentioned already. Acetabular coverage is achieved best in transiliac osteotomies up to 10 years. Then, only by triple pelvic osteotomies the acetabulum in total can be redirected to a normal coverage. But this operation is more difficult. Residual dysplasias therefore should be treated as early as possible in the way demonstrated here

Objectives. We have previously investigated an association between the genome copy number variation (CNV) and acetabular dysplasia (AD). Hip osteoarthritis is associated with a genetic polymorphism in the aspartic acid repeat in the N-terminal region of the asporin (ASPN) gene; therefore, the present study aimed to investigate whether the CNV of ASPN is involved in the pathogenesis of AD. Methods. Acetabular coverage of all subjects was evaluated using radiological findings (Sharp angle, centre-edge (CE) angle, acetabular roof obliquity (ARO) angle, and minimum joint space width). Genomic DNA was extracted from peripheral blood leukocytes. Agilent’s region-targeted high-density oligonucleotide tiling microarray was used to analyse 64 female AD patients and 32 female control subjects. All statistical analyses were performed using EZR software (Fisher’s exact probability test, Pearson’s correlation test, and Student’s t-test). Results. CNV analysis of the ASPN gene revealed a copy number loss in significantly more AD patients (9/64) than control subjects (0/32; p = 0.0212). This loss occurred within a 60 kb region on 9q22.31, which harbours the gene for ASPN. The mean radiological parameters of these AD patients were significantly worse than those of the other subjects (Sharp angle, p = 0.0056; CE angle, p = 0.0076; ARO angle, p = 0.0065), and all nine patients required operative therapy such as total hip arthroplasty or pelvic osteotomy. Moreover, six of these nine patients had a history of operative or conservative therapy for developmental dysplasia of the hip. Conclusions. Copy number loss within the region harbouring the ASPN gene on 9q22.31 is associated with severe AD. A copy number loss in the ASPN gene region may play a role in the aetiology of severe AD. Cite this article: T. Sekimoto, M. Ishii, M. Emi, S. Kurogi, T. Funamoto, Y. Yonezawa, T. Tajima, T. Sakamoto, H. Hamada, E. Chosa. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia. Bone Joint Res 2017;6:439–445. DOI: 10.1302/2046-3758.67.BJR-2016-0094.R1

The purpose of our study was to find out the midterm results of the Müller acetabular roof reinforcement ring in primary and revision total hip arthroplasty. From 1988 to 1998, 48 total hip arthroplasties using the acetabular roof reinforcement ring (39 patients) was performed by one surgeon (PDB). We reviewed all patients who had a minimum of five year follow up. There were 37 hips (31 patients) with a mean follow up of 7 years (5 to 12 years). Acetabular deficiencies were classified according to the AAOS classification. Acetabular reconstruction was done using the Müller acetabular roof reinforcement ring with the polyethylene cup cemented to the ring, and morcellized cancellous bone graft. Müller straight stem femoral prosthesis was used in all cases for femoral reconstruction. All patients were followed up annually and outcome assessed using Harris hip score. There were 27 primary procedures and 10 revisions. 30 patients (81%) had cavitary, 2 (5%) had segmental and 5 (14%) had combined defects. Survival analysis was done with failure defined as radiological evidence of loosening of the acetabular component. Statistical analysis was done using SPSS for Windows (SPSS Inc, Chicago, Illinois). 5 patients died due to unrelated causes and 2 patients were lost for follow up. The mean Harris hip score improved from 42 preoperatively to 82 postoperatively (p< 0. 001)(Wilcoxon Signed Rank test). Both mean pain and function score showed improvement from 12 to 39 postoperatively (p< 0. 001) and 12 to 32 (p< 0. 001) respectively. 5 patients had radiological loosening of the ring. The migration rate was 13%. The cumulative survival rate at 12 years, excluding all patients who died and were lost for follow up, was 79. 3% (95% confidence interval 71. 4 to 87. 2, standard error 4). There was no statistical difference in the failure rate between primary and revision procedures (chi-square test). This series show satisfactory medium term results with Müller roof reinforcement ring and cancellous bone graft in acetabular deficiencies with poor bone stock

The term of hip dysplasia means an abnormality of shape, size or spatial configuration of the acetabulum. It also concerns the femoral head, with mutual relationships, proportions and alignment between the femoral head and the acetabulum the most crucial factors. The reason of any symptoms in hip dysplasia is the dysplastic acetabulum and its disproportion in relation to the femoral head. Dysplasia of the acetabulum appearing at puberty has been attributed to secondary “absorption” of bony acetabulum. The presence of fatigue fractures at a later age has been considered as resulting from trauma. However, the fragments of the acetabular rim should be ascribed to overloading of the rim in dysplastic hips, causing fracture and separation of its segment. They are sometimes associated with cysts in the acetabular roof. Limbus tears with or without an associated bony fragment are known to occur after traumatic dislocation of the hip but also without any history of injury. There is no explanation of their cause or their relation to acetabular dysplasia. Limbus tears have been diagnosed by arthroscopy, arthrography and CT scans. Clinical signs. No hip dysplasia in adults is really symptom-free. A casual examination applied between the painful episodes may appear so normal, that the articular origin of the pain may be doubted. In most cases pain is elicited by passive movement of the thigh into full flexion, adduction and internal rotation. This combination of movements brings the proximal and anterior parts of the femoral neck into the contact with the rim of the acetabulum, exactly at the point where the labrum is likely to be damaged. Preop imaging. An anteroposterior radiograph, or “faux profil” view of Lequesne de Seze may demonstrate a congruent but short acetabular roof (Type II) or an incongruent hip with a shallow acetabulum and a more vertical than normal acetabular roof (Type I). Type I hip is potentially or really unstable. The femoral head has migrated laterally or anteriorly or in both directions, distorting the spherical shape of actebular inlet into an oval. A simple 3-dimensional classification is recommended by myself using conventional X-ray and CT scan on equatorial level. The CE angle and sectors angle acc. Anda are used to describe the anterior, lateral and posterior coverage. To check the possibilities of reduction, the anteroposterior radiograph is made in max. abduction of the hip. To simulate the correction movement of the acetabular part we use our own “Super pelvis” software. Intra-op control. For intraoperative correction control we use a C-arm, which also controls step by step all stages of the periacetabular osteotomy. To check the final correction the X-ray of both hips is absolutely obligatory. What we should check is: the displacement of the acetabular fragment (to avoid lateralization, if necessary to make medialisation) and the positions of the anterior and posterior acetabular rim. If this is impossible with the normal a-p X-ray, the C-arm is used for achieving the “faux profil”. The computer assisted orthopaedic surgery system appears the most accurate intra-op control

Aims: To evaluate technical and clinical results of a new 2-incision technique of rotational acetabular osteotomy. Methods: 27 patients, with a mean age of 40 years, were reviewed after a minimum of 1 year subsequently to rotational acetabular osteotomy, which was done through short low midline and iliac approaches. An analysis of complications, the length of rehabilitation period, time to union of the osteotomy, radiographic correction of acetabular roof, proceeding of hip arthrosis, as well as of clinical status at follow-up, using scores by Merle DñAubigne and Harris, was performed. Results: No major operative complications were observed. The median time to union of osteotomy and a painless status was 10 weeks. Femoral head covering by acetabular roof increased signiþcantly, whereas the range of motion of the operated hip was not compromised by the operation. A signiþcant increase in the mean scores, mainly caused by a decrease in pain, were observed in a subgroup of 20 patients with a minimum follow-up of 2 years. The most signiþcant factor predisposing poor outcome was grave preoperative arthrosis of the hip. Conclusions: This new technique of osteotomy is safe and less traumatic than previous methods, allowing early weight bearing and a fast recovery. The early clinical results are satisfactory

Since June 2002 15 hip autologous chondrocyte transplantations were arthroscopically performed for both acetabular roof and femoral head chondral defects. 15 Patients affected by chondral defect in the hip joint were treated with autologous chondrocyte transplantation. The mean follow up was 13.8 months (range 16 – 12 months) and the chondral defect was classified as 3rd – 4th degree, according to the Outerbridge’s classification. The defects were located on the acetabular roof in 12 cases, on the femoral head in 2 cases and on booths articular surfaces in 1 case. 9 patients were female and 6 male. The mean age was 40.7 years (from 52 to 22).In all cases the procedure was arthroscopically performed. A Bioseed C tissue was employed as a scaffold for chondrocytes, cultured in a tridimentional shape. A group of untreated 15 patients, matched for chondral defect degree, sex distribution and mean age was selected as control. All the Patients of both groups were pre and post operatively evaluated with the Harris Hip Score (HHS). Patients treated with hip autologous chondrocyte transplantation significantly improved after surgery (mean pre-op HHS 51.3; mean post-op HHS 85.3) compared with the untreated group (mean pre-op HHS 52.1; mean post-op HHS 64.5). Worst results were obtained in Patients affected by chondral defect located on the femoral head and when the joint space was reduced. Hip arthroscopy steel represent a new approach for treatment of hip’s disorders. Chondral defects of the hip can be treated with autologous chondrocyte transplantation, performed by hip arthroscopy. This study demonstrates the efficacy of this procedure compared with untreated patients

Background. Rotational acetabular osteotomy (RAO) is an effective treatment option for symptomatic acetabular dysplasia. However, excessive lateral and anterior correction during the periacetabular osteotomy may lead to femoroacetabular impingement. We used preoperative planning software for total hip arthroplasty to perform femoroacetabular impingement simulations before and after rotational acetabular osteotomies. Methods. We evaluated 11 hips in 11 patients with available computed tomography taken before and after RAO. All cases were female and mean age at the time of surgery was 35.9 years. All cases were early stage osteoarthritis without obvious osteophytes or joint space narrowing. Radiographic analysis included the center-edge (CE) angle, Sharp's acetabular angle, the acetabular roof angle, the acetabular head index (AHI), cross-over sign, and posterior wall sign. Acetabular anteversion was measured at every 5 mm slice level in the femoral head using preoperative and postoperative computed tomography. Impingement simulations were performed using the preoperative planning software ZedHip (LEXI, Tokyo, Japan). In brief, we created a three-dimensional model. The range of motion which causes bone-to-bone impingement was evaluated in flexion (flex), abduction (abd), external rotation in flex 0°, and internal rotation in flex 90°. The lesions caused by impingement were evaluated. Results. In the radiographic measurements, the CE angle, Sharp's angle, acetabular roof angle, and AHI all indicated improved postoperative acetabular coverage. The cross-over sign was recognized pre- and postoperatively in each case. Acetabular retroversion appeared in one case before RAO and in three cases after RAO. Preoperatively, there was a tendency to reduce the acetabular anteverison angle in the hips from distal levels to proximal. In contrast, there was no postoperative difference in the acetabular anteversion angle at any level. In our simulation study, bone-to-bone impingement occurred in flex (preoperative/postoperative, 137°/114°), abd (73°/54°), external rotation in flex 0°(34°/43°), and internal rotation in flex 90°(70°/36°). Impingement occurred within internal rotation 45°in flexion 90°in two preoperative and eight postoperative cases. The impingement lesions were anterosuperior of the acetabulum in all cases. Discussion. It is easy to make and assess an impingement simulation using preoperative planning software, and our data suggest the simulation was helpful in a clinical setting, though there were some remaining problems such as approximation of the femoral head center and differences in femur movement between the simulation and reality. In the postoperative simulation there was a tendency to reduce the range of motion in flex, abd, and internal rotation in flex 90°. There was a correlation between acetabular anteversion angle and flex. Since impingement occurred within internal rotation 45°in flexion 90°in eight postoperative simulations, we consider there is a strong potential for an increase in femoroacetabular impingement after RAO

[Introduction]. Total hip arthroplasty (THA) markedly improves pain, gait, and activities of daily living for most patients with osteoarthritis. However, pelvic osteotomy has been recommended for young and active patients with hip dysplasia, because THA in that population is associated with high rates of revision THA. The rotational acetabular osteotomy (RAO) of Ninomiya and Tagawa, and the eccentric rotational acetabular osteotomy of Hasegawa for hip dysplasia reportedly are successful in young and active patients. However, even after the surgery of RAO, osteoarthritis developed in some cases and leaded to the conversion to THA. The differences of bone quality of acetabulum have been reported between at the surgery of THA after RAO and at the surgery of primary THA. We should not discuss the results of these two THA equally. The purpose of this study is to report the results of THA after RAO. [Patients and Methods]. We retrospectively reviewed 33 patients (37 hips) treated by total hip arthroplasty after rotational acetabular osteotomy between 1992 and 2012. Five cases were performed RAO with valgus osteotomy. At the time of THA surgery, the overall mean age of the patients was 57.5 years (range, 39–72 years). The average of follow-up period was 7.0 years (range, 8–258 months). One surgeon (TT) evaluated the hips clinically using the Japanese Orthopaedics Association (JOA) score. The radiographic measurements were performed by the other physician (JY) blinded to the clinical scores. Radiographical examination was performed using AP X-ray. We evaluated the presence of osteolysis and loosening of the implants. We evaluated the stability of stem implants using Engh classification and of cup implants using Hodgkinson classification. [Results]. The cases of this study were converted to THA in an average 17.2 years after the surgery of RAO. JOA score was 55.7 points before THA and 86.7 points at the final follow-up. Osteolysis were found in five cases. Thirty-three cases showed good implant stability, but four cases showed fibrous union between cup and acetabulum. Three cases were converted to the revision THA due to fibrous union. All revision cases were acetabular side. [Discussion]. There were no reports about results of THA after RAO. Osteotomy should be considered for young patients because of the high rates of revision THA needed owing to prolongation of the average lifespan. McAuley et al reported the results of THA in patients 50 years and younger patients. They described the survival rates for femoral and acetabular components, using any revision as the end point, were 89% at 10-year followup and 60% at 15-year followup. Osteosclerosis of the acetabular roof bone should be careful in the case of THA after RAO. The cancellous bone could hardly be founded, even if the enough reaming was performed. Osteosclerosis may cause the difficulty in ingrowth of new bone into the implant, and lead to fibrous union between the acetabular roof bone and the implant. These two revision cases showed fibrous union before their THA. Primary fixation is very important in the case of THA after RAO. Primary fixation is very important in the case of THA after the RAO

Background: A retroverted acetabulum has been hypothesized as a cause of osteoarthritis. This study was performed to evaluate whether radiographical cross-over sign influence the painful femoro-acetabular impingement or the radiographical progression of osteoarhritis after rotational acetabular osteotomy (RAO) for dysplastic hip. Methods: Between 1987 and 1999, 104 patients (115 hips) who had pre- or early stage osteoarthritis of the hip due to dysplasia underwent a RAO. There were 99 women and five men; their mean age at the time of surgery was 34.7 years. The mean follow-up period was 13 years. Clinical follow-up was performed with use of the system of Merle d’Aubigne and the impingement sign was evaluated. Radiographical analyses included measurements of the center-edge angle, acetabular roof angle, head lateralization index, joint congruency, cross-over sign, posterior wall sign, acetabular index of depth to width, pistol grip deformity and femoral head-femoral neck ratio. Results: The mean clinical score improved significantly from 14.6 preoperatively to 17.0 at follow-up. The impingement sign at the follow-up was observed in 14 hips (12.2%). The center-edge angle improved significantly from mean −0.6 degrees to a postoperative mean of 34 degrees. The acetabular roof angle improved from 30 degrees to 2.2 degrees, and head lateralization index from 0.64 to 0.60. The cross-over sign was observed in 8 hips (7.0%) preoperatively and in 49 hips (42.6%) postoperatively. The posterior wall sign was observed in 70 hips (60.9%) preoperatively and observed in 73 hips (63.5%) postoperatively. The mean preoperative acetabular index of depth to width was 35.5% and the mean preoperative femoral head to femoral neck ratio was 1.49. The pistol grip deformity was observed in only 4 hips (3.5%) preoperatively. The impingement sign after the RAO was positive significantly in the postoperative cross-over sign positive hips (p=0.0074). Radiographical progression of osteoarthritis was observed in 11 hips (cross over sign positive; 7 hips, cross over sign negative; 4 hips). The Kaplan-Meier survivorship analysis predicted a survival rate of 84.6 % at 15 years. The only factors significantly associated with radiographic signs of progression of osteoarthritis after RAO were fair (rather than excellent and good) postoperative joint congruency (p< 0.0001) and age at surgery (p=0.0042). Presence of postoperative cross-over sign had no effect on the outcome (p=0.2073). Conclusions: Although there was no significant radiographical progression of osteoarthritis despite a significant retroversion in most cases, the goal of RAO should be a correct alignment of the acetabulum including a correct version with a negative cross-over sign

The ultimate goal of surgery for acetabular fractures is hip joint preservation for the rest of the patient’s life. However, besides Letournel’s series, long term survi-vorship in this predominantly young patient group has never been published in a very large series. The aim of this study was to determine the cumulative 20-year sur-vivorship of the hip after fixation of acetabular fractures and to identify factors predicting the need for total hip arthroplasty. A Kaplan-Meier survivorship analysis of 1218 consecutive surgically treated acetabular fractures was carried out. 816 fractures were available for analysis with a mean follow up of 10.3 years (range 2–29 years). All the surgeries were performed by a single surgeon in accordance to an established treatment protocol based on Letournel’s principles. Inclusion criteria were a minimum follow-up of two years or failure at any time. Failure was defined as conversion to total hip arthroplasty of hip arthrodesis. A Cox-regression analysis identified significant risk factors predicting the need for total hip arthroplasty. Analyzed parameters comprised data on patient history, preoperative clinical examination, associated injuries, fracture pattern, radiographic and intra-operative features, and the accuracy of reduction. The cumulative 20-years survivorship was 79% (95% CI, 76–81%). Statistically significant factors influencing the need for artificial hip replacement/arthrodesis were: age over 40 years (Hazard ratio [HR] 2.4), femoral head damage (HR 2.6), acetabular impaction (HR 1.5), postoperative incongruence of the acetabular roof (2.9), involvement of the posterior wall (HR 1.6), anterior dislocation (5.9), initial displacement > 20mm (HR 1.6), and a malreduction with residual displacement > 1mm (HR 3.0). There was a significantly different survivorship of the individual fracture types. The worst survivorship occurred in anterior wall fractures (34% at 20 years) and the best survivorship in both column fractures (87% at 20 years). The accuracy of reduction improved significantly over time. In summary, the hip joint can be successfully preserved and prosthetic replacement avoided in 79% of displaced acetabular fractures at 20 years. Many of the factors influencing the long term prognosis are already determined at the time of injury. The factors that can be influenced by the surgeon are anatomic reduction, achievement of congruency of the acetabular roof and correction of marginal impaction. The presented unique results even exceed Letournel’s series in size and follow up. Therefore, they provide benchmark data for any type of comparative evaluation studies dealing with surgical treatment of acetabular fractures in future

The purpose of this study is to determine how the lateral shape of the acetabulum changes during Perthes disease and if there is any correlation between the lateral acetabulum shape and final result and type of treatment. The study population consisted of 243 patients with unilateral involvement who had reached skeletal maturity at last follow up. There were 35 (14.4%) female and 208 (85.6%) male patients. The mean age at the onset of symptoms was 7 years and 1 month. AP X-ray films were estimated during fragmentation, reossification and last follow up. Group A consisted of 56 hips, 126 hips were classified as group B and 61 hips as group C according to the Herring classification. For the lateral acetabular shape we proposed a classification: group A – a normal concave acetabular roof, group B – a horizontal flat roof and group C – a roof convexly rounded and up going. All hips were treated by containment methods (bed rest and traction in abduction-78 hips, Petri cast-31 hips, brace-94 hips, varus osteotomy-20 hips, Salter oste-otomy-12 hips and shelf arthroplasty-8 hips). The outcomes of treatment were evaluated according to the Stulberg classification. During fragmentation stage we found 78 (32.1%) hips with normal lateral acetabular shape-type A. Horizontal roof-type B was noted in 136 (56%) hips and in 29 (11.9%) type C was observed. We observed improvement in the shape of lateral acetabulum after treatment. At the last follow up there were 124 (51%) hips with type A, 81 (33.3%) with type B and 38 (15.7%) with type C. Statistical analysis revealed significant correlation between lateral acetabular shape and Stulberg classification. A normal concave acetabular roof at the fragmentation stage leaded mainly to Stulberg group 1and 2 whereas a roof convexly rounded and up going leaded to Stulberg group 3, 4 or 5 (p< 0.0001). Analysis showed no statistical significant correlation between treatment by using bed rest and traction in abduction, Petri cast, braces and development the lateral acetab-ular shape (p=0.09). Only treatment by using surgical methods improved the lateral acetabular shape at the last follow up (p=0.0015). The acetabulum is a mould for remodeling of the deformed femoral head in Perthes disease and the lateral acetabulum plays the most important role. We can expect that normal shape of the acetabulum gives good result at final follow up whereas a roof convexly rounded usually follows to Stulberg group 3, 4 or 5. Only surgical treatment improves the shape of the acetabulum

Adolescent and young adult patients with a history of DDH and residual hip dysplasia tend to have an early presentation of symptoms. In these patients, a severe acetabular dysplasia, aspheric femoral head and/or high greater trochanter are often observed. We evaluated the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients younger than 21 years. We performed 492 RAOs for hip dysplasia from 1987 to 2017. In these cases, patients younger than 21 years at the time of surgery were 40 patients (46 hips). We evaluated 34 patients (40 hips, follow-up rate; 85%) retrospectively. There were 32 females and two males; their mean age at the time of surgery was 17.8 years (12–21). The mean follow-up period was 16.8 years (1–30). In eight hips, isolated RAO was not adequate to correct instability and/or congruency. For these hips, four varus femoral osteotomies, two valgus femoral osteotomies and two greater trochanter displacement were combined with RAO. The mean clinical score (JOA) was improved from 80 to 90 significantly at the final follow-up. The mean CE angle was improved from −3.4 (−35–10) degrees to 27 (8–42) degrees, acetabular roof angle from 30 (15–60) degrees to 6.7 (−3–30) degrees, head lateralization index from 0.665 (0.5–1.0) to 0.614 (0.429–0.7) postoperatively. Radiographic OA progression was observed in four hips, but no hip was converted to THA. The RAO is an effective technique for surgical correction of a relatively severe dysplastic hip in adolescent and young adults

Tannast has recently shown that safe hip dislocation (SHD) for femoroacetabular impingement treatment does not result in atrophy and degeneration of periarticular hip muscles. In more complex procedures, such as relative neck lengthening for Perthes disease (PD) or modified Dunn procedure for slipped capital epiphysis (SCFE), minimus gluteus femoral insertion is detached to achieve enough mobility of osteotomized trochanter and to fix the latter more distally. Aim of this study was to evaluate MRI appearance of minimus and medius gluteus after relative neck lengthening. Patients treated with SHD and relative neck lengthening eventually associated to epiphyseal realignment for PD or SCFE treatment underwent magnetic resonance imaging (MRI) to study gluteus minimus (MI) and medius (ME) muscles. In the axial T1-weighted sequences, cross sectional area (CSA) and signal intensity were evaluated at acetabular roof level. Statistical comparison was made with the opposite healthy side. Fifteen patients underwent an MRI at an average of 59 months (SD=27.3) after surgery. Average ratio between gluteus minimus CSA (treated/healthy side) was 0.90 (SD=0.2): this reduction in volume was statistically significant (p=0.04) as well as the signal intensity (p=0.04). CSA and signal intensity of gluteus medius did not differ between two sides (respectively p=0.78 and p=0.30). In conclusion, gluteus medius appearance was not influenced by distal fixation of the trochanter. The minimus gluteus was reduced in volume as much as 10% in respect to healty side; increased signal intensity in MRI T1-weighted (fatty infiltration) was found in the minimus gluteus