Assessing the Weight-Bearing Surface in Dysplastic Acetabulae: The Sourcil Index

Horberg, John V.; Bailey, Jean; Mikesell, Tim A.; Graham, R. David; Allan, Douglas C.

doi:10.1016/j.artd.2021.07.006

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…A quarter of those in the ‘unreported’ group had an LCEA <15 which is universally agreed to be dysplastic 9,13–15 . The LCEA was infrequently included in reports and the agreement between these values and the operating surgeons was poor, while assessors' interobserver reliability was excellent overall and is comparable with that reported in the literature 16,17 …”

Section: Discussionmentioning

confidence: 73%

“…9,[13][14][15] The LCEA was infrequently included in reports and the agreement between these values and the operating surgeons was poor, while assessors' interobserver reliability was excellent overall and is comparable with that reported in the literature. 16,17 There are many potential pitfalls in the measurement of the LCEA. Errors in measurement such as inclusion of the lateral bony margin in the LCEA calculation and failure to correct for pelvic orientation contributed to the under reporting of dysplasia in our cohort, see Figure 1.…”

Section: Discussionmentioning

confidence: 99%

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Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports

Woodward,

Lightfoot,

Vesey

et al. 2023

J Med Imag Rad Onc

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IntroductionTimely recognition of dysplastic hip morphology is critical to facilitate appropriate management before significant joint damage has developed. It is likely that radiologist under reporting contributes to delays in diagnosis. This study aimed to assess how often adult hip dysplasia goes undetected in radiological reports and to identify clinical and radiological variables that impact the likelihood of detection of dysplasia by radiologists.MethodsReferral details and radiology reports of patients who underwent periacetabular osteotomy by a single surgeon for symptomatic hip dysplasia between 1 January 2016 and 30 June 2020 were reviewed. Four assessors measured the lateral centre edge angle from the pelvic radiograph performed at time of referral. Film quality and other radiographic parameters were also assessed.ResultsSixty‐eight patients were included, 84% were female and the median age was 28.1 years. Dysplasia was not documented in the radiology report in 49% of cases. Dysplasia was more likely to be reported with no history of injury, an aspherical femoral head, lower lateral centre edge angle, higher acetabular index, increased femoral head shaft angle, higher femoro‐epiphyseal acetabular roof index, or if there was disruption of Shenton's line, with the first three variables being independent predictors of radiologist detection.ConclusionHip dysplasia should be considered in all adolescents/young adults presenting with hip pain. Causes of radiologist under reporting are likely multifactorial. Clinical information can cause cognitive biases and result in selective looking. A systematic approach to pelvis radiographs should include assessment of acetabular coverage and active search for evidence of femoral head migration.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports

Woodward,

Lightfoot,

Vesey

et al. 2023

J Med Imag Rad Onc

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Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage

Rivas,

Weinstein,

Tatum

et al. 2024

Clin Orthop Relat Res

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Background The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. Questions/purposes To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the “acetabular sourcil” location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? Methods Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient’s standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the “time” separating the 3D acetabular contributions of the sourcil edges was performed. Results The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. Conclusion Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. Clinical Relevance This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.

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Microfilm Coatings: A Biomaterial-Based Strategy for Modulating Femoral Deflection

Olivares-Hernandez,

Olivares-Robles,

Méndez-Méndez

et al. 2024

JFB

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Wear on the surface of the femoral head increases the risk of hip and femur fractures. Biomechanical experiments conducted on the femur are based on its bending and torsional rigidities. Studies regarding the deflection of the femur bone when the femoral head is coated with microfilms composed of durable and compatible biomaterials are poor. This study aimed to investigate the effects of different biomaterial microfilm coatings over the femoral head on the deflection of the human femur. We utilized 2023 R1 finite element analysis (FEA) software to model the directional deformation on the femoral head and examine the femur’s deflection with varying microfilm thicknesses. The deflection of the femur bone was reported when the femoral head was uncoated and coated with titanium, stainless steel, and pure gold microfilms of different thicknesses (namely, 50, 75, and 100 μm). Our results show that the femur’s minimum and maximum deflection occurred for stainless steel and gold, respectively. The deformation of the femur was lower when the femoral head was coated with a 50-micrometer microfilm of stainless steel, compared to the deformation obtained with gold and titanium. When the thickness of the microfilm for each of the materials was increased, the deformation continued to decrease. The minimum deformation of the femur occurred for a thickness of 100 μm with stainless steel, followed by titanium and gold. The difference in the directional deformation of the femur between the materials was more significant when the coating was 100 μm, compared to the thicknesses of 50 and 75 μm. The findings of this study are expected to significantly contribute to the development of advanced medical techniques to enhance the quality of life for patients with femur bone-related issues. This information can be used to develop more resilient coatings that can withstand wear and tear.

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Assessing the Weight-Bearing Surface in Dysplastic Acetabulae: The Sourcil Index

Cited by 4 publications

References 17 publications

Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports

Hip dysplasia hiding in plain sight: A retrospective analysis of radiology reports

Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage

Microfilm Coatings: A Biomaterial-Based Strategy for Modulating Femoral Deflection

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