Gender and disease severity determine proximal femoral morphology in developmental dysplasia of the hip

Boughton, Oliver; Uemura, Keisuke; Tamura, Kazushi; Takao, Masaki; Hamada, Hirofumi; Cobb, Justin P.; Sugano, Nobuhiko

doi:10.1002/jor.24272

Cited by 19 publications

(18 citation statements)

References 45 publications

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“…Fifty‐three consecutive cases of patients who underwent primary curved periacetabular osteotomy for developmental dysplasia of the hip (DDH) between April 2009 and November 2017 were identified for initial consideration for this study, which was approved by our Institutional Review Boards. This patient cohort was selected as changes in PSI alters femoral head coverage in patients with DDH, 17 a disease found predominantly in women which is the main cause of secondary hip osteoarthritis in Japan 18,19 . Since only three of these 53 patients were male, the males were excluded to homogenize the cohort, leaving 50 female cases.…”

Section: Methodsmentioning

confidence: 99%

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Uemura

Atkins

Okamoto

et al. 2020

Journal Orthopaedic Research

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Pelvic sagittal inclination (PSI) is often evaluated in patients with hip pathology using lateral radiographs. However, it would be useful if PSI could be predicted from an anteroposterior radiograph since this film is ubiquitous in the evaluation of hip pathology. Herein, computer‐modeling was applied to predict PSI from radiographic measurements assessed in the anteroposterior plane. Three‐dimensional surface models of the pelvis, femur, and sacrum were reconstructed from computed tomography images of 50 women with hip dysplasia. This study cohort was selected as changes in PSI alter femoral head coverage, which is relevant to the diagnosis and treatment of hip dysplasia, a known cause of hip osteoarthritis. Five radiographic parameters commonly used to independently estimate PSI were evaluated after bone surfaces were projected to an anteroposterior plane, including the symphysis to sacrococcygeal joint distance (S‐S distance), the pelvic foramen aspect ratio (PF ratio), the distance between the symphysis and a line connecting the femoral head centers (S‐H distance), the sacro‐femoral‐pubic angle (SFP angle), and the pelvic vertical ratio (PVR). Regression models determined the ability of these parameters to predict PSI from −20° to 20° at 1° increment. All five parameters showed a strong correlation with the PSI (all r > 0.9). From the regression models, PSI was estimated with a median (maximum) absolute error of 3.6° (18.4°), 3.8° (17.7°), 5.2° (17.9°), 5.8° (28.8°), and 3.2° (23.5°) for the S‐S distance, PF ratio, S‐H distance, SFP angle, and PVR, respectively. The regression model for S‐S distance had a mean slope of 2.18 that ranged from 1.98 to 2.41 when the sacrococcygeal joint was located superior to the symphysis. Results indicated that substantial errors occur when estimating the actual value of PSI from an anteroposterior radiograph. However, the change in PSI could be estimated from the S‐S distance, which may aid surgeons to successfully increase head coverage through periacetabular osteotomy and to locate the acetabular cup in a functional position for total hip arthroplasty.

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Section: Methodsmentioning

confidence: 99%

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Uemura

Atkins

Okamoto

et al. 2020

Journal Orthopaedic Research

Self Cite

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“…Compared with their findings, the current study showed similar correlations, but smaller differences. In their study, patients with Crowe types were not listed, which demonstrates different femoral anteversion, and larger differences than that of other previous studies were shown.…”

Section: Discussionmentioning

confidence: 78%

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Zhai

Zhang

et al. 2020

Orthopaedic Surgery

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Objective: To investigate the optimal level of femoral neck for measuring femoral anteversion to predict postoperative stem anteversion in Crowe type I developmental dysplasia of the hip.Methods: This retrospective study analyzed 108 Crowe type I hips that underwent THA between January 2016 and December 2017, including 70 women and 19 men with a mean age of 63.08 AE 9.13 (range, 41-83) years. The single-wedge stem was used in 37 hips, the double-wedge stem was used in 71 hips. Computed tomography scans were performed pre-and post-operation. Femoral anteversion at six levels of the proximal femur were measured via preoperative two-dimensional computed tomography. Femoral anteversion at the level of the femoral neck osteotomy plane and postoperative stem anteversion were measured via three-dimensional reconstructed models.Results: The mean follow-up period was 18.5 months (range, 12-27 months). The mean preoperative Harris Hip Score was 51.5 AE 8.7 and improved to 90.4 AE 7.8 (P < 0.001) by the last follow-up. There were no intraoperative fractures, and no infections occurred during the follow-up period. Two patients developed deep venous thrombosis. There was no sign of prosthetic loosening in all hips. No significant correlations were found between the height of the femoral neck osteotomy plane and postoperative stem anteversion (r = −0.119, P = 0.220). Femoral anteversion decreased gradually from 64.00 AE 10.51 at the center of lesser trochanter to 15.21 AE 13.31 at the head-neck junction, which was changed from more to less than stem anteversion (24.37 AE 13.86 ). The femoral anteversion at femoral head-neck junction (15.21 AE 13.31 ) was significantly less than postoperative stem anteversion (P = 0.000), with a difference of −9.16 AE 9.27 . The femoral anteversion at the level of the osteotomy plane (28.48 AE 15.34 ) was significantly more than the postoperative stem anteversion (P = 0.000), with a difference of 4.11 AE 9.56 . Among all six levels and the level of osteotomy, femoral anteversion at the 10-mm level above the proximal base of lesser trochanter (22.65 AE 12.92) displayed the smallest difference (−1.72 AE 8.90 ) and a good correlation (r = 0.764) with postoperative stem anteversion for all 108 hips, with a moderate correlation of 0.465 for single-wedge stem hips and an excellent correlation of 0.821 for double-wedge stem hips.Conclusion: For Crowe type I hips, femoral anteversion would be different if it was measured via different levels of the femoral neck. The 10-mm level above the proximal base of the lesser trochanter could be an optimum choice for measuring femoral anteversion to predict postoperative stem anteversion.

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“…clearly de ned FNA as the angle between the femoral neck axis and condylar plane (determined by the femoral shaft axis and the femoral condyle axis), which has been widely recognized [4]. With technology progresses, it is found that FNA is closely related to the hip stress and dysplasia, and is critical for the choice of surgical methods [5,6]. Therefore, how to accurately measure FNA has always been a hotspot in the orthopaedic eld.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of CT for Measuring Femoral Neck Anteversion in Children With Developmental Dislocation of the Hip Verified Using 3D Printing Technology

Cai¹,

Piao

Zhang

et al. 2021

Preprint

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Background: Accurate femoral neck anteversion angle (FNA) measurement is of great significance in the diagnosis and treatment of developmental dysplasia of the hip (DDH) in children. The FNA measurement still remains a controversy. We aimed to verify the accuracy of our CT method by 3D printing technology , and to evaluate its clinical value. Methods: Sixty-eight children with unilateral DDH were enrolled, and their FNA was measured using 2D-CT and 3D-CT, respectively, by three observers. This procedure was repeated 3 months later. The above measurement outcomes were then compared with the results in the 3D-printed femur (3D-PF) model. The FNA in the 3D-PF model was measured by three observers collectively through electronic angle instrument. Results: The primary measurement of FNA at the affected hips by 2D-CT was 44.0±6.1, 49.5±8.9 and 52.8±7.9 degrees, respectively. On the 3D-CT, it was 47.6±5.4, 49.3±6.8 and 48.6±6.2 degrees. Three months later, the FNA on 2D-CT was 49.3±10.5, 42.8±7.4 and 45.1±9.3 degrees, and it was 48.0±6.5, 48.9±7.2 and 49.0±5.7 degrees on 3D-CT, respectively. The FNA in the 3D-PF model at the affected and unaffected hips was 48.5±6.6 and 36.9±13.1 degrees. There were significant differences between 2D-CT and 3D-PF measurements, but no significant difference was found between 3D-CT and 3D-PF measurements. The results by 2D-CT showed significant differences among groups and between the groups. However, the results by 3D-CT had no significant differences among groups or between the groups. Conclusion: The results of our study showed that 3D-CT is a more precise, and reproducible method for FNA measurement in DDH. The FNA at the affected hips is 11.6 degree larger than the unaffected in DDH children aged 3-8 years.

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Gender and disease severity determine proximal femoral morphology in developmental dysplasia of the hip

Cited by 19 publications

References 45 publications

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination?

Optimal Level of Femoral Neck for Predicting Postoperative Stem Anteversion in Total Hip Arthroplasty for Crowe Type I Dysplastic Hip

Accuracy of CT for Measuring Femoral Neck Anteversion in Children With Developmental Dislocation of the Hip Verified Using 3D Printing Technology

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