Preoperative and Postoperative Assessment of Rotational Acetabular Osteotomy for Dysplastic Hips in Children by Three-Dimensional Surface Reconstruction Computed Tomography Imaging

Azuma, Hirohiko; Taneda, Hitoshi; Igarashi, Hayato; Fujioka, Masashi

doi:10.1097/01241398-199010010-00007

Cited by 35 publications

(20 citation statements)

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“…Anterior rotation, ie, forward tilt or extension, of the acetabular fragment is one of the conventional maneuvers performed during periacetabular osteotomies to correct anterolateral acetabular deficiency. However, previous studies suggested anterior rotation of the acetabulum can aggravate posterior acetabular insufficiency [3,16]. Our observations confirmed anterior rotation of the acetabular fragment is an anatomically reasonable maneuver for patients with an anterolateral deficiency to enhance the anterior and anterosuperior articulating surfaces on the femoral head.…”

Section: Discussionsupporting

confidence: 74%

Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia

Fujii

Nakashima

Sato

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 74%

Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia

Fujii

Nakashima

Sato

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Although Azuma et al [2,16] reported an average one-grade improvement in anterior coverage at the expense of a onegrade decrease in posterior coverage, we observed no such effect in our study. We believe that decreased posterior coverage is related more to external transverse rotation than anterior rotation of the acetabular fragment and onegrade of external transverse rotation costs one grade in posterior coverage.…”

Section: Discussioncontrasting

confidence: 55%

“…Tonnis [13,14] used vertically placed K-wire to monitor transverse plane rotation intraoperatively, and the figure-of-four maneuver with temporal internal fixation of the hip was used by Pol Le Coeur [15]. While these authors demonstrated the ease of their methods to displace the acetabular fragment and achieve correction of the dysplasia, many others [1,2,16] have demonstrated the presence of unintended position of the acetabulum postoperatively, leading to excessive external rotation, retroversion or decreased posterior coverage. We believe that the assessment to obtain normalization of the acetabular deficiencies should analyze all the parameters around the femoral head and compare the final aspect of the osteotomized acetabulum to the opposite NOH.…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional computed tomography analysis and anteversion study after periacetabular osteotomy of pelvis in children

Jawish

Khalife²,

Ghorayeb³

2007

Journal of Children's Orthopaedics

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Purpose Three-dimensional computed tomography (CT) is the method of choice in understanding the morphological changes after periacetabular osteotomy in children. We studied different parameters and compared aspects of operated hip (OH) with non-operated hip (NOH) to define the maneuver that promotes normalization of the hip during repositioning of the acetabulum. Methods A total of 22 patients with 25 OHs underwent CT control scans an average of 4 years after surgery. The patients, with a mean age of 6.8 years, had either Legg-Calvé-Perthes disease (12 cases) or dysplasia (10 cases).The measurements included the anterior and posterior coverage angles of the hip and version of the acetabulum on axial CT views. The 3D reconstructed images measured the inclination of the antero– and postero–lateral lips, the external rotation and the anterior inclination of the acetabulum. Results The mean anterior coverage angle was 27° for OHs, 31° for NOHs, and 12° versus 10.3° for the posterior coverage angle. Acetabular anteversion was 2° for OHs (6.3° in the dysplastic OHs) and 6° for NOHs. The mean angle of inclination of the antero–lateral lip was 37° for OHs, 47° for NOHs, and the postero–lateral lip inclination was 56° for OHs and 67° for NOHs. Inferior 3D views showed a mean internal acetabular rotation of 1.5° (4.8° in the dysplastic OH), 3° for NOH. The anterior acetabular inclination angle measured with lateral 3D views was 6° for OHs, 11° for NOHs. Conclusion Our analysis demonstrated a mean anteversion of the acetabulum despite normalization of the anterior coverage of the hip, particularly in the dysplastic group, in which the osteotomized fragments had anteversion superior to NOH. The unexpected external rotation used to improve anterior coverage of a coax magna in Legg-Calvé-Perthes disease was responsible for the retroversion and the decrease of the posterior coverage.

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“…Malpositioning leads to insufficient femoral head coverage, restricted ROM, femoroacetabular impingement, and progressive osteoarthritis leading to hip arthroplasty [9,16,20,28,53]. The position for optimal correction is specific for each patient, and fairly narrowly defined [54].…”

Section: Introductionmentioning

confidence: 99%

Pelvic Positioning Creates Error in CT Acetabular Measurements

Bosse¹,

Lee

Henderson

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background CT allows for accurate measurement of acetabular orientation and shape, but malpositioning of the pelvis may lead to measurement variance. Purpose We therefore sought to determine: (1) whether acetabular anteversion measurements using the femoral head centers differed from those using the posterior ischia, and (2) the extent to which changing obliquity, rotation, and tilt of a pelvis in a CT scanner affected the measurement of acetabular variables. Methods A radiopaque human pelvis model with articulated hips was suspended from a plastic sheet as part of an adjustable frame. Changes in the transverse and sagittal planes created rotation and tilt, while rotating the frame in the coronal plane created obliquity. CT scans were obtained, varying the combinations of obliquity, rotation, and tilt by intervals of 5°, up to 20°. Acetabular anteversion (AA), anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), and horizontal acetabular sector angle (HASA) were measured. Results The two methods for measuring AA yielded values differing by 1°to 4°but correlated (r = 0.981) across the spectrum of pelvis positioning. Pelvic obliquity and tilt were linearly associated with changes in the measurements. For each 1°-increase in pelvic obliquity, AA changed À0.4°, and AASA, PASA, and HASA changed 1.93°, 0.99°, and 2.80°, respectively. For each 1°-increase in pelvic tilt, AA changed 0.8°, and AASA, PASA, and HASA changed À1.07°, 0.52°, and À0.51°, respectively. Rotation had no affect on the variables. Conclusions Small changes in pelvic obliquity and tilt were associated with variances in acetabular measurements. The measured changes were directly proportional to the changes in obliquity and tilt, and were additive. Pelvic rotation created no changes in measurement. Clinical Relevance Incorrect interpretation of acetabular anteversion and coverage may lead to unsatisfactory acetabular fragment positioning during reorientational surgery. Although intraoperative positioning of an acetabular fragment may not be as precise as the tools for preoperative planning, it is important for a surgeon to have the most precise data available for planning a procedure, and know where error can occur in collecting the data.Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Preoperative and Postoperative Assessment of Rotational Acetabular Osteotomy for Dysplastic Hips in Children by Three-Dimensional Surface Reconstruction Computed Tomography Imaging

Cited by 35 publications

References 0 publications

Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia

Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia

Three-dimensional computed tomography analysis and anteversion study after periacetabular osteotomy of pelvis in children

Pelvic Positioning Creates Error in CT Acetabular Measurements

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