The lateral center-edge angle as radiographic selection criteria for periacetabular osteotomy for developmental dysplasia of the hip in patients aged above 13 years

Abstract

Background This retrospective study sought to delineate the radiographic characteristics of DDH patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy. Methods We enrolled patients with Hartofilakidis type I DDH without dislocation who underwent periacetabular osteotomy between August 2009 and August 2012. LCEA, anterior central edge angle (ACEA), femoral neck-shaft angle (FNSA), Shenton line and Tönnis acetabular index (AI) were evaluated by anteroposterior and 65° false⁃profile pelvic X-ray radiographs in the standing position. Femoral neck anteversion angle (FNA), labral lesion, labral inversion and cartilage lesion were evaluated by direct magnetic resonance arthrography. DDH was categorized by LCEA into four grades (grade I: 10° ≤ LCEA< 20°, grade II: 0° ≤ LCEA< 10°, grade III: -10° ≤ LCEA< 0°, grade IV: LCEA<-10) and osteoarthritis (OA) severity was assessed using Tönnis OA classification. Pearson correlation analysis was done between LCEA and other variables. Results Totally patients (274 hips) with a mean age of 27.3 years (range 13–47 years) were included. The mean LCEA was 3.5° (range: − 30° to 20°). Based on LCEA grades, grade I DDH was present in 104 hips, grade II in 40 hips, grade III in 76 hips, and grade IV in 54 hips. Based on Tönnis OA classification, 54.5% hips (150/274) were grade 0, 33.1% hips (91/274) grade 1, 8.4% hips (23/274) grade 2 and 4% hips (11/274) grade 3. Pearson correlation analysis showed a negative correlation between LCEA grade and Tönnis OA grades ( r = 0.3987; P < 0.001). Cochran-Armitage trend test further showed a positive correlation between LCEA grades and labral lesion ( P < 0.001) and interrupted Shenton line ( P < 0.001). Conclusion The LCEA classification scheme offers a simple and practical approach to categorize the level of acetabulum coverage on the femoral head, hip deformity and characteristics of DDH. Our findings could provide clinically useful guidance for orthopedic surgeons in preparation for periacetabular osteotomy in DDH patients aged above 13 years.

Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults

“…negative correlation with the LCEA, which is in accordance with previous studies (Werner et al 2012, Zhang et al 2020).…”

The Three-Dimensional Morphology of Femoral Medullary Cavity in the Developmental Dysplasia of the Hip

“…The subject pool consisted of 56 adult patients (56 hips) who were diagnosed as DDH according to a comprehensive assessment with the lateral center edge angle [the lateral center edge angle <20° ( Zhang et al, 2020 )], acetabular angle [the acetabular angle >47° ( Fujii et al, 2012 )] and qualitative subluxation estimation, and were scheduled for total hip arthroplasty in our clinic from January 2019 to December 2019. The pool also included 30 healthy subjects with no signs of hip disease who acted as the control group ( Table 1 ).…”

Role of the Anterior Center-Edge Angle on Acetabular Stress Distribution in Borderline Development Dysplastic of Hip Determined by Finite Element Analysis

“…Current diagnosis and the severity evaluation mainly rely on the morphologic information, such as the LCEA, the ACEA, the Tönnis angle, and so on, which were provided by medical imaging. It has been reported that the LCEA could be considered as a reliable index because it is closely related to other radiographic markers and is highly associated with cartilage damage and osteoarthritis severity ( Zhang et al, 2020 ). Moreover, it has been extensively used for the clinical diagnosis of DDH.…”