Aims. Pelvic incidence (PI) is considered an important anatomical parameter for determining the sagittal balance of the spine. The contribution of an abnormal PI to hip osteoarthritis (OA) remains controversial. In this study, we aimed to investigate the relationship between PI and hip OA, and the difference in PI between hip OA without anatomical abnormalities (primary OA) and hip OA with developmental dysplasia of the hip (DDH-OA). Methods. In this study, 100 patients each of primary OA, DDH-OA, and control subjects with no history of hip disease were included. CT images were used to measure PI, sagittal femoral head coverage, α angle, and acetabular anteversion. PI was also subdivided into three categories: high PI (larger than 64.0°), medium PI (42.0° to 64.0°), and low PI (less than 42.0°). The
Purpose. Patients with acetabular dysplasia demonstrate altered biomechanics during gate and other activities. We hypothesized that these patients exhibit a compensatory increase in the anterior pelvic tilt during gait. Materials & Methods. Twelve patients were included in this prospective radiographic and gait analysis study prior to the PAO. All were women. The mean age was 27 years (+/− 8 yrs). Tonnis grade was zero in nine, and one in three hips. All patients performed multiple one-minute walking trials on the level, the incline, and the decline treadmill surfaces in an optical motion capture lab. Anterior pelvic tilt is reported in (+), while the posterior pelvic tilt is reported in (–) values. Results. Radiographic Data. : The mean alpha angle measured from the Dunn and the frog lateral images was 63.0º±17.4, and 54.7º±16.4, respectively. The mean LCEA was 14.9°±6.1, and the mean
Introduction. Radiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) is of paramount importance. Plain radiographic examination is time and resource intensive. Fluoroscopic based assessment is increasingly utilized but can introduce distortion. Our purpose was to determine the correlation of intraoperative fluoroscopy-based measurements with a fluoroscopic tool that corrects for distortion with postoperative plain-film measurements. Methods. We performed a prospective validation study on 32 PAO's (28 patients) performed by a single academic surgeon. Preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs were evaluated with lateral center edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and
Topic. Utilizing radiographic, physical exam and history findings, we developed a novel clinical score to aid in the surgical decision making process for hips with borderline/ transitional dysplastic hips. Background. Treatment of borderline acetabular dysplasia (BD) is controversial with some patients having primarily instability-based symptoms while others have impingement-based symptoms. The purpose of this study was to identify the most important patient characteristics influencing the diagnosis of instability vs. non-instability, develop a clinical score (Borderline Hip Instability Score, BHIS) to collectively characterize these factors and to externally validate BHIS in a multicenter cohort BD patients. Methods. First a retrospective cohort of 186 hips undergoing surgical treatment of BD (LCEA 20°-25°) from a single surgeon experienced in arthroscopic and open techniques was used. Multivariate analysis determined characteristics associated with presence of instability (PAO+/−hip arthroscopy) or absence of instability (isolated hip arthroscopy) based on clinical diagnosis. During the study period, 39.8% of the cohort underwent PAO. Multivariate analysis with bootstrapping was performed and results were transformed into a BHIS nomogram (higher score representing more instability). Then, BHIS was externally validated in 114 BD patients enrolled in a multicenter prospective cohort study across 10 surgeons (with varied treatment approaches from arthroscopy to open procedures). Results. The most parsimonious, best fit model included 4 variables associated with the diagnosis of instability: acetabular inclination (AI),
Introduction. The outcome of periacetabular osteotomy in dysplastic hips is dependent on the absence of pre-operative osteoarthritis [OA]. The purpose of this study was to analyze whether Tonnis grading is a reliable predictor of OA in patients with hip dysplasia. Methods. Thirty patients were identified who had undergone hip arthroscopy surgery to assess their suitability for periacetabular osteotomy. Radiographs were assessed for
Purpose. Periacetabular osteotomy (PAO) is a versatile acetabular reorienting procedure that is most commonly used to provide greater femoral head coverage in adolescent hip dysplasia. However, PAO can also be used to reorient the acetabulum in the opposite direction to treat femoroacetabular impingement (FAI) due to acetabular over-coverage. We describe the indications, surgical technique, and early results of reverse PAO to reduce femoral head coverage in symptomatic hips with FAI due to acetabular over-coverage. Methods. IRB approval was obtained to retrospectively review cases of symptomatic acetabular over-coverage treated with reverse PAO and that had a minimum of two years follow-up. All hips had atypical intraoperative positioning of the acetabular fragment to uncover the lateral and anterior aspects of the femoral head, with or without anteverting the acetabulum. Prospectively collected pre- and post-operative demographics, WOMAC scores, Modified Harris Hip Score (MHHS), and radiographic measurements consisting of the lateral center edge angle (LCEA), Tönnis angle (TA), and
The outcome of periacetabular osteotomy in dysplastic hips is dependent on the absence of preoperative osteoarthritis [OA]. The purpose of this study was to analyze whether Tonnis grading is a reliable predictor of OA in patients with hip dysplasia. Thirty patients were identified who had undergone hip arthroscopy surgery to assess their suitability for periacetabular osteotomy. Radiographs were assessed for
Introduction. The aim of this study was to compare patient reported outcomes, radiographic measurements, and survival free from total hip arthroplasty (THA) in patients who underwent periacetabular osteotomy (PAO) for mild, moderate, or severe developmental dysplasia of the hip (DDH). Methods. We performed a retrospective cohort study on all patients (n=223, n=274 hips) who underwent a PAO procedure between May 1996 and May 2016, by a single surgeon at one academic center. Cases with a history of retroversion (n=64), Perthes (n=5), and those with <2 years of follow-up (n=63) were excluded. Patients were evaluated based on severity of dysplasia using the preoperative lateral center edge angle (LCEA): 18° – 25° was considered mild dysplasia (n=19), 10° – 17° moderate (n=62), and <10° severe (n=61). There was no difference in patient characteristics (age, sex, body mass index, or ASA score) between then cohorts (all, p>0.05). NIH PROMIS outcome measures included the physical function computerized adaptive test (PF CAT) and the Global 10 health assessment. Generalized estimating equations were used for all comparisons and missing data was imputed using the multivariate imputation by chained equations method. A Kaplan-Meier analysis was used to assess survival. Failure was defined as conversion to THA and follow-up was ended at time of failure or at the time of last follow-up. Mean follow-up was five years (1 – 19). Results. Using the mild group as a reference, there was no difference in the PF CAT T-scores for moderate (p=0.167) or severe (p=0.910) dysplasia. These findings were similar for the Global physical and Mental Health T-scores (all, p>0.05). These outcomes were all within ½ of the standard deviation of the US general population (T-Score 50, SD 10) and demonstrate an average level of function or health. There was no difference in the numeric pain scores at last follow-up (all, p>0.05), with scores of approximately 2 – 3 units. There was no difference (all, p>0.05) in the proportion of patients achieving the correction goal for the LCEA (20° – 40°) where 95% (95% CI, 85% – 105%) of the mild group, 95% (95% CI, 90% – 100%) of the moderate group, and 76% (95% CI, 65% – 87%) in the severe group achieved this goal. The average amount of correction was roughly 12° (9° – 15°) in the mild, 15° (13° – 16°) in the moderate (p=0.185), and 23° (21° – 25°) in the severe group (p<0.001). The post-operative
Aims: A retrospective review of all periacetabular osteotomies (PAO) performed at a general elective orthopaedic Hospital over a 7-year period. To assess the clinical, functional and radiographic outcome associated with PAO when introduced as a new procedure to a non-super-specialised regional centre. Methods: A retrospective review of 85 PAOs performed on 79 patients at Cappagh Hospital between 1/4/1998 and 1/4/2005. The medical records and radiographic images of all patients were reviewed. Clinical follow-up evaluations were also performed. Results: 85 PAOs were performed on 79 patients. Mean age at time of surgery was 22.9 years (range, 14–41 years) with an increased preponderance of females (F:M=10:1) and right sided hip involvement (R:L=1.1:1). The mean Merle D’Aubigne and Postel hip score increased from 12.4 (range 9–14) preoperatively to 16 (range 11–18) postoperatively (P<
0.0001). The average lateral center edge angle increased from 5° preoperatively to 26° postoperatively (P<
0.0001). The
The purpose of this study was to review the early results of a consecutive series of patients undergoing periac-etabular osteotomy (PAO) at Cappagh National Orthopaedic Hospital. The procedure was first carried out in 1998, and a total of 85 PAOs have been performed in 79 patients. The mean follow-up was 42 months (range 6-84 months). There were 72 females and 7 males with a mean age at the time of the operation of 22.9 years (range, 14-41 years). The preoperative diagnosis was developmental hip dysplasia in 80 hips, Legg-Calve-Perthes disease in one hip, congenital coxa vara in three hips, and slipped capital femoral epiphysis in one hip. The average Merle d’Aubigne score increased from 12.4 points preoperatively to 16 points at latest followup. The lateral center edge angle of Wiberg was between – 20 and +28 before surgery and was improved from 12 to 48 (average 30 degrees) following PAO. While, the
The role of femoral and acetabular version in correction of dysplasia of the hip has been undereported. Between June 1995 and September 2000, a Bernese periacetabu-lar osteotomy (BPO) was performed in 25 patients (26 hips) by the senior author with an average follow-up of 3.7 years (range 2-5 years). The mean age of the patients (24 female, 1 male) at the time of surgery was 29.4 years (range, 11.5 to 45 years). Only patients with a primary diagnosis of acetabular dysplasia were included in this series. The average Harris hip score increased from 55.1 (range 34–75) preoperatively to 92.9 (range 72–100) at the latest follow up (p<
0.0001). The mean pre-operative Merle d’Aubign score increased from 13.5 (range 10–15) to 17 (range 15–18) at the latest follow up. The mean lateral centre edge angle of Wiberg increased from 13.10 (range 00–200) pre-operatively to 52.60 (range 200-740) at latest follow-up (p<
0.0001). The
Management of symptomatic residual acetabular dysplasia in adolescence and early adulthood remains a major therapeutic challenge. At our unit the two senior authors review all patients preoperatively and simultaneously perform each procedure. In the four years from 1998 forty-three Bernese osteotomies were performed in 40 patients with residual acetabular dysplasia. The mean average age at surgery was 21 years (range 12 – 43 years) and there were 34 female patients. The indication for surgery was symptomatic hip dysplasia (all idiopathic but for one male with a history of slipped capital femoral epiphysis) presenting with pain and restricted ambulation. 4 patients had previous surgery on the affected hip (2 Salter’s osteotomy, one Shelf procedure and one proximal femoral osteotomy). 27.5% of patients had symptomatic bilateral disease. 42% of patients had Severin class IV or V dysplasia at presentation. 100% of patients had preservation of the hip joint at last follow-up evaluation (mean 2.4 years), with excellent results in 82%, an average post-operative Harris hip score of 96, and an average d’Aubigne hip score of 16.1. The mean post-operative improvements in radiographic measures were as follows:
Management of symptomatic residual acetabular dysplasia in adolescence and early adulthood remains a major therapeutic challenge. At our unit the two senior authors review all patients preoperatively and simultaneously perform each procedure. In the four years from 1998 forty-three Bernese osteotomies were performed in 40 patients with residual acetabular dysplasia. The mean average age at surgery was 21 years (range 12 – 43 years) and there were 34 female patients. The indication for surgery was symptomatic hip dysplasia (all idiopathic but for one male with a history of slipped capital femoral epiphysis) presenting with pain and restricted ambulation. 4 patients had previous surgery on the affected hip (2 Salter’s osteotomy, one Shelf procedure and one proximal femoral osteotomy). 27.5% of patients had symptomatic bilateral disease. 42% of patients had Severin class IV or V dysplasia at presentation. 100% of patients had preservation of the hip joint at last follow-up evaluation (mean 2.4 years), with excellent results in 82%, an average post-operative Harris hip score of 96, and an average d’Aubigne hip score of 16.1. The mean post-operative improvements in radiographic measures were as follows:
Acetabular dysplasia is the most common cause of secondary osteoarthritis of the hip joint resulting in many young adults requiring total hip replacement (THR). Although THR has a predictably good functional result, the longevity of prosthetic replacement in this young cohort of patients has been notably inconsistent. Therefore, there has been an increasing interest in better methods for treating acetabular dysplasia in young adults with the emphasis shifting from the femoral to the acetabular side during the last 10 years. For reorientation of the acetabular fragment to improve coverage, various pelvic and periacetabular osteotomies have been proposed. Most necessitate more than one incision and change of patient position. The Bernese periacetabular osteotomy (PAO) combines complete and incomplete osteotomies, as well as a controlled fracture requiring only one approach. This is beneficial for the vascular supply of the acetabular fragment and allows an additional anterior capsulotomy without restrictions. The osteotomies of the PAO are close to the joint and therefore allow a pronounced acetabular reorientation similar to juxta-articular triple osteotomies. Moreover, anteversion and medialization/lateralization of the center of rotation can be corrected with only minimal changes of the pelvic geometry. This enables a normal delivery in young females. The partially remaining posterior column protects the sciatic nerve from iatrogenic damage. The polygonal shape of the osteotomy and avoidance of soft tissue stripping (abductors) are advantageous for the stabilization of the reoriented fragment, thus facilitating early mobilization and rehabilitation. Seventy-five dysplastic hips with a minimal follow-up of 10 years after PAO were evaluated. There were good to excellent result in 73% of these patients. The mean lateral center edge angle increased from 6° to 34° and the mean
We assessed the long-term outcomes of a large cohort of patients who have undergone a periacetabular osteotomy (PAO), and sought to validate a patient satisfaction questionnaire for use in a PAO cohort. All patients who had undergone a PAO from July 1998 to February 2013 were surveyed, with several patient-reported outcome measures (PROMs) and radiological measurements of preoperative acetabular dysplasia and postoperative correction also recorded. Patients were asked to rate their level of satisfaction with their operation in achieving pain relief, restoration of activities of daily living, ability to perform recreational activity, and their overall level of satisfaction with the procedure.Aims
Methods
Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies. In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD.Aims
Methods
Cam type femoroacetabular impingement (FAI) is due to an aspheric femoral head, which is best quantified by the alpha angle described on MRI and CT-scan. Radiographic measurement of the alpha angle is not well codified and studies from the literature cannot conclude on the best view to measure it. Most authors also describe a mixed type FAI which associates an aspheric femoral head with an excessive anterior acetabular coverage of the femoral head.
The aim of the current study was to assess the reliability of the Ottawa classification for symptomatic acetabular dysplasia. In all, 134 consecutive hips that underwent periacetabular osteotomy were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior, or posterior. A total of 74 cases were selected for reliability analysis, and these included 44 dysplastic and 30 normal hips. A group of six blinded fellowship-trained raters, provided with the classification system, looked at these radiographs at two separate timepoints to classify the hips using standard radiological measurements. Thereafter, a consensus meeting was held where a modified flow diagram was devised, before a third reading by four raters using a separate set of 74 radiographs took place.Aims
Methods