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The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Femoral head coverage in patients with hip dysplasia (DDH) is typically quantified using 2D measurements of the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, as the morphology of DDH is complex and varies between patients, 2D measurements may not predict the true 3D femoral head coverage. Herein, 2D and 3D coverage were quantified before and after curved periacetabular osteotomy (CPO) and their relationships were assessed.

Materials and methods

Forty-three hips that underwent CPO for DDH were analyzed. For 2D evaluation, LCEA was quantified from X-rays and CT images. The ACEA was measured from CT images (CT-ACEA) and digitally reconstructed radiographs generated from CT images (DRR-ACEA). Three-dimensional coverage was quantified from CT reconstructions of the hip and evaluated in the anterior, superior, posterior, and inferior regions of the femoral head. Two-dimensional measurements were correlated to 3D coverage to assess their relationships.

Results

The median preoperative 3D percent coverage was 17.7, 36.1, 56.1, and 14.6% for the anterior, superior, posterior, and inferior region, respectively. After CPO, all LCEAs and ACEAs increased significantly (all p < 0.001). For the 3D coverage, anterior and superior coverage significantly increased while the posterior and inferior coverage decreased (all p < 0.001). Moderate to strong correlations were detected between the two LCEAs and the 3D superior coverage in both the preoperative and postoperative period. For the correlation between 3D anterior coverage, no significant correlation was found between the CT-ACEA while a moderate correlation was found between the DRR-ACEA (rs = 0.41, p = 0.023).

Conclusions

Our results indicate that the LCEA can be used to predict 3D coverage in the superior region of the femoral head. However, as the CT-ACEA or DRR-ACEA had no or only moderate correlation between the 3D anterior coverage, these measurements are not recommended for evaluating/estimating the 3D anterior coverage in patients with DDH.

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Acknowledgements

We acknowledge funding from the LS Peery Discovery Program in Musculoskeletal Restoration, the Nakatomi Foundation, the Nakatani Foundation for Advancement of Measuring Technologies in Biomedical Engineering and the National Institutes of Health under grant numbers R01-EB016701, P41-GM103545, R01-GM083925, and R21-AR063844.

Funding

This study was supported by the LS Peery Discovery Program in Musculoskeletal Restoration, the Nakatomi Foundation, the Nakatani Foundation for Advancement of Measuring Technologies in Biomedical Engineering and the National Institutes of Health under grant numbers R01-EB016701, P41-GM103545, R01-GM083925, and R21-AR063844.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT, 84108, USA

    Keisuke Uemura & Andrew E. Anderson

  2. Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan

    Toshihito Hiraiwa & Kunihiko Tokunaga

  3. Department of Radiology, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan

    Masashi Okamoto

  4. Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA

    Andrew E. Anderson

  5. Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, 84112, USA

    Andrew E. Anderson

  6. Department of Physical Therapy, University of Utah, Salt Lake City, UT, 84108, USA

    Andrew E. Anderson

Authors
  1. Keisuke Uemura
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  2. Toshihito Hiraiwa
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  3. Masashi Okamoto
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  4. Kunihiko Tokunaga
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  5. Andrew E. Anderson
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Contributions

KU designed the study, processed data, conducted the study, and drafted the manuscript. TH conducted the measurements to assess inter-observer agreement and reviewed the results. MO and KT assisted with the acquisition of data and reviewed the results. AA supervised the study, reviewed the results, and edited the manuscript. All authors provided final approval of the manuscript.

Corresponding author

Correspondence to Andrew E. Anderson.

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Conflict of interest

None of the authors report conflicts of interest associated with the design, execution, and publication of this study. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in this study were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

This study was approved by the Institutional Review Board of each participating hospital, and written informed consent was waived because of the retrospective design.

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Uemura, K., Hiraiwa, T., Okamoto, M. et al. The anterior center edge angle has limited ability to predict three-dimensional coverage of the femoral head in patients with developmental dysplasia of the hip undergoing curved periacetabular osteotomy. Arch Orthop Trauma Surg 143, 1323–1330 (2023). https://doi.org/10.1007/s00402-021-04258-4

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  • DOI: https://doi.org/10.1007/s00402-021-04258-4

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