The morphology of the femur in developmental dysplasia of the hip

Sugano, Nobuhiko; Noble, Philip C.; Kamaric, Emir; Salama, Joseph K.; Ochi, T.; Tullós, Hugh S.

doi:10.1302/0301-620x.80b4.0800711

Cited by 181 publications

(184 citation statements)

References 22 publications

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“…Total hip replacement on patients with CDH of the hip is a technical challenge (Sugano et al 1998). The survivorship in our study is on a par with that of the best uncemented stems in the Swedish Hip Register (Malchau et al 2002).…”

Section: Discussionmentioning

confidence: 65%

Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: An RSA, clinical and radiographic study

et al. 2006

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Section: Discussionmentioning

confidence: 65%

Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: An RSA, clinical and radiographic study

et al. 2006

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“…However, the simplification of the complex interaction between the acetabular and femoral shape to a 2-D model might be insufficient. Three-dimensional measurements described in the literature based on CT scans mainly focus on the special morphology of the dysplastic shaft of the proximal femur and its implications for total hip arthroplasty [1,2,23,28,33]. Previous studies of the epiphysis of the longitudinal growth plate of the femur [32] cannot be Table 2.…”

Section: Discussionmentioning

confidence: 99%

Femoral Morphology Differs Between Deficient and Excessive Acetabular Coverage

Steppacher

Tannast

Werlen

et al. 2008

Clinical Orthopaedics &Amp; Related Research

144

111

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Structural deformities of the femoral head occurring during skeletal development (eg, Legg-Calvé-Perthes disease) are associated with individual shapes of the acetabulum but it is unclear whether differences in acetabular shape are associated with differences in proximal femoral shape. We questioned whether the amount of acetabular coverage influences femoral morphology. We retrospectively compared the proximal femoral anatomy of 50 selected patients (50 hips) with developmental dysplasia of the hip (lateral center-edge angle [LCE] B 25°; acetabular index C 14°) with 45 selected patients (50 hips) with a deep acetabulum (LCE C 39°). Using MRI arthrography we measured head sphericity, epiphyseal shape, epiphyseal extension, and femoral head-neck offset. A deep acetabulum was associated with a more spherical head shape, increased epiphyseal height with a pronounced extension of the epiphysis towards the femoral neck, and an increased offset. In contrast, dysplastic hips showed an elliptical femoral head, decreased epiphyseal height with a less pronounced extension of the epiphysis, and decreased head-neck offset. Hips with different acetabular coverage are associated with different proximal femoral anatomy. A nonspherical head in dysplastic hips could lead to joint incongruity after an acetabular reorientation procedure.

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“…The axis of the femoral neck was defined as a straight line that passed through the center of the femoral head and which fit best to the centroids of 2-mm slices through a central segment of the neck. 17 2. The osteotomy surface of the TRO simulation was defined as a spherical surface with its center at the center of the femoral head (Fig.…”

Section: Segmentationmentioning

confidence: 99%

MRI‐based surgical simulation of transtrochanteric rotational osteotomy for femoral head osteonecrosis

Koyama

Sugano

Nishii

et al. 2009

Journal Orthopaedic Research

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Transtrochanteric rotational osteotomy (TRO) is one of the joint-preserving surgical treatments for osteonecrosis of the femoral head (ONFH). It can prevent collapse of the femoral head as necrotic lesions in the weight-bearing portion can be moved sufficiently to a less weight-bearing portion by anterior rotation, posterior rotation, or varus angulation. Patient selection and preoperative planning are important to determine indications for TRO. It has been reported that successful TRO requires at least 34% of the weight-bearing area supported by the intact part of the femoral head. However, this ratio is difficult to preoperatively quantify according to the rotation angle using conventional two-dimensional MR images or X-rays. Therefore, we developed a method of simulating TRO using three-dimensional (3D) models reconstructed from 3D MR images and applied it to serial patients with types C1 and C2 osteonecrosis at stage 1 or 2. The simulation visualized positional changes of the necrotic lesion in the weight-bearing area and enabled quantitation of the postoperative intact ratio. Our surgical simulation is useful for evaluating the postoperative intact ratio and for determining indications for TRO as well as the optimal angle of femoral head rotation and varus angulation. Osteonecrosis of the femoral head (ONFH) predominantly occurs in young and middle-aged adults. 1 If a necrotic lesion in the weight-bearing portion is large, the femoral head will progressively collapse in the natural course, resulting in osteoarthrosis of the hip that requires total hip arthroplasty even in young patients. The ratio to which the necrotic lesion of the ONFH occupies the weight-bearing portion of the acetabulum on anteroposterior (AP) radiographs or magnetic resonance (MR) images has been reported to be closely associated with the prognosis of idiopathic ONFH. 2 The type classification of idiopathic ONFH by the working group of the Japanese Ministry of Health, Labor and Welfare 3 is based on this ratio and consists of types A, B, C1, and C2 (Fig. 1). Patients with type C1 and C2 lesions that exceed the medial two-thirds of the weight-bearing portion have a poor prognosis of progressive collapse in the absence of surgical intervention, 2 so joint-preserving strategies such as osteotomy are important for such patients.Transtrochanteric rotational osteotomy (TRO) 4-6 is one of the joint-preserving surgical treatments for ONFH (Fig. 2), that can prevent collapse of the femoral head and consequent osteoarthrosis of the hip. To achieve this, the necrotic lesion of the femoral head in the weight-bearing portion must be moved sufficiently to less weight-bearing portion after transtrochanteric osteotomy by rotating the femoral head and neck anteriorly or posteriorly along the femoral neck axis with or without varus angulation. To accurately determine indications for TRO, and for TRO to be successful, patient selection and preoperative planning are critical. It has been reported that the ratio of the transposed intact articular...

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The morphology of the femur in developmental dysplasia of the hip

Cited by 181 publications

References 22 publications

Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: An RSA, clinical and radiographic study

Comparison of the uncemented Cone and the cemented Bimetric hip prosthesis in young patients with osteoarthritis: An RSA, clinical and radiographic study

Femoral Morphology Differs Between Deficient and Excessive Acetabular Coverage

MRI‐based surgical simulation of transtrochanteric rotational osteotomy for femoral head osteonecrosis

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