Location of Acetabular Deficiency and Associated Hip Dislocation in Neuromuscular Hip Dysplasia: Three-Dimensional Computed Tomographic Analysis

Kim, Hui Taek; Wenger, Dennis R.

doi:10.1097/01241398-199703000-00002

Cited by 21 publications

(43 citation statements)

References 9 publications

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“…The 3-D bone reconstructions were created using the surface rendering function in OsiriX with the default software settings (pixel value, 300; medium resolution, 0.50; smooth iterations, 20). The use of 3-D reconstructions of medical images for descriptive anatomic studies or for examination of pathologic lesions is well documented [1,2,6,7,13,17,18]. The novelty of our method is, however, the digitization of specific points, or regions of interest, on 3-D bone surfaces and the exportation of their coordinates to spreadsheets for additional data processing.…”

Section: Methodsmentioning

confidence: 99%

The Asymmetric Profile of the Acetabulum

Vandenbussche

Saffarini

Taillieu

et al. 2008

Clinical Orthopaedics &Amp; Related Research

125

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Despite the curvaceous profile of the acetabulum, orthopaedic surgeons have continued to implant hemispheric cups since the introduction of total hip arthroplasty. The geometric discrepancies between the natural acetabulum and implant can result in painful iliopsoas impingement attributable to prosthetic overlap at the anterior acetabular ridge over which the iliopsoas tendon extends to leave the pelvis. We expanded on previous in vitro observations of acetabular morphology using a large in vivo sample and quantified the dimensions of the psoas valley. We studied computed tomographic scans of 200 healthy hips from 50 men and 50 women. The acetabular ridges were digitized on three-dimensional bone reconstructions and their coordinates were manipulated in spreadsheets to deduce acetabular diameter, anteversion, and inclination and to plot the rim profile. Our results confirm the acetabular rim is an asymmetric succession of three peaks and three troughs. The psoas valley has the following shape distribution: 79% curved, 11% angular, 10% irregular, and 0% straight. The mean depth of the psoas valley is 5 mm and the latitude of its trough is on average 6 mm below the acetabular equator. The use of side-specific cups that replicate the curvaceous acetabular profile could prevent prosthetic overlap and reduce the incidence of iliopsoas impingement.

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Section: Methodsmentioning

confidence: 99%

The Asymmetric Profile of the Acetabulum

Vandenbussche

Saffarini

Taillieu

et al. 2008

Clinical Orthopaedics &Amp; Related Research

125

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“…27 The technique has other potential applications. CT reformatting is gaining popularity in the management of neuromuscular disease of the hip, 16,34 and has been used to plan computer-assisted periacetabular osteotomy. 25 In future it may be used in the assessment of subluxation of the hip, 35 and for measuring the thickness of cartilage.…”

Section: Discussionmentioning

confidence: 99%

CT evaluation of periacetabular osteotomies

Haddad¹,

Garbuz²,

Duncan³

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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W e have previously described a simple and reproducible three-dimensional technique of CT for the measurement of the cover of the femoral head in acetabular dysplasia in adults. We now describe the application of this technique in ten patients with symptomatic dysplasia to assess the degree and direction of dysplasia and to measure the cover obtained at acetabular osteotomy.The indices obtained gave a useful indication of the degree and direction of the dysplasia and confirmed which components had been used most efficiently to achieve cover. The information is easily presented in graphical form and gives a clearer indication of the cover obtained than the indices derived from plain radiographs. Accurate assessment of indices of dysplasia and of cover of the femoral head is difficult, 1-4 but is essential when planning and evaluating osteotomies around the hip. 1,5-7 Some information concerning lateral cover of the femoral head can be obtained from plain radiographs by measuring the centre-edge angle of Wiberg, and about anterolateral cover from the 'false-profile' view of Lequesne and de Seze. 1,[8][9][10][11][12][13] Complicated mathematical estimations of acetabular cover have also been made from plain radiographs but the methods are complex and include many assumptions regarding the geometry of the hip. 8,14 More information may be obtained from CT 7,11,[15][16][17][18][19] and three-dimensional (3D) CT studies, 20,21 but these involve high exposures to radiation and are difficult to interpret. No MRI techniques have been described for assessing acetabular dysplasia.We have devised a simple and reproducible 3DCT technique to measure cover of the acetabulum in adults. 22 We now describe its use in planning the correction required for periacetabular osteotomy and in assessing the amount obtained. Patients and MethodsWe studied ten women with a mean age of 26 years (16 to 41) who had symptomatic acetabular dysplasia. We measured the centre-edge angles (CEA) on the anteroposterior (AP) and false-profile views (VCA), the acetabular index of the weight-bearing zone (TA), the femoral head extrusion index (FHEI) and the lateral subluxation index (LSI) 1,[8][9][10]13,23,24 (Table I) before and after operation. All measurements were made on standing AP pelvic and falseprofile views by two independent observers. We also carried out 3DCT on all the patients before and after operation to identify the degree and direction of the dysplasia, to plan the correction required at the time of periacetabular osteotomy, to assess the correction obtained subsequently and to compare it with the preoperative plan, the contralateral side and a normal control group (Figs 1 to 6). For CT we used a GE HiLight Scanner (GE Medical Systems, Milwaukee, Wisconsin). The subject was positioned supine with the midline of the body aligned with the central axis of the scanning table. The hips were extended and the feet stabilised with the hips in 15° of external rotation. Care was taken to ensure that there was no pelvic tilt or flexion of the hip ...

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“…The degree of acetabular dysplasia has been known to correlate with the migration percentage of hip displacement [6,9,17]. With femoral deformities, imbalance of muscle forces and lack of ambulation lead to excessive anteversion and coxa valga that increase with the levels of gross motor function [31].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Hip Displacement in Children With Cerebral Palsy

Chang

Wang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment. Questions For children with cerebral palsy with Gross Motor Function Classification System Level IV or V, we questioned (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) whether the patient with a windblown posture has greater degrees of femoral anteversion? Methods We retrospectively studied 31 consecutive children with cerebral palsy with Level IV or V gross motor function who underwent three-dimensional CT for preoperative assessment of hip displacement between January 2010 and December 2013. Among the children, 23 had a windblown posture and eight had symmetric hip motion. Femoral anteversion and true neck-shaft angle were measured from the three-dimensional CT images. Migration percentage was the dependent variable we chose to study in relation to femoral anteversion, neck-shaft angle, maximal hip abduction, and hip flexion contracture, using correlations and multiple linear regressions. Using ANOVA and Scheffé's post hoc tests, we analyzed and compared the data of 23 abducted hips and 23 adducted hips in the 23 children with windblown posture and in 16 displaced hips in the eight children with symmetric hip abduction. Results Greater migration percentage was associated with less hip abduction range (r = À0.86; p \ 0.001). Femoral anteversion had a weak correlation (r = 0.28; p \ 0.05) to migration percentage, and the association became insignificant after considering hip abduction motion. Adducted windblown hips had greater femoral anteversion

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Location of Acetabular Deficiency and Associated Hip Dislocation in Neuromuscular Hip Dysplasia: Three-Dimensional Computed Tomographic Analysis

Cited by 21 publications

References 9 publications

The Asymmetric Profile of the Acetabulum

The Asymmetric Profile of the Acetabulum

CT evaluation of periacetabular osteotomies

Determinants of Hip Displacement in Children With Cerebral Palsy

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