Skip to main content

Advertisement

Log in

A Quantitative Method to Assess Focal Acetabular Overcoverage Resulting From Pincer Deformity Using CT Data

  • Basic Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Current assessment techniques for focal acetabular overcoverage are neither consistent nor quantitatively accurate.

Questions/purposes

We propose: (1) a method to precisely quantify the amount of focal acetabular overcoverage in a patient’s pincer deformity based on CT data; (2) to evaluate the consistency of this method; and (3) to compare the method with conventional radiographic assessments.

Methods

We developed a method to assess focal acetabular overcoverage using points selected from CT scans along the acetabular rim after realigning the pelvis into a neutral position. Using four resampled and segmented pelvic CT scans of cadaveric specimens with virtually induced impingement, two observers independently tested the algorithm’s consistency. Our algorithm assessed the amount of focal acetabular overcoverage using CT data and projected data from reconstructed radiographs.

Results

(1) We successfully showed the feasibility of the software to produce consistent, quantitative measurements. (2) Testing showed the average difference between observers in aligning the pelvis was 0.42°, indicative of a consistent approach. (3) Differences between measurements on three-dimensional (3-D) CT and simulated radiographs were significant.

Conclusions

The proposed method represents a new avenue in consistently quantifying focal acetabular overcoverage using CT models while correcting for pelvic tilt and rotation. Our analysis confirms AP hip radiograph simulations overestimate the amount of overhanging acetabular rim in a pincer deformity.

Clinical Relevance

This technique has potential to improve preoperative diagnostic accuracy and enhance surgical planning for correction of a pincer deformity resulting from focal acetabular overcoverage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1A–B
Fig. 2A–B
Fig. 3A–B
Fig. 4

Similar content being viewed by others

References

  1. Armiger RS, Armand M, Lepistö J, Minhas D, Tallroth K, Mears SC, Waites MD, Taylor RH. Evaluation of a computerized measurement technique for joint alignment before and during periacetabular osteotomy. Comput Aided Surg. 2007;12:215–224.

    PubMed  Google Scholar 

  2. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.

    Article  PubMed  CAS  Google Scholar 

  3. Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(suppl 4):47–66.

    Article  PubMed  Google Scholar 

  4. Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J. Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. J Bone Joint Surg Br. 2009;91:1031–1036.

    Article  PubMed  CAS  Google Scholar 

  5. Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br. 2008;90:1428–1434.

    Article  PubMed  CAS  Google Scholar 

  6. de Greef M, Crezee J, van Eijk JC, Pool R, Bel A. Accelerated ray tracing for radiotherapy dose calculations on a GPU. Med Phys. 2009;36:4095–4102.

    Article  PubMed  Google Scholar 

  7. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  8. Goitein M, Abrams M, Rowell D, Pollari H, Wiles J. Multi-dimensional treatment planning: II. Beam’s eye-view, back projection, and projection through CT sections. Int J Radiat Oncol Biol Phys. 1983;9:789–797.

    Article  PubMed  CAS  Google Scholar 

  9. Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the ‘crossover-sign.’ J Orthop Res. 2007;25:758–765.

    Article  PubMed  Google Scholar 

  10. Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.

    Article  PubMed  Google Scholar 

  11. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  PubMed  CAS  Google Scholar 

  12. Richards PJ, Pattison JM, Belcher J, Decann RW, Anderson S, Wynn-Jones C. A new tilt on pelvic radiographs: a pilot study. Skeletal Radiol. 2009;38:113–122.

    Article  PubMed  CAS  Google Scholar 

  13. Sadowsky O, Cohen JD, Taylor RH. Projected tetrahedra revisited: a barycentric formulation applied to digital radiograph reconstruction using higher-order attenuation functions. IEEE Trans Vis Comput Graph. 2006;12:461–473.

    Article  PubMed  Google Scholar 

  14. Sherouse GW, Novins K, Chaney EL. Computation of digitally reconstructed radiographs for use in radiotherapy treatment design. Int J Radiat Oncol Biol Phys. 1990;18:651–658.

    Article  PubMed  CAS  Google Scholar 

  15. Shirley P, Tuchman A. A polygonal approximation to direct scalar volume rendering. SIGGRAPH Comput Graph. 1990;24:63–70.

    Article  Google Scholar 

  16. Siddon RL. Fast calculation of the exact radiological path for a three-dimensional CT array. Med Phys. 1985;12:252–255.

    Article  PubMed  CAS  Google Scholar 

  17. Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.

    Article  PubMed  Google Scholar 

  18. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278–286.

    PubMed  Google Scholar 

  19. Spoerk J, Bergmann H, Wanschitz F, Dong S, Birkfellner W. Fast DRR splat rendering using common consumer graphics hardware. Med Phys. 2007;34:4302–4308.

    Article  PubMed  Google Scholar 

  20. Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007;25:122–131.

    Article  PubMed  Google Scholar 

  21. Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm: reliable and validated. J Orthop Res. 2008;9:1199–1205.

    Article  Google Scholar 

  22. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays: a comparison of six parameters. Skeletal Radiol. 2006;35:149–155.

    Article  PubMed  CAS  Google Scholar 

  23. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–190.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Dr Ofri Sadowsky for generously providing the software necessary to construct DRRs.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryan J. Murphy MS.

Additional information

One or more of the authors (RJM, MA, TKS) have received funding from grant number 3 R01 EB006839 of the National Institute of Biomedical Imaging and Bioengineering (NIH/NIBIB) and grant number 1T32EB006351 from the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

This work was performed at Johns Hopkins University and the Johns Hopkins University Applied Physics Laboratory, Baltimore, MD, USA.

About this article

Cite this article

Murphy, R.J., Subhawong, T.K., Chhabra, A. et al. A Quantitative Method to Assess Focal Acetabular Overcoverage Resulting From Pincer Deformity Using CT Data. Clin Orthop Relat Res 469, 2846–2854 (2011). https://doi.org/10.1007/s11999-011-1958-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1958-z

Keywords

Navigation