Abstract
Background
Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique.
Methods
Three-dimensional computed tomography of 18 normal hips and 3 symptomatic dysplastic hips were analyzed. Through the center of the femoral head, vertical images were obtained at 10° intervals from 0° to 180° of rotation, using multiplanar reformation technique. Subsequently we measured 19 center–edge angles (CEAs) from each acetabulum. Four types of virtual osteotomy were performed on the three dysplastic hips. The adequacy of acetabular coverage after osteotomy was determined by comparing CEAs after correction with normal CEAs.
Results
Pearson correlation coefficients between the CEAs measured from normal cases and postoperative cases after lateral rotation of osteotomized fragments were 0.906 in case 1, 0.975 in case 2, 0.976 in case 3. Additional anterior rotation increased anterior acetabular coverage and simultaneously decreased posterior coverage in all three cases.
Conclusion
Computer-aided virtual surgery technique based on three-dimensional computed tomography information enabled acetabular coverage to be quantified preoperatively in Bernese osteotomy. Lateral rotation of osteotomized acetabular fragments improved anterior and posterior coverage as well as lateral coverage.
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References
de Kleuver M, Kapitein PJ, Kooijman MA, van Limbeek J, Pavlov PW, Veth RP (1999) Acetabular coverage of the femoral head after triple pelvic osteotomy: no relation to outcome in 51 hips followed for 8–15 years. Acta Orthop Scand 70:583–588
Bedi A, Dolan M, Leunig M, Kelly BT (2011) Static and dynamic mechanical causes of hip pain. Arthroscopy 27:235–251
Ganz R, Klaue K, Mast J (1990) Peri-acetabular reorientation osteotomy. Acta Orthop Belg 56:357–369 (French)
Janzen DL, Aippersbach SE, Munk PL, Sallomi DF, Garbuz D, Werier J, Duncan CP (1998) Three-dimensional CT measurement of adult acetabular dysplasia: technique, preliminary results in normal subjects, and potential applications. Skeletal Radiol 27:352–358
Konishi N, Mieno T (1993) Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique. J Bone Joint Surg Am 75:1318–1333
Mieno T, Konishi N, Hasegawa Y, Genda E (1992) Three-dimensional evaluation of acetabular coverage of the femoral head in normal hip joints and hip joints with acetabular dysplasia. Nippon Seikeigeka Gakkai Zasshi 66:11–22
Klaue K, Wallin A, Ganz R (1988) CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res 232:15–25
Delaunay S, Dussault RG, Kaplan PA, Alford BA (1997) Radiographic measurements of dysplastic adult hips. Skeletal Radiol 26:75–81
Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J (2008) Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br 90:1428–1434
Haddad FS, Garbuz DS, Duncan CP, Janzen DL, Munk PL (2000) CT evaluation of periacetabular osteotomies. J Bone Joint Surg Br 82:526–531
Bowman KF Jr, Fox J, Sekiya JK (2010) A clinically relevant review of hip biomechanics. Arthroscopy 26:1118–1129
Pfeifer R, Hurschler C, Ostermeier S, Windhagen H, Pressel T (2008) In vitro investigation of biomechanical changes of the hip after Salter pelvic osteotomy. Clin Biomech (Bristol, Avon) 23:299–304
Klaue K (1995) Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. J Bone Joint Surg Am 77:153–154
Chosa E, Tajima N, Nagatsuru Y (1997) Evaluation of acetabular coverage of the femoral head with anteroposterior and false profile radiographs of the hip joint. J Orthop Sci 2:378–390
Murphy SB, Ganz R, Muller ME (1995) The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 77:985–989
Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL (2005) Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am 87:254–259
Rab GT (2007) Lateral acetabular rotation improves anterior hip subluxation. Clin Orthop Relat Res 456:170–175
Ziebarth K, Balakumar J, Domayer S, Kim YJ, Millis MB (2011) Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res 469:447–453
Stevens MS, Legay DA, Glazebrook MA, Amirault D (2010) The evidence for hip arthroscopy: grading the current indications. Arthroscopy 26:1370–1383
Roach JW, Hobatho MC, Baker KJ, Ashman RB (1997) Three-dimensional computer analysis of complex acetabular insufficiency. J Pediatr Orthop 17:158–164
Snyder GM, Lozano Calderon SA, Lucas PA, Russinoff S (2011) Accuracy of computer-navigated total hip arthroplasty. J Arthroplasty (epub ahead of print)
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Suh, D.H., Lee, D.H., Jeong, W.K. et al. Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia. Arch Orthop Trauma Surg 132, 447–454 (2012). https://doi.org/10.1007/s00402-011-1435-x
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DOI: https://doi.org/10.1007/s00402-011-1435-x