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Crossover sign after rotational acetabular osteotomy for dysplasia of the hip

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

This study was performed to evaluate whether the radiographic crossover sign influences the painful femoroacetabular impingement or the radiographic progression of osteoarthritis after rotational acetabular osteotomy (RAO).

Methods

A total of 104 patients (115 hips) with preosteoarthritis (pre-OA) or early-stage OA of the hip due to dysplasia underwent RAO. Their mean age at the time of surgery was 34.7 years. The mean follow-up period was 13 years. Clinical follow-up was performed with the system of Merle d’Aubigne, and the impingement sign was evaluated. Radiographic analyses included the center-edge angle, acetabular roof angle, head lateralization index (HLI), joint congruency, crossover sign, posterior wall sign, acetabular index of depth to width, pistol grip deformity, and femoral head/femoral neck ratio.

Results

The mean clinical score improved significantly from 14.6 preoperatively to 17.0 at follow-up. The impingement sign at follow-up was observed in 14 hips (12.2%). The center-edge angle, acetabular roof angle, and head lateralization index (HLI) improved significantly after surgery. The crossover sign was observed in 8 hips (7.0%) preoperatively and in 49 hips (42.6%) postoperatively. The posterior wall sign was observed in 70 hips (60.9%) preoperatively and in 73 hips (63.5%) postoperatively. The impingement sign after RAO was positive significantly in the postoperative crossover sign-positive hips. Radiographic progression of OA was observed in 11 hips (crossover sign was positive in 7 hips and negative in 4 hips). The only factors significantly associated with radiographic progression after RAO were fair postoperative joint congruency and age at surgery.

Conclusions

Although there was no significant radiographic progression of OA despite significant retroversion, anterior impingement and radiographic crossover sign after RAO are should be checked during the procedure. The goal of RAO should be correct alignment of the acetabulum including a correct version with a negative crossover sign.

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References

  1. Aronson, J. Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect 1986;35:119–128.

    PubMed  CAS  Google Scholar 

  2. Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. J Bone Joint Surg Am 1995;77:626–647.

    Google Scholar 

  3. Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am 1973;55:343–350.

    PubMed  CAS  Google Scholar 

  4. Eppright RH. Dial osteotomy of the acetabulum in the treatment of dysplasia of the hip. J Bone Joint Surg Am 1975;57:1172.

    Google Scholar 

  5. Wagner H. Osteotomies for congenital hip dislocation. In: The hip. St. Louis: Mosby; 1976. p. 45–66.

    Google Scholar 

  6. Ninomiya S, Tagawa H. Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am 1984;66:430–436.

    PubMed  CAS  Google Scholar 

  7. Ganz R, Klaue K, Vinh TS, Mast JW. A new peri-acetabular osteotomy for the treatment of hip dysplasia: technique and preliminary results. Clin Orthop 1988;232:26–36.

    PubMed  Google Scholar 

  8. Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am 1995;77:73–85.

    PubMed  CAS  Google Scholar 

  9. Nakamura S, Ninomiya S, Takatori Y, Morimoto S, Umeyama T. Long-term outcome of rotational acetabular osteotomy: 145 hips followed for 10–23 years. Acta Orthop Scand 1998;69:259–265.

    Article  PubMed  CAS  Google Scholar 

  10. Schramm M, Pitto RP, Rohm E, Hohmann D. Long-term results of spherical acetabular osteotomy. J Bone Joint Surg Br 1999;81:60–66.

    Article  PubMed  CAS  Google Scholar 

  11. Yasunaga Y, Ikuta Y, Shigenobu T, Nakamura S, Yamamoto S, Nakashiro J. Rotational acetabular osteotomy for dysplastic hip dysplasia; medial enlargement of the acetabulum. Acta Orthop Scand 2001;72:8–12.

    Article  PubMed  CAS  Google Scholar 

  12. Yasunaga Y, Ochi M, Shimogaki K, Yamamoto S, Iwamori H. Rotational acetabular osteotomy for hip dysplasia: 61 hips followed for 8–15 years. Acta Orthop Scand 2004;75:10–15.

    Article  PubMed  Google Scholar 

  13. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip. Clin Orthop 2008;466:264–272.

    Article  PubMed  Google Scholar 

  14. Siebenrock KA, Scholl E, Lottenback M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop 1999;363:9–20.

    PubMed  Google Scholar 

  15. Meyers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop 1999;363:93–99.

    Google Scholar 

  16. Steppacher SD, Tannast M, Werlen S, Siebenrock A. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop 2008;466:782–790.

    Article  PubMed  CAS  Google Scholar 

  17. Charnley J. Numerical grading of clinical results. In: Charnley J, editor. Low friction arthroplasty of the hip. Berlin: Springer; 1979. p. 20–24.

    Google Scholar 

  18. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Chir Scand 1939;83(suppl):58.

    Google Scholar 

  19. Yasunaga Y, Kanazawa T, Ikuta Y, Takahashi K, Hisatome T. The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy. J Bone Joint Surg Br 2001;83:1001–1004.

    Article  PubMed  CAS  Google Scholar 

  20. Yasunaga Y, Terayama H, Tanaka R, Yamasaki T, Ishii Y, Ochi M. Rotational acetabular osteotomy: surgical techniques. J Bone Joint Surg Am 2007;89(suppl 2):246–255.

    Article  PubMed  Google Scholar 

  21. Merle d’Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 1954;36:451–475.

    Google Scholar 

  22. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome: a clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991;73:423–429.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Massie WK, Howorth MB. Congenital dislocation of the hip: Part 1. Method of grading results. J Bone Joint Surg Am 1950;32:519–531.

    PubMed  Google Scholar 

  25. Hijikata H, Tagawa H, Toyoshima H. Rotational acetabular osteotomy with resection of capital drop. Hip Joint 1985;11:277–282 (in Japanese).

    Google Scholar 

  26. Reynolds D, Lucas J, Klaue K. Retroverted of the acetabulum. J Bone Joint Surg Br 1999;81:281–288.

    Article  PubMed  CAS  Google Scholar 

  27. Heyman CH, Herndon CH. Legg-Perthes disease: a method for the measurement of roentgenographic results. J Bone Joint Surg Am 1950;32:767–778.

    PubMed  CAS  Google Scholar 

  28. Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognised childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Proceedings of the third open scientific meeting of the Hip Society. St. Louis: Mosby; 1975. p. 212–218.

    Google Scholar 

  29. Doherty M, Courtney P, Doherty S, Jenkins W, Maciewicz RA, Muir K, et al. Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a casecontrol study. Arthritis Rheum 2008;58:3172–3182.

    Article  PubMed  Google Scholar 

  30. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995;77:985–989.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Artificial Joints & Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuji Yasunaga & Toshihiro Matsuo

  2. Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Takuma Yamasaki, Masakazu Ishikawa, Nobuo Adachi & Mitsuo Ochi

Authors
  1. Yuji Yasunaga
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  2. Takuma Yamasaki
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  3. Toshihiro Matsuo
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  4. Masakazu Ishikawa
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  5. Nobuo Adachi
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  6. Mitsuo Ochi
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Yasunaga, Y., Yamasaki, T., Matsuo, T. et al. Crossover sign after rotational acetabular osteotomy for dysplasia of the hip. J Orthop Sci 15, 463–469 (2010). https://doi.org/10.1007/s00776-010-1489-6

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  • DOI: https://doi.org/10.1007/s00776-010-1489-6

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