Rotational Acetabular Osteotomy for Severe Dysplasia of the Hip With a False Acetabulum

Shindo, Hiroyuki; Igarashi, Hayato; Taneda, Hitoshi; Azuma, Hirohiko

doi:10.1302/0301-620x.78b6.0780871

Cited by 13 publications

(15 citation statements)

References 11 publications

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“…Careful 3D planning is required and overcorrection with posterior uncovering must be avoided. 11,18,28 Two recent studies after acetabular osteotomy 29,30 have relied solely on indices obtained from AP radiographs, such as the CE angle, acetabular angle and cover of the femoral head. These may allow some qualitative assessment of the acetabular cover to be made but are limited by potential errors, 2-4 the overlap of bony structures and by the lack of 3D information.…”

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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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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“…In the population described by Janssen et al [10], six radiographs (18.8%) showed radiographic signs of progression of OA at the final followup. Nakamura et al [14] also described an increase in OA with time, graded according to the Japanese Orthopaedic Association [15,16]. Of the 112 hips with Grade I or II OA preoperatively, only 70% (79 hips) still had Grade I or II OA at the last followup, and the rest had progressive degenerative changes.…”

Section: Discussionmentioning

confidence: 99%

Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years?

Stralen

Hellemondt

Ramrattan

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…However, the gender proportion, mean age at CPO, and mean duration of followup were not different between the two groups. Fourth, we defined SD hips as Severin Group IV-b, in accordance with previous research [3,4,[16][17][18][19]. However, the mean preoperative CE angle of our subluxated hips with Severin Group IV-b (À6°) was small compared with those reported in other studies (À11°t o À21.1°), which included dislocated hips classified as Severin Group V. We did not have much experience using periacetabular osteotomy for the treatment of Severin Group V dislocated hips.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, the mean AROs of normal male and female hips [16] were 4.6°and 5.6°, respectively. Studies of other osteotomy techniques showed the mean postoperative ARO was 2.9°to 12.8°, and the mean postoperative HLI was 25.6% to 72.3% [2,3,11,16,17,19,25]. Our study showed using CPO for treatment of SD hips classified as Severin Group IV-b with preoperative CE angles as low as À20°could restore the weightbearing area and medialization without the use of additional techniques (bone grafting at the osteotomy site of the ilium, release of the joint capsule, and adductor tenotomy).…”

Section: Discussionmentioning

confidence: 99%

“…This treatment was chosen because the acetabular fragment was easy to move and reposition, and the size of the gap at the osteotomy surface could be minimized with the curvilinear C-shaped osteotomy [15,21]. Nozawa et al [17] and Shindo et al [19] used a periacetabular osteotomy with a bone graft for the treatment of severe dysplastic hips classified as Severin Group V. Clohisy et al [3,4] and Ninomiya [16] used a periacetabular osteotomy with some additional techniques, such as osteotomy of the proximal femur, release of the joint capsule, and adductor tenotomy, for patients classified as having Severin Groups IV and V hips. Based on previous reports, we assumed the treatment for dislocated hips classified as Severin Group V may require additional techniques to reposition the hip.…”

Section: Introductionmentioning

confidence: 99%

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