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Biomechanical Optimization-Based Planning of Periacetabular Osteotomy

  • Li Liu
  • Klaus Siebenrock
  • Lutz-P. Nolte
  • Guoyan Zheng
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1093)

Abstract

Modern computerized planning tools for periacetabular osteotomy (PAO) use either morphology-based or biomechanics-based methods. The latter rely on estimation of peak contact pressures and contact areas using either patient-specific or constant thickness cartilage models. We performed a finite element analysis investigating the optimal reorientation of the acetabulum in PAO surgery based on simulated joint contact pressures and contact areas using patient-specific cartilage model. Furthermore we investigated the influences of using patient-specific cartilage model or constant thickness cartilage model on the biomechanical simulation results. Ten specimens with hip dysplasia were used in this study. Image data were available from CT arthrography studies. Bone models were reconstructed. Mesh models for the patient-specific cartilage were defined and subsequently loaded under previously reported boundary and loading conditions. Peak contact pressures and contact areas were estimated in the original position. Afterward we used validated preoperative planning software to change the acetabular inclination by an increment of 5° and measured the lateral center-edge angle (LCE) at each reorientation position. The position with the largest contact area and the lowest peak contact pressure was defined as the optimal position. In order to investigate the influence of using patient-specific cartilage model or constant thickness cartilage model on the biomechanical simulation results, the same procedure was repeated with the same bone models but with a cartilage mesh of constant thickness. Comparison of the peak contact pressures and the contact areas between these two different cartilage models showed that good correlation between these two cartilage models for peak contact pressures (r = 0.634 ∈[0.6, 0.8], p < 0.001) and contact areas (r = 0.872 > 0.8, p < 0.001). For both cartilage models, the largest contact areas and the lowest peak pressures were found at the same position. Our study is the first study comparing peak contact pressures and contact areas between patient-specific and constant thickness cartilage models during PAO planning. Good correlation for these two models was detected. Computer-assisted planning with FE modeling using constant thickness cartilage models might be a promising PAO planning tool when a conventional CT is available.

Keywords

Hip dysplasia Periacetabular osteotomy (PAO) Planning Biomechanical simulation Finite element analysis (FEA) Image-guided surgery Joint preservation surgery 

Notes

Acknowledgments

This work was supported by the open source dysplastic hips image data from the University of Utah [17] and partially supported by Natural Science Foundation of SZU (grant no. 2017089) and Japanese-Swiss Science and Technology Cooperation Program.

This chapter was modified from the paper published by our group in PLoS One (Li et al., PLoS One 2016; 11(1):e0146452). The related contents were reused with permission.

References

  1. 1.
    Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new Periacetabular osteotomy for the treatment of hip dysplasias technique and preliminary results. Clin Orthop Relat Res 232:26–36. PMID: 3383491Google Scholar
  2. 2.
    Steppacher SD, Tannast M, Ganz R, Siebenrock KA (2008) Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466(7):1633–1644.  https://doi.org/10.1007/s11999-008-0242-3. PMID: 18449617CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA (2015) What are the radiographic reference values for acetabular under-and overcoverage? Clin Orthop Relat Res 473(4):1234–1246.  https://doi.org/10.1007/s11999-014-4038-3 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. Am J Roentgenol 188(6):1540–1552.  https://doi.org/10.2214/AJR.06.0921. PMID: 17515374CrossRefGoogle Scholar
  5. 5.
    Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA et al (2008) Radiographic analysis of femoroacetabular impingement with Hip2Norm-reliable and validated. J Orthop Res 26(9):1199–1205.  https://doi.org/10.1002/jor.20653. PMID: 18404737CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P et al (2009) Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res 467(3):666–675.  https://doi.org/10.1007/s11999-008-0626-4. PMID: 19048356CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    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. PMID: 3383480Google Scholar
  8. 8.
    Millis MB, Murphy SB (1992) Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop Relat Res 274:154–159. PMID: 1729000Google Scholar
  9. 9.
    Dutoit M, Zambelli P (1999) Simplified 3D-evaluation of periacetabular osteotomy. Acta Orthop Belg 65(3):288–294. PMID: 10546351PubMedPubMedCentralGoogle Scholar
  10. 10.
    Janzen D, Aippersbach S, Munk P, Sallomi D, Garbuz D, Werier J et al (1998) Three-dimensional CT measurement of adult acetabular dysplasia: technique, preliminary results in normal subjects, and potential applications. Skelet Radiol 27(7):352–358.  https://doi.org/10.1007/s002560050397. PMID: 9730324CrossRefGoogle Scholar
  11. 11.
    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 Vol 90(11):1428–1434.  https://doi.org/10.1302/0301-620X.90B11.20073 CrossRefGoogle Scholar
  12. 12.
    Armand M, Lepistö J, Tallroth K, Elias J, Chao E (2005) Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years. Acta Orthop 76(3):303–313. PMID: 16156455CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Zhao X, Chosa E, Totoribe K, Deng G (2010) Effect of periacetabular osteotomy for acetabular dysplasia clarified by three-dimensional finite element analysis. J Orthop Sci 15(5):632–640.  https://doi.org/10.1007/s00776-010-1511-z. PMID: 20953924CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Zou Z, Chávez-Arreola A, Mandal P, Board TN, Alonso-Rasgado T (2013) Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis. J Orthop Res 31(3):472–479.  https://doi.org/10.1002/jor.22245. PMID: 23097237CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Harris MD, Anderson AE, Henak CR, Ellis BJ, Peters CL, Weiss JA (2012) Finite element prediction of cartilage contact stresses in normal human hips. J Orthop Res 30(7):1133–1139.  https://doi.org/10.1002/jor.22040. PMID: 22213112CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Liu L, Ecker T, Schumann S, Siebenrock K, Nolte L, Zheng G (2014) Computer assisted planning and navigation of periacetabular osteotomy with range of motion optimization. Springer, Heidelberg, pp 643–650Google Scholar
  17. 17.
    Henak CR, Abraham CL, Anderson AE, Maas SA, Ellis BJ, Peters CL et al (2014) Patient-specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia. Osteoarthr Cartil 22(2):210–217.  https://doi.org/10.1016/j.joca.2013.11.003. PMID: 24269633CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Liu L, Ecker T, Xie L, Schumann S, Siebenrock K, Zheng G (2015) Biomechanical validation of computer assisted planning of periacetabular osteotomy: a preliminary study based on finite element analysis. Med Eng Phys.  https://doi.org/10.1016/j.medengphy.2015.09.002 CrossRefGoogle Scholar
  19. 19.
    Anderson AE, Ellis BJ, Maas SA, Peters CL, Weiss JA (2008) Validation of finite element predictions of cartilage contact pressure in the human hip joint. J Biomech Eng 130(5):051008.  https://doi.org/10.1115/1.2953472. PMID: 19045515CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Caligaris M, Ateshian GA (2008) Effects of sustained interstitial fluid pressurization under migrating contact area, and boundary lubrication by synovial fluid, on cartilage friction. Osteoarthr Cartil 16(10):1220–1227.  https://doi.org/10.1016/j.joca.2008.02.020. PMID: 18395475CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J et al (2001) Hip contact forces and gait patterns from routine activities. J Biomech 34(7):859–871.  https://doi.org/10.1016/S0021-9290(01)00040-9. PMID: 11410170CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Phillips A, Pankaj P, Howie C, Usmani A, Simpson A (2007) Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions. Med Eng Phys 29(7):739–748.  https://doi.org/10.1016/j.medengphy.2006.08.010 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ferguson S, Bryant J, Ganz R, Ito K (2003) An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech 36(2):171–178.  https://doi.org/10.1016/S0021-9290(02)00365-2. PMID: 12547354CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Konrath GA, Hamel AJ, Olson SA, Bay B, Sharkey NA (1998) The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip. J Bone Joint Surg 80(12):1781–1788CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA (2011) Role of the acetabular labrum in load support across the hip joint. J Biomech 44(12):2201–2206.  https://doi.org/10.1016/j.jbiomech.2011.06.011. PMID: 21757198CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Armiger RS, Armand M, Tallroth K, Lepistö J, Mears SC (2009) Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up. Acta Orthop 80(2):155–161.  https://doi.org/10.3109/17453670902947390. PMID: 19404795CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Niknafs N, Murphy RJ, Armiger RS, Lepistö J, Armand M (2013) Biomechanical factors in planning of periacetabular osteotomy. Frontiers in bioengineering and biotechnology; 1.  https://doi.org/10.3389/fbioe.2013.00020. PMID: 25152876
  28. 28.
    Lepistö J, Armand M, Armiger RS (2008) Periacetabular osteotomy in adult hip dysplasia–developing a computer aided real-time biomechanical guiding system (BGS). Suomen ortopedia ja traumatologia = Ortopedioch traumatologi i Finland = Finn J Orthop Traumatol 31(2):186. PMID: 20490364Google Scholar
  29. 29.
    Haefeli P, Steppacher S, Babst D, Siebenrock K, Tannast M (2015) An Increased Iliocapsularis-to-rectusfemoris Ratio Is Suggestive for Instability in Borderline Hips. Clin Orthop Relat Res 473(12):3725–3734.  https://doi.org/10.1007/s11999-015-4382-y CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Li Liu
    • 1
    • 2
  • Klaus Siebenrock
    • 3
  • Lutz-P. Nolte
    • 2
  • Guoyan Zheng
    • 2
  1. 1.National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science CenterShenzhen UniversityShenzhenChina
  2. 2.Institute for Surgical Technology and BiomechanicsUniversity of BernBernSwitzerland
  3. 3.Department of Orthopedic Surgery, InselspitalUniversity of BernBernSwitzerland

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