Evaluation of cartilage coverage with magnetic resonance imaging in residual dysplasia and its impact on surgical timing

Abstract

ObjectiveThe aim of this study was to measure the cartilaginous coverage of the acetabulum using magnetic resonance imaging (MRI) and to analyze its effect on the timing and necessity of secondary operations in residual acetabular dysplasia (RAD).MethodsThe MRI results of 33 children (30 girls and 3 boys) aged between 5 and 9 years who were operated on unilaterally via a posteromedial limited approach were compared with the radiographical findings of acetabular dysplasia at follow-up. The acetabular index (AI) and the center-edge (CE) angles were measured. MRI was used to measure the osseous acetabular index (OAI), cartilage acetabular index (CAI), and cartilaginous center-edge angles (CCE). The Children's Hospital's Oakland Hip Evaluation Score (CHOHES) was used for the assessment of clinical and functional results. The Severin scoring system was used to evaluate the radiographic results. The Mann-Whitney U test and Spearman correlation tests were used for statistical analysis.ResultsIn all, 30 (90.9%) girls and 3 (9.1%) boys with an average age of 7.4 years (range: 5–9 years) and a mean follow-up period of 6.1 years (range: 4–8 years) were included. While there was a significant difference between non-dislocated hips and operated hips in 3 measurements (AI, Wiberg CE, and Ogata CE) using X-rays (p < 0.05), no significant difference was found in the MRI measurements (OAI, CAI, and CCE) (p > 0.05). The CAI values were lower than the AI measured on X-ray (p = 0.035). The mean CCE was higher than the mean CE (p = 0.022). The mean CHOHES score was 83.1 (range: 52–100) and the score of 62% patients was above 90. There was no significant difference in terms of CHOHES score according to age at the time of operation (p = 0.43). Three (9.1%) patients were Severin class I, 8 (24.3%) patients were class II, 12 (36.3%) patients were class III and 10 (30.3%) patients were class IV. There was no correlation between preoperative hip dislocation and Severin score (p = 0.056). No significant difference was found between the ambulatory and non-ambulatory groups in terms of Severin classification (p = 0.063).ConclusionCartilaginous acetabulum should be taken into account in RAD measurements. MRI may be a more appropriate option for the evaluation of acetabular cartilaginous coverage in the evaluation of RAD and the decision to perform surgery, though X-rays are currently the most used method. The results revealed no effect on functional or radiological scores as a result of being of walking age.Level of studyLevel III, Diagnostic Study.

Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip

“…The AI was measured on standard anteroposterior radiograph. Series MRI were performed before operation and regularly in follow-ups [19][20][21]. Cartilaginous acetabular index (CAI), cartilage coronal acetabular head index (CCAHI), and cartilage sagittal acetabular head index (CSAHI) were measured on the T1-W SE anatomic sequence in the coronal and sagittal planes that showed the largest diameter of the femoral head according to Douira's study [22].…”

Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip

“…15 Although the disadvantages of this modality include availability, costs, and the use of general anaesthesia in young children, studies focusing on MRI evaluation of cartilage coverage have been reported recently. 16,17 The objective of this study was to evaluate the cartilaginous acetabulum and labrum by a new method that measures the cartilaginous and labral landmarks on postoperative magnetic resonance images taken at 5 years of age to identify predictors of acetabular development.…”

The Method of Contact Area Assessment between the Femoral Head and Acetabulum in Children that Takes into Account Triradiate Cartilage

“…Існує багато досліджень, присвячених вивченню взаємодії ГСК та кульшової западини у дорослих [8][9][10][11][12][13][14][15][16][17][18][19], наймолодший пацієнт у цих дослідженнях був віком 8 років [13]. Однак досліджень щодо оцінки взаємодії ГСК та кульшової западини у дітей віком до 6 років немає.…”

“…Взаємовідношення кульшової западини та ГСК можна оцінити різними методами (рентгенологічне дослідження, КТ, МРТ, трупний матеріал [8,[14][15][16][17][18][19][21][22]). Найбільш рутинним методом дослідження є рентгенологічне дослідження, проте цей метод не дає повної інформації щодо 3D-морфології кульшової западини [9].…”