Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up

Armiger, Robert S.; Armand, Mehran; Tallroth, Kaj; Lepistö, Jyri; Mears, Simon C.

doi:10.3109/17453670902947390

Cited by 72 publications

(89 citation statements)

References 28 publications

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“…However, the number of patients with an acetabular or femoral head cyst before PAO was low and we encourage caution with any interpretations. Since six patients had a decrease in cyst volume, a regenerative process can take place in the bony tissue after PAO where the biomechanical loading on the hip changes [2,11]. In our study, this was supported by all bone cysts except two being located anterolaterally in the hip, where degeneration in the dysplastic hip often is found [7] and where peak contact stress is localized [21,27].…”

Section: Discussionsupporting

confidence: 65%

Cartilage Thickness and Cyst Volume Are Unchanged 10 Years After Periacetabular Osteotomy in Patients Without Hip Symptoms

Mechlenburg

Nyengaard

Gelineck

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Periacetabular osteotomy (PAO) may affect cartilage thickness and cyst volume in patients with hip dysplasia. However, as no studies randomizing patients to either PAO or conservative treatment have been performed, to our knowledge, it is unknown if PAO directly affects the development or progression of osteoarthritis in patients with hip dysplasia. Questions/purposes We investigated (1) changes of cartilage thickness in the hip after PAO; (2) how many patients had subchondral bone cysts in the acetabulum or femoral head; (3) changes in cyst volume; and (4) patients' hip function and pain after PAO. Patients and Methods In this prospective study, 26 patients (22 women and four men) with hip dysplasia were enrolled with the goal of having MRI of the hip before undergoing PAO and again at 1, 2 1 .2, and 10 years after PAO. Of the 26 patients, 17 (65%) underwent complete followup 10 years after PAO, whereas nine could not be included. Of those nine, three had undergone THA, three had substantial hip symptoms, and three were lost to followup. Thickness of acetabular and femoral cartilage and volume of subchondral bone cysts were estimated in the remaining 17 patients. Ten years postoperatively, the patients' Hip disability and Osteoarthritis Outcome Scores (HOOS) were collected. Results Preoperatively, the mean thickness of the acetabular cartilage was 1.38 ± 0.14 mm compared with 1.43 ± 0.07 mm 10 years postoperatively (p = 0.73). The mean thickness of the femoral cartilage preoperatively was 1.37 ± 0.20 mm compared with 1.30 ± 0.07 mm 10 years postoperatively (p = 0.24). Seven patients had an increase in cyst volume, six had a decrease, and four had no cysts to start with and remained without cysts. Preoperatively, the median total cyst volume per patient was 6.0 cm 3 (range, 1.6-188.3 cm 3 ) compared with 2.9 cm 3 (range, 0.7-8.2 cm 3 ) (p = 0.18) at 10 years followup. At 10 years, the mean subscores for the HOOS were: pain, 79 ± 16;

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Section: Discussionsupporting

confidence: 65%

Cartilage Thickness and Cyst Volume Are Unchanged 10 Years After Periacetabular Osteotomy in Patients Without Hip Symptoms

Mechlenburg

Nyengaard

Gelineck

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Finite element analysis has shown that reconstructive procedures such as the Bernese periacetabular osteotomy (PAO) can increase joint contact area and decrease joint contact pressures [6,36] but cannot reach predicted normal values, probably because of the irregular shape of dysplastic hips [20,74]. Medium-term results (5.5 years to 15 years) after PAO show a rate of conversion to THA between 7% and 15% [19,36,43,68].…”

Section: Discussionmentioning

confidence: 99%

How Are Dysplastic Hips Different? A Three-dimensional CT Study

Bosse

Wedge

Babyn

2015

Clinical Orthopaedics &Amp; Related Research

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Background Surgical correction of acetabular dysplasia can postpone or prevent joint degeneration. The specific abnormalities that make up the dysplastic hip are controversial. Questions/purposes (1) What are the relative size, shape, and orientations of the typical nondysplastic hip? (2) How do these variables differ in the developmentally dysplastic hip? (3) Are there version differences between the acetabuli of dysplastic and nondysplastic hips? (4) Are there pairs of variables in which the change in one is always accompanied by a change in the other for both nondysplastic and dysplastic acetabuli? Methods Of 117 consecutive three-dimensional (3-D) CT scans performed for hip dysplasia between March 1988 and October 1995, 48 met criteria of developmentally dysplastic hips by plain radiography. These were retrospectively compared with 55 pelvic 3-D CT scans culled from 81 consecutive scans performed for reasons other than hip dysplasia (ie, hip pain, trauma, infection) that did not affect the hip or pelvic landmarks. The 3-D reconstructions were orientated anatomically for standardization of the measurements to be compared. Representative 3-D volumes of the acetabular space were constructed from which we could measure anatomic positions and dimensional information. One author performed all image orientation and measurements. Results Nondysplastic acetabuli are essentially hemispheric with height equal to width and twice the depth. The dysplastic acetabuli were elongated in females (52.4 ± 6.2 mm for dysplastic versus 46.5 ± 4.6 mm for nondysplastic (mean difference, 5.0; 95% confidence interval [CI], 1.9-8.0; p = 0.002) and shallower in both females (18.7 ± 4.9 mm for dysplastic versus 23.6 ± 4.0 mm for nondysplastic; mean difference, 6.5; 95% CI, 4.4-8.5; p \ 0.0001) and males (21.1 ± 4.8 mm for dysplastic versus 25.0 ± 4.3 mm for nondysplastic, mean difference, 5.3; 95% CI, 2.6-8.1; p = 0.0002); width was similar to that of nondysplastic hips. Acetabular openings were slightly more vertical than nondysplastic hips in females (5°; 95% CI, 1.9-8.1; p = 0.002) but not in male subjects. The dysplastic acetabuli were smaller in volume (18% in females, p = 0.002, and 19% in males, p = 0.0012) and had less space occupied by the femoral head compared with nondysplastic hips (p \ 0

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“…Acetabular deficiency and malalignment result in an abnormal force transfer across the hip joint leading to pathologically elevated cartilage stresses [1,2]. Pathological cartilage stresses accumulate over time affecting cartilage metabolism [3].…”

mentioning

confidence: 99%

“…The mechanical goal of acetabular reorientation is to decrease articular surface contact stresses by increasing the contact area in affected hips [1,2,6]. Several investigators have created biomechanical models of dysplastic hips.…”

mentioning

confidence: 99%

“…Several investigators have demonstrated that acetabular reorientation using the Bernese PAO significantly reduced contact stresses. For example, using discreet element analysis techniques on orthogonal X-rays, it was determined that the Bernese PAO decreased contact stresses 1.7-fold in 12 patients [1]. In another study, it was determined that acetabular reorientation increased the load-bearing area from 7.4 to 11.0 cm [2] using stereological methods on CT scans from 6 patients who had PAO surgery [2].…”

mentioning

confidence: 99%

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