Overcorrection of the acetabular roof angle or anterior center–edge angle may cause decrease of range of motion after curved periacetabular osteotomy

Hayashi, Shinya; Hashimoto, Shingo; Matsumoto, Tomoyuki; Takayama, Koji; Kamenaga, Tomoyuki; Niikura, Takahiro; Kuroda, Ryosuke

doi:10.1093/jhps/hnaa065

Cited by 9 publications

(15 citation statements)

References 22 publications

(16 reference statements)

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“…Hamada et al reported that the mean femoral anteversion was similar between patients with postoperative anterior impingement and nonimpingement after RAO 16 . We previously reported that combined anteversion was significantly correlated with flexion and IR after curved PAO 12 . However, research on the correlation between combined anteversion and postoperative clinical outcomes after PAO is rare.…”

Section: Discussionmentioning

confidence: 91%

“…16 We previously reported that combined anteversion was significantly correlated with flexion and IR after curved PAO. 12 However, research on the correlation between combined anteversion and postoperative clinical outcomes after PAO is rare.…”

Section: Discussionmentioning

confidence: 99%

“…We recently reported that a threshold postoperative combined anterior CE and α angles of 108° was the most accurate predictive factor for the occurrence of postoperative anterior impingement 14 . However, this could not be confirmed because, in our previous studies, the diagnosis of postoperative anterior impingement was obtained through clinical symptoms and physical examination 12–14 …”

Section: Introductionmentioning

confidence: 90%

“…When we previously focused on the relationship between the α angle and postoperative anterior impingement after PAO, the typical aspherical femoral heads in DDH increased the risk of secondary cam‐type FAI that is reportedly symptomatic in 48% of all cases after reorientation 10 . We have previously discovered that, in patients who have undergone curved PAO, the postoperative range of motion (ROM) for flexion and internal rotation (IR) was significantly associated with the postoperative three‐dimensional (3D) anterior center‐edge (CE) angles, indicating that excessive anterior acetabular coverage decreases the ROM, thus leading to postoperative anterior impingement 12,13 . We hypothesized that the development of postoperative anterior impingement may be affected by both the anterior acetabular coverage procedure and the shape of the femoral head and neck.…”

Section: Introductionmentioning

confidence: 99%

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Anterior acetabular coverage and femoral head–neck measurements predict postoperative anterior impingement: A simulation study

Hayashi

Hashimoto

Kuroda

et al. 2022

Journal Orthopaedic Research

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The aim of this simulation study was to evaluate the relationship of elements of anterior acetabular coverage and femoral head–neck shape with the occurrence of postoperative anterior impingement after curved periacetabular osteotomy (PAO). Sixty‐two patients with symptomatic developmental dysplasia of the hip who had undergone curved PAO were selected. The likelihood of developing postoperative anterior impingement was explored through simulations of the range of motion by collision detection of the pelvis and femur. Postoperative anterior impingement was defined as impingement that occurred during postoperative bone flexion <105° or postoperative internal rotation <20° at 90° flexion. The three‐dimensional center‐edge (CE) angles, acetabular and femoral versions, radiographic alpha angles of the femoral head, combination angles of anterior CE and alpha angles, and combined anteversions of acetabular and femoral versions were compared between patients with postoperative anterior impingement and nonimpingement. A receiver operator characteristic (ROC) analysis was conducted to determine thresholds of the examined radiographic parameters and calculate their accuracy for predicting postoperative anterior impingement. A multivariate analysis was performed to test whether combined anteversion, anterior CE angle, and combination angle are associated with excellent modified Harris Hip Scores (mHHSs). ROC analysis demonstrated a combination angle ≥108° was predictive of the occurrence of postoperative anterior impingement after curved PAO, which can lead to impaired clinical outcomes. Conversely, a combination angle <108° was significantly associated with mHHS ≥ 90 points. To avoid postoperative anterior impingement, osteochondroplasty of the femoral head or anterior CE angle control should be performed for patients with preoperative combination angles ≥90°.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Anterior acetabular coverage and femoral head–neck measurements predict postoperative anterior impingement: A simulation study

Hayashi

Hashimoto

Kuroda

et al. 2022

Journal Orthopaedic Research

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“…Surgeons try to achieve a horizontal acetabular weight-bearing area [ 4 ] with PAO while ensuring that the osteotomy sites stay in contact to avoid nonunion. The acetabular inclination (AI) angle should be between 0° and 10°, whereas the CE angle is aimed to be approximately 35° for the best outcome, according to Hartig-Andreasen [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Laterality on Radiographic Outcomes of the Bernese Periacetabular Osteotomy

Heimer

Perka

et al. 2022

JPM

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The purpose of this study was to compare the pre and postoperative radiographic findings and analyze the complication rate with respect to the laterality in periacetabular osteotomy in right-handed surgeons. Satisfaction rate and radiographic findings were prospectively collected between 2017 and 2019 and retrospectively reviewed. For analysis, all measurements of the CT scans were performed by a musculoskeletal fellowship-trained radiologist. Complications were classified into two categories: perioperative or postoperative. All surgeries were performed by three right-hand dominant hip surgeons. A total of 41 dysplastic hips (25 right and 16 left hips) in 33 patients were included. Postoperatively, a significantly lower acetabular index angle on the left side was observed at −2.6 ± 4.3 as compared to the right side at 1.6 ± 6.5 (p < 0.05). The change in Center edge (CE) angle was significantly lower for the left side 13.7 ± 5.5° than on the right side, measured at 18.4 ± 7.3 (p < 0.001); however, the overall CE angle was comparable at 38.5 ± 8.9° without any significant difference between the operated hips (left side at 37.8 ± 6.1° versus right side at 39.0 ± 10.3; p = 0.340). No significant differences in other radiographic measurements or surgical time were observed. For complications, the right side was more commonly affected, which may also explain a higher satisfaction rate in patients who were operated on the left hip with 92.3%. The change in lateral CE angle was significantly lower for the left side and the right hip seems to be predisposed to complications, which correlate with a lower satisfaction rate in right-handed surgeons.

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Shelf acetabuloplasty may inhibit range of motion: A computer simulation analysis

Miyajima,

Kobayashi,

Yukizawa

et al. 2023

Journal Orthopaedic Research

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Shelf acetabuloplasty has been performed in patients with developmental dysplasia of the hip (DDH); however, the appropriate position of the shelf has not been determined, particularly with respect to avoiding range of motion (ROM) loss. The aim of this study was to investigate the frequency of ROM inhibition and the influence of 3D position of the shelf following actual shelf acetabuloplasty and virtual surgery using computer simulation analysis. CT data from 15 patients with DDH who underwent shelf acetabuloplasty were collected between August 2019 and February 2022. 3D models of a hip joint were constructed using Zed Hip®︎. Maximal internal rotation (MIR) at 45° and 90° flexion was measured in each patient. The frequency and position of ROM inhibition was determined in a real postoperative model virtually. In addition, a second analysis using virtual acetabuloplasty was performed. Upon placing the shelf, three patterns were provided for the following four parameters: height, coronal inclination, center‐edge angle (CEA), and anteroposterior position. The predictors for ROM inhibition were analyzed using a logistic regression model.　In the actual postoperative model, a limitation of MIR at 90° and 45° of flexion occurred in 60% and 66.7% of patients, respectively. A higher CEA and anterior position are major factors limiting MIR. The analysis of the virtual shelf acetabuloplasty model revealed that anterior position and CEA were significant factors causing ROM inhibition. As for clinical significance, the results of the current study indicated the optimal location of the shelf to avoid iatrogenic impingement after shelf acetabuloplasty.This article is protected by copyright. All rights reserved.

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Overcorrection of the acetabular roof angle or anterior center–edge angle may cause decrease of range of motion after curved periacetabular osteotomy

Cited by 9 publications

References 22 publications

Anterior acetabular coverage and femoral head–neck measurements predict postoperative anterior impingement: A simulation study

Anterior acetabular coverage and femoral head–neck measurements predict postoperative anterior impingement: A simulation study

The Impact of the Laterality on Radiographic Outcomes of the Bernese Periacetabular Osteotomy

Shelf acetabuloplasty may inhibit range of motion: A computer simulation analysis

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