Acetabular Dysplasia

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Focal concavity of posterior superior acetabulum and its relation with acetabular dysplasia and retroversion in adults without advanced hip osteoarthritis

Focal concavity of posterior superior acetabulum and its relation with acetabular dysplasia and retroversion in adults without advanced hip osteoarthritis

Methods: Consecutive adult patients with hip pain who visited our hospital and had three-dimensional pelvic CT images were retrospectively analyzed after approval of the institutional review board; exclusion criterions included diseases, injuries and operations that affect the morphology of the hip including radiographic osteoarthritis Tönnis grades 2 and 3. Focal concavity of posterior superior acetabulum was evaluated by three-dimensional CT image. Acetabular dysplasia was determined by lateral center edge (LCE) angle <25°, Tönnis angle >10°, and anterior center edge (ACE) angle <25° on standing hip radiographs. Acetabular version angle was measured at the one- fourth cranial level of axial CT image. A subgroup analysis included only younger adult patients up to 50 years. Results: The subjects analyzed were 46 men (92 hips) and 54 women (108 hips) with a median age of 57.5 (21 – 79) and 51.0 (26 – 77) years, respectively. Focal concavity of posterior superior acetabulum was observed in 13 hips; 7 patients had unilaterally, while 3 patients showed bilaterally. Among these hips, pain was observed in 8 hips but 4 hips (2 patients) were associated with injuries. This morphologic abnormality was not associated with acetabular dysplasia determined by LCE angle <25°, Tönnis angle >10° or ACE angle <25°. Of note, no acetabulum with the deformity plus dysplasia was retroverted. These findings were confirmed in a subgroup analysis including 22 men (44 hips) and 27 women (54 hips) with a median age of 31.0 (21 – 50) and 41.0 (26 – 50) years, respectively.
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Prevalence and characteristics of cam-type femoroacetabular deformity in 100 hips with symptomatic acetabular dysplasia: a case control study

Prevalence and characteristics of cam-type femoroacetabular deformity in 100 hips with symptomatic acetabular dysplasia: a case control study

A few studies have examined whether development of secondary FAI after acetabular reorientation is one of the major causes of clinical failure [12,13,36,37]. Troelsen et al. [36] reported an 81.6% survivorship rate at a mean of 9.2 years after periacetabular osteotomy, with 14% of hips requiring total hip replacement at a mean of 6.8 years. Of the surviving hips, 34% had groin pain, 25% had clicking or locking and 18% had a positive im- pingement test. Despite the overall good results, these symptoms raise the issue of residual FAI as a potential contributing factor to clinical failure. Nassif et al. [37] reported that periacetabular osteotomy provides relia- ble intermediate and long-term results for patients with Table 3 Lateral whole-spine radiographic evaluations in the acetabular dysplasia (AD) only and AD + cam-type
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Modified triple pelvic osteotomy for adult symptomatic acetabular dysplasia: clinical and radiographic results at midterm follow-up

Modified triple pelvic osteotomy for adult symptomatic acetabular dysplasia: clinical and radiographic results at midterm follow-up

The limitations of the present study include its retrospective design, relatively small number of patients, and inherent difficulties in retrieving complete data. Moreover, radiographic measurements may vary from one observer to another, introducing a significant uncontrolled variable. In this study, no hip procedures were converted to total hip arthroplasty at a mean follow-up of 8.93 years, which was considered a relatively short follow-up period. The long-term clinical results of the procedure remain unknown, and further studies with longer follow-up periods are required to clarify this. However, we believe that our data provided evidence that our modified triple pelvic osteotomy can effectively delay the progression and exacerbation of symptomatic acetabular dysplasia.
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Factors associated with diagnostic stage of hip osteoarthritis due to acetabular dysplasia among Japanese female patients: a cross sectional study

Factors associated with diagnostic stage of hip osteoarthritis due to acetabular dysplasia among Japanese female patients: a cross sectional study

These results were mainly derived from Western coun- tries, where the aetiology of hip OA is mostly primary OA. To date, no previous study have reported the associ- ation between obesity and hip OA in Japan, where the aetiology and background characteristics of hip OA are different from Western countries. In Japan, the majority of hip OA was caused by acetabular dysplasia, whereas only about 10 % of patients were primary OA. Besides, fe- male patients accounted for about 90 % [15, 16]. We therefore targeted Japanese female patients with secondary hip OA due to acetabular dysplasia, and examined the as- sociated factors with OA staging at diagnosis, in special reference to body weight. The present study focused on the weight after age 20, when complete closure of the growth plate in the hips has usually occurred, and investi- gated the association of weight at age 20, the current weight, and weight change on the risk of severer disease stage at diagnosis.
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Mild acetabular dysplasia and risk of osteoarthritis of the hip : a case control study

Mild acetabular dysplasia and risk of osteoarthritis of the hip : a case control study

control group appears to be real, although it is possible that mea- surement error/variability could be responsible. The dominant side of participants is another plausible explanation, although hip dysplasia did not differ between those in the control group with right or left handedness. Our criteria for dysplastic CE angles were very close to the 25° threshold used in many studies, and we also included data using a 20° threshold for comparison pur- poses. Interestingly, the 20° threshold excluded almost all control hips, suggesting that it is either extremely specifi c for dysplasia or may exclude positives. This resulted in variable ORs during univariate analysis, which are unlikely to be reliable. Instead, the thresholds closer to 25° were superior for calculating risks. The criteria we used for acetabular dysplasia were considerably less than the 9 mm standard used in other studies, but both yielded similar fi ndings. The use of the standard thresholds of 25° for CE angle and 9 mm for AD appear to be justifi ed, and their use in future studies seems appropriate.
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Multiplanar evaluation of radiological findings associated with acetabular dysplasia and investigation of its prevalence in an Asian population: a CT based study

Multiplanar evaluation of radiological findings associated with acetabular dysplasia and investigation of its prevalence in an Asian population: a CT based study

Acetabular dysplasia (AD) is a well-known cause of osteoarthritis (OA) of the hip [1, 2]. The morphological abnormalities associated with AD result in instability of the hip joint, leading to labral tears, cartilage degener- ation, and development of OA. AD is the most common cause of hip OA, especially in Asian countries [3, 4]. The parameters employed for diagnosing AD on the cor- onal plane are the center–edge (CE) angle [5], Sharp angle [6], acetabular index [7], acetabular depth ratio (ADR) [8], and acetabulum head index (AHI) [9]. The anterior (AASA) and posterior (PASA) acetabular sector angles [10] are used to diagnose AD on the axial plane, and the vertical-center-anterior margin (VCA) angle [11] is used to diagnose AD on the sagittal plane. Although the prevalence of AD has been reported using hip joint radiography, pelvic radiography, or urography, it has been discussed only in terms of the coronal plane. Umer et al. [12] reported that the prevalence of AD was 7.3% (CE angle <20°) using pelvic radiography in a patient- based Asian population.
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Evaluation of radial distribution of cartilage degeneration and necessity of pre contrast measurements using radial dGEMRIC in adults with acetabular dysplasia

Evaluation of radial distribution of cartilage degeneration and necessity of pre contrast measurements using radial dGEMRIC in adults with acetabular dysplasia

Delayed gadolinium-enhanced magnetic resonance im- aging of cartilage (dGEMRIC) is a minimally invasive technique to assess the biochemical properties of articu- lar cartilage. The intravenously injected anionic contrast agent gadopentetate (Gd-DTPA 2- ) distributes in cartilage inversely to the concentration of negatively charged gly- cosaminoglycans (GAGs). GAGs provide cartilage with its compressive stiffness and are lost early during devel- opment of OA [11]. The dGEMRIC technique has been shown to be useful for assessing cartilage integrity in dysplastic hips by using coronal T1 mapping sequences [10,12]. The radial dGEMRIC is obtained by radial refor- mation from a 3D data set using dual flip angle T1 map- ping sequence. Compared to conventional coronal T1 mapping, the radial dGEMRIC provides radial reformat- ted slices rotating from anterior to posterior perpendicu- lar to the acetabular rim, allowing evaluation of the cartilage status in various radial regions of the entire hip joint. Distribution of the T1 dGEMRIC values measured using radial dGEMRIC have been found to be unique in different sub-groups of femoroacetabular impingement (FAI) [13]. These patterns of cartilage degeneration, reflected by the radial dGEMRIC index, have not yet been fully investigated on dysplastic hips at different stages of secondary OA.
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Early gait analysis after curved periacetabular osteotomy for acetabular dysplasia

Early gait analysis after curved periacetabular osteotomy for acetabular dysplasia

There have been no reports on gait function after surgery in patients treated with CPO, and the recovery process for temporospatial factors, such as postoperative gait velocity and st[r]

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Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis

Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis

This study has several limitations. First, as a numerical simulation investigation, FEA has its inherent limitations such as simplified treatment in the material properties and loading and boundary conditions, which may have some impact on the analytic results. Using similar experimental conditions, the numerical predictions were successfully corroborated against the results from a cadaveric experiment [25], which validated the FE model for this study. Second, only the loading condition of a single-legged stance was investigated in this study. Therefore, the effect of PAO on stress distribution in articular cartilage in loading conditions of other daily activities and other phase of the entire gait cycle could not be evaluated, and this is the focus of our future research. Third, only three subjects were studied; the sample size in this study was relatively small. Further investigations would include more subjects with differ- ent severities of dysplasia. Fourth, we did not consider the proximal femoral deformities in the analysis in this study. It is true that not only the correction of acetabu- lar fragment but also the proximal femur influences the mechanical transmission in the hip joint. However, there are only a few DDH patients accompanied by proximal femoral deformities, especially for those mild and moderate DDH. Therefore, we focused on the effect of different severities of acetabular dysplasia on mechanical transmission in the hip joint in this study.
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Ultrasound Screening for Developmental Dysplasia of the Hip in the Neonate: The Effect on Treatment Rate and Prevalence of Late Cases

Ultrasound Screening for Developmental Dysplasia of the Hip in the Neonate: The Effect on Treatment Rate and Prevalence of Late Cases

All the infants with late dis- covered acetabular dysplasia in the general screening group and two of the three in the selectively screened group were judged normal on ultrasound examina[r]

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Morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures—a nested case-control study

Morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures—a nested case-control study

The specific risk factors for dislocation have not yet been identified but generally can be classified into patient factors, surgical factors, and morphological factors. Patient factors (history of neurological disease and weakness of abduction muscles), morphological factors (center-edge angle, femoral neck offset, and leg length discrepancy), and surgical factors (surgery approach, choice of pros- thesis, and repair of the short external rotator tendons) were reported to play an important role in dislocation after bipolar hemiarthroplasty [9–12]. Adanir et al. re- ported measurements such as the center-edge angle and acetabular depth (which evaluated the shallowness of the acetabulum) were used to assess acetabular dysplasia [13], but the relationship between these measurements and dis- location after bipolar hemiarthroplasty for patients with- out acetabular dysplasia remained unclear. In the current study, we explored the morphological risk factors for dis- location after bipolar hemiarthroplasty.
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Morphology of Acetabulum and Femoral Head Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

Morphology of Acetabulum and Femoral Head Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

We performed a retrospective examination of pre- and postoperative radiographs on 24 hips in 23 patients, which included 22 females and 1 male, who were underwent acetabular osteotomy. We have improved and changed surgical procedure since 2009. Therefore, osteotomy was performed on 10 hips with RAO and 14 hips with CPO between December 2004 and December 2012. Osteotomy was performed with the RAO from De- cember 2004 to February 2009, and with the CPO from February 2009 to December 2012. The mean age of these patients upon presentation was 30.8 years (ranged 19 to 44 years). Minimum follow up periods are 2 years after surgery. The Tönnis classification was used to grade the extent of OA [13] [14]. Six hips had grade 0, and eighteen hips had grade 1 OA according to the Tönnis classification system. We excluded patients with mod- erate and severe hip osteoarthritis (Tönnis grade 2 and 3) and major femoral head deformities such as typical capital drop deformity, Perthes’ disease, or slipped capital femoral epiphysis (SCFE). All of the patients includ- ing in this study were diagnosed with dysplasia. The surgical indications for RAO and CPO included sympto- matic acetabular dysplasia under the age of 45˚, a lateral center-edge (CE) angle of less than 20˚ and a Sharp an- gle of greater than 45˚ on anteroposterior (AP) radiographs (Figure 1), and the improvement of joint congruency on an AP radiograph in the abducted position. The radiological assessment of potential cam-type deformity was based on the measurement of the alpha angle on the cross-table lateral view. It was measured by first drawing the best fitting circle around the femoral head, then a line through the center of the neck and the center of the head. From the center of the femoral head a second line was drawn to the point where the superior surface of the head-neck junction first departs from the circle. The angle between these two lines is the alpha-angle (Figure 2). Several studies have defined the upper limit of normal for the alpha angle as being 50.5 ˚ [1] [15], and we ap- plied the cut-off angle of more than 50.5 ˚ to define cam impingement deformity [1]. On the AP pelvic radio- graph, Sharp angle, CE angle, crossover sign, and posterior wall sign [16] (Figure 3) were evaluated. Acetabular retroversion was defined as the presence of a crossover sign [16]-[18].
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Coverage of Femoral Head at Weight Bearing Interface of the Hip Joint in Children: An MRI Analysis

Coverage of Femoral Head at Weight Bearing Interface of the Hip Joint in Children: An MRI Analysis

Congruence of articulating surface of the hip joint at each weight-bearing position was observed in all cases. Mar- gin of bony acetabulum was hard to identify for irregu- lar ossification at the rim in some cases. Of 190 hip joints, clear margin of bony acetabulum was seen in 172 hip joints (90.53%). Cartilage surface of the joints was clear- er with regular shape. Clear margin of cartilage acetabu- lum was seen in 188 hip joints (98.95%). Acetabular la- brum was clearly identified in 180 hip joints (94.74%). Of all cases, clear display of anatomical structures in- cluding margin of both bony and cartilage acetabulum and the labrum were shown in 158 hip joints (83.16%).
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Study of acetabular erosion and activity level after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years

Study of acetabular erosion and activity level after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years

Measurement of acetabular erosion: The effect of pelvic rotation on common landmarks. R.G. Wetherel, A.A. Amis, F.W. Heatley from London state that the line drawn between acetabular margins are significantly more accurate for proximal migration, than teardrop, sacroiliac or sacroiliac-symphysis line. Line drawn tangential to the brim and through the horizontal mid-point of the obturator foramen is more accurate than Kholer`s line, ilio-ischial or iliopubic line. In combination the two lines can give more accurate assessment and they are less affected by the difference in rotation commonly found in plain radiographs.
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Original Article Titanium trabecular metal acetabular components and S-ROM prosthesis with subtrochanteric osteotomy for treating Crowe IV developmental dysplasia of the hip

Original Article Titanium trabecular metal acetabular components and S-ROM prosthesis with subtrochanteric osteotomy for treating Crowe IV developmental dysplasia of the hip

removal of the soft tissue from inside and sur- rounding the true acetabulum, an ultra-small acetabular file was used for filing the true ace- tabulum while preserving the thickness of the anterior and posterior acetabular wall. First, the bottom of the acetabulum was filed, during which, the filing of the posterior-superior side entering into the false acetabulum was avoid- ed, with a depth up to the inner plate of the acetabular base, in order to further enlarge the acetabulum. Finally, anti-filing was performed using the acetabular file to expand the acetabu- lum by compacting the bone mass, followed by implantation of an acetabular cup with a 40-46 mm diameter. The pulp chamber was opened at the proximal femur, while a medullary file was used for reaming. Then, the osteotomy was transversely conducted at 2 cm below the small rotor, and a testing mold was installed to reset the hip joint. Subsequently, the distal limbs were tracted until the lower extremities had the same length, the distal femur that was super- imposed with the proximal femur was cut off using a pendulum saw, followed by withdrawal of the testing mold and implantation of the S-ROM femoral prosthesis for restoring the hip joint. The stability of the hip joint was con- firmed, and the resected surface was encircled with the cut-off cortical bone plate and tied with steel wires, followed by layer-interrupted suture to close the incision. In this study, the cementless prosthesis was selected, the ace- tabular cup was TM acetabular cup (Johnson & Johnson, USA) and polyethylene lined, and the femoral stem prosthesis was S-ROM prosthesis (Johnson & Johnson, USA).
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The biomechanical differences of rotational acetabular osteotomy, Chiari osteotomy and shelf procedure in developmental dysplasia of hip

The biomechanical differences of rotational acetabular osteotomy, Chiari osteotomy and shelf procedure in developmental dysplasia of hip

Developmental Dysplasia of Hip (DDH) is a common congenital deformity of hip. If appropriate measures are not taken, DDH often develops into secondary hip osteoarthritis (OA) due to the abnormal stress of hip [1-5]. Although total hip arthroplasty (THA) is an effect- ive treatment for late stage OA, its application for young DDH patients is still controversial in consideration of the survival rate of prosthesis [6,7]. It is widely accepted that joint preserving operations such as periacetabular osteotomy should be selected whenever possible [8-12]. Rotational acetabular osteotomy (RAO), Chiari osteo- tomy and shelf procedure are three different periaceta- bular osteotomies, which are often used for adolescent
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Bone geometry of the hip is associated with obesity and early structural damage – a 3 0 T magnetic resonance imaging study of community based adults

Bone geometry of the hip is associated with obesity and early structural damage – a 3 0 T magnetic resonance imaging study of community based adults

This study has several limitations. The relationships between acetabular over-coverage measures and hip struc- tures were examined cross-sectionally and we cannot de- termine whether an increased acetabular depth precedes hip structural changes, or vice versa. For instance, it is unclear whether an increased acetabular depth resulted in reduced cartilage volume, or whether reduced cartilage volume increased the acetabular depth. Longitudinal stud- ies are needed to address this issue. This is also partly the case for obesity measures, although change in obesity was measured over an average of 16.9 years preceding MRI assessment, providing evidence that weight gain might increase acetabular over-coverage. Reverse causality is less likely since participants had not sought medical attention for hip pain, and therefore acetabular over- coverage predating weight gain via activity limitation is unlikely. Radiographs were not performed in this study. Some participants may have had early radiographic OA but MRI measurement of hip cartilage volume, a con- tinuous measure, correlates with radiographic hip OA [19]. Although acetabular depth has not previously been a focus of many studies, it has been validated as a meas- ure of pincer deformity using MRI [16]. Assessment of acetabular depth at two time points would enable asso- ciations between changes in obesity and changes in bony geometry to be assessed. In this study, we have ex- amined hip morphometry and have not examined other bone properties such as periarticular bone mineral density, trabeculae structure and bone attrition. It is unlikely that one bone property (for example, shape) changes in isola- tion without simultaneous changes in other bone proper- ties (for example, attrition), signifying that bone may remodel as a continuum, with changes in several proper- ties. Further studies examining other bone properties are, however, needed to substantiate such claims. Moreover, in this cohort, the prevalence of anterior and posterior fem- oral head cartilage defects or BMLs was low. Larger stud- ies will help to address such issues and determine whether MRI structural abnormalities outside of the central region are also associated with acetabular over-coverage. The low prevalence of cartilage defects may also be attributable to our conservative method for assessing defects (that is, deep ulceration with 50% loss of thickness or greater) [26], which may have underestimated cartilage defects.
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A retrospective and prospective analysis of functional and radiological outcome in acetabular fractures treated with open reduction and internal fixation

A retrospective and prospective analysis of functional and radiological outcome in acetabular fractures treated with open reduction and internal fixation

In 1964, Judet et al. published their now classic article entitled Fractures of the Acetabulum, Classification and Surgical Approaches for Open Reduction. This manuscript describes the use of the AP and two 45 o oblique views of the pelvis to evaluate the acetabular fractures. These radiographic views, now known as Judet views, named after the author, include the obturator view, and the iliac oblique view. These are now the standard radiographic films used for evaluation of acetabular fractures. This article represented a substantial step forward in the understanding of acetabular anatomy and fracture classifications.
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An acetabular preserving procedure for pelvic giant cell tumor involving partial acetabulum

An acetabular preserving procedure for pelvic giant cell tumor involving partial acetabulum

femoral head faces the acetabular fossa. The cortex of the femoral neck can bear greater pressure and provide better holding force when implanting the screws, while the can- cellous bone of the femoral head can be easily trimmed and reamed when preparing the socket. Second, it may be technically demanding to match the defect. According to the preoperative simulation, we had a preliminary under- standing on how to trim the bone graft. Then, the recipro- cating bone saw was well applied to carefully trim the graft to obtain the satisfactory matching of the defect. Third, it is of particular importance that the screws cannot protrude into the socket following reaming of the acetabu- lar fossa. And screw orientation should be close or parallel to the conduction force of the acetabulum for the reason that axial compression of the graft can enhance bone graft incorporation with the host bone. Our preoperative simulation to the placement of the screws can be a good solution to this concern.
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Hip resurfacing in a district general hospital: 6 year clinical results using the ReCap hip resurfacing system

Hip resurfacing in a district general hospital: 6 year clinical results using the ReCap hip resurfacing system

On the plain anterio-posterior (AP) radiograph, the acetabular angle of inclination and femoral stem shaft angle were measured as described by Beaulé et al. [13]. Radiolucensies were measured in millimeters and acetabu- lar radiolucency was classified in three zones according to DeLee and Charnley (Figure 2A) [14]. Any femoral radiolucencies were classified in the three zones as described by Beaulé et al. (Figure 2B) [13]. Heterotopic bone formation was classified as described by Brooker et al. [15]. Neck narrowing was measured as described by Grammatopoulos et al., using the first post operative radiograph and the most recent radiograph for compari- son [16]. Clinical and radiological FU and statistical analyses were done by an independent observer, with a sample set of radiographic measurements audited by an experienced radiologist.
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