Safe fixation with two acetabular screws after Ganz periacetabular osteotomy

Mechlenburg, Inger; Kold, Søren; Rømer, Lone; Søballe, Kjeld

doi:10.1080/17453670710013906

Cited by 20 publications

(21 citation statements)

References 22 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparing the original Tönnis angles (Table 1) with those determined at the optimal CE angle (Table 6), the optimal CE angle position represents a reduction in Tönnis angle for hips CE10, CE13, CE20, and CE29, to angles that were either within or close to what is considered the normal range, 1–10° 10. The Tönnis angle for CE28 was increased slightly at the optimal CE angle; however, this may be due to the abnormal shape of the head for this hip.…”

Section: Resultsmentioning

confidence: 99%

“…The CE angle in a normal hip is >25°. A hip with a CE angle <20° may be diagnosed as DDH 9, 10. The periacetabular osteotomy (PAO) to correct DDH depends on the clinical condition of the patient and the severity of the disease 8.…”

mentioning

confidence: 99%

“…The periacetabular osteotomy (PAO) to correct DDH depends on the clinical condition of the patient and the severity of the disease 8. Bernese PAO is a type of pelvic osteotomy described by Ganz et al11 that changes the position of the acetabulum to increase coverage of the head, stabilizing the joint and reducing contact pressure 4–10, 12…”

mentioning

confidence: 99%

See 2 more Smart Citations

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Zou

Chávez-Arreola

Mandal

et al. 2012

Journal Orthopaedic Research

View full text Add to dashboard Cite

Periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in developmental dysplasia of the hip (DDH). It changes the position of the acetabulum to increase femoral head coverage and distribute the contact pressure over the cartilage surface. The success of PAO depends significantly on the surgeon's experience. Using computed tomography data from patients with DDH, we developed a 3D finite element (FE) model to investigate the optimal position of the acetabulum following PAO. A virtual PAO was performed with the acetabulum rotated in increments from the original center edge (CE) angle. Contact area, contact pressure, and Von Mises stress in the femoral and pelvic cartilage were analyzed. Five dysplastic hips from four patients were modeled. Contact area, contact pressure, and Von Mises stress in the cartilage all varied according to the change of CE angle through virtual PAO. An optimal position could be achieved for the acetabulum that maximizes the contact area while minimizing the contact pressure and von Mises stress in the pelvic and femoral cartilage. The optimal position of the acetabulum was patient dependent and did not always correspond to what would be considered a ''normal'' CE angle. We demonstrated for the first time the interrelation of correction angle, contact area, and contact pressure between the pelvic and femoral cartilage in PAO surgery. Keywords: developmental dysplasia of the hip; periacetabular osteotomy; finite element Developmental dysplasia of the hip (DDH) is an abnormal development of the acetabulum, the femoral head or both. It affects between 1% and 3% of newborn babies and was shown to be the cause of 29% of hip replacements in people under the age of 60. 1 Apart from the pain and discomfort associated with DDH, lack of treatment may lead to osteoarthritis and significant disability. In childhood, early diagnosis and treatment may allow appropriate bony development and avoid complicated and hazardous surgical procedures. However in adults, osteotomy is often the most appropriate treatment. The success largely depends on the surgeon's experience. [2][3][4][5][6][7][8] The diagnosis of DDH is based on the center edge (CE) angle formed by a vertical line passing through the center of the femoral head and a line from the center of the head to the edge of the acetabulum (Fig. 1). The CE angle in a normal hip is >258. A hip with a CE angle <208 may be diagnosed as DDH. 9,10 The periacetabular osteotomy (PAO) to correct DDH depends on the clinical condition of the patient and the severity of the disease. 8 Bernese PAO is a type of pelvic osteotomy described by Ganz et al. 11 that changes the position of the acetabulum to increase coverage of the head, stabilizing the joint and reducing contact pressure. [4][5][6][7][8][9][10]12 The advantages of the Ganz PAO over other pelvic osteotomies are: the cuts are reproducible and can be performed with one incision; post-operatively the posterior column is intact and patients do not need a cast or brace;...

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Zou

Chávez-Arreola

Mandal

et al. 2012

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…The approach involves minor incision of the soft tissue and early mobilization ( Troelsen et al 2000 ). Radiological follow-up ( Mechlenburg et al 2007 , 2009 ) and clinical follow-up ( Troelsen et al 2000 ) after minimally invasive PAO have been reported, but little is known about objective measures of physical function. Decreased hip flexion moment and reduced walking speed in patients undergoing PAO have been reported in 2 prospective studies ( Pedersen et al 2006 , Sucato et al 2010 ).…”

mentioning

confidence: 99%

Joint kinematics and kinetics during walking and running in 32 patients with hip dysplasia 1 year after periacetabular osteotomy

et al. 2014

Self Cite

View full text Add to dashboard Cite

Background and purpose — Hip dysplasia can be treated with periacetabular osteotomy (PAO). We compared joint angles and joint moments during walking and running in young adults with hip dysplasia prior to and 6 and 12 months after PAO with those in healthy controls.Patients and methods — Joint kinematics and kinetics were recorded using a 3-D motion capture system. The pre- and postoperative gait characteristics quantified as the peak hip extension angle and the peak joint moment of hip flexion were compared in 23 patients with hip dysplasia (18–53 years old). Similarly, the gait patterns of the patients were compared with those of 32 controls (18–54 years old).Results — During walking, the peak hip extension angle and the peak hip flexion moment were significantly smaller at baseline in the patients than in the healthy controls. The peak hip flexion moment increased 6 and 12 months after PAO relative to baseline during walking, and 6 months after PAO relative to baseline during running. For running, the improvement did not reach statistical significance at 12 months. In addition, the peak hip extension angle during walking increased 12 months after PAO, though not statistically significantly. There were no statistically significant differences in peak hip extension angle and peak hip flexion moment between the patients and the healthy controls after 12 months.Interpretation — Walking and running characteristics improved after PAO in patients with symptomatic hip dysplasia, although gait modifications were still present 12 months postoperatively.

show abstract

“…At this stage, the applicability of an intrapelvic plate was determined; however, because previous biomechanical studies showed that 2 screws were sufficient for ideal fixation, plate fixation was not performed. 21 …”

Section: Methodsmentioning

confidence: 99%

Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study

Elmadağ

Uzer

Yıldız

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

View full text Add to dashboard Cite

ObjectiveThe aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO).MethodsThe Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations.ResultsAfter the osteotomy, the mean CE angle was improved from 19.8° to 25.2°, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers.ConclusionsBilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed.

show abstract

Safe fixation with two acetabular screws after Ganz periacetabular osteotomy

Cited by 20 publications

References 22 publications

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis

Joint kinematics and kinetics during walking and running in 32 patients with hip dysplasia 1 year after periacetabular osteotomy

Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study

Contact Info

Product

Resources

About