Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia

Lee, Dong Hoon; Jeong, Woong Kyo; Park, Sang Won; Kang, Chang Ho; Lee, Soon Hyuck

doi:10.1007/s00402-011-1435-x

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…It is difficult to obtain adequate acetabular coverage of the femoral head after PAO. In a virtual osteotomy study using CT images of the hips with acetabular dysplasia, Dong Hun Suh et al [19] suggested that when covering the femoral head, anterior displacement of the bone fragment is sometimes necessary in addition to lateral displacement. Siebenrock et al [20] reported that pincer FAI occurred in 29% of the cases they examined after PAO.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia

Imai

Kamada

Miyawaki

et al. 2020

International Orthopaedics (SICOT)

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Aim of the study To compare the outcomes after computer-assisted peri-acetabular osteotomy (PAO) and conventional PAO performed for hip dysplasia (DDH). Methods Ninety-one patients (98 hips) were enrolled in this study. In each case, DDH was treated with either conventional PAO, in which the angle and direction of the osteotomy was determined by intra-operative X-ray examination, or with computer-assisted PAO, which used the 3D navigation system. Forty hips underwent conventional PAO and 58 hips underwent computer-assisted PAO. Results Japanese Orthopaedic Association hip scores improved significantly from 70.0 points pre-operatively to 90.7 points post-operatively in patients with conventional PAO, and from 74.5 points pre-operatively to 94.2 points post-operatively in patients with computer-assisted PAO. In all patients with computer-assisted PAO, the post-operative AHI and VCA angle were within the radiographic target zone. Some patients with conventional PAO had post-operative AHI and VCA angle outside of the target zone. We performed total hip arthroplasty (THA) on five of the 98 PAO hips (5.1%) after an average follow-up period of 5.4 years. None of 58 hips (0%) with computer-assisted PAO was revised. Discussion Computer-assisted PAO enabled intra-operative confirmation of osteotomy sites, and the position of the osteotomized bone fragment could be confirmed in real time. Adequate anterior and lateral coverage of the femoral head in patients with computer-assisted PAO resulted in no need for early conversion to THA, in contrast to conventional PAO. Conclusion Computer-assisted PAO not only improved accuracy and safety but also achieved sufficient anterior and lateral displacement to prevent the progression of DDH.

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Section: Discussionmentioning

confidence: 99%

Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia

Imai

Kamada

Miyawaki

et al. 2020

International Orthopaedics (SICOT)

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“…Among treatment methods for developmental dysplasia of the hip, RAO [1, 5, 6], ERAO [2] and periacetabular osteotomy [3, 4] are performed by resecting the acetabulum surrounding the femoral head, including acetabular cartilage, and displacement of the resected fragment laterally, thereby sufficiently covering the femoral head in order to prevent the progression of disease [1–6]. However, Dong Hun Suh et al [25] suggested that, in covering the femoral head, anterior displacement of the fragment of the bone is necessary in addition to lateral displacement in some cases, based on the virtual osteotomy using CT images of the hips with the acetabular dysplasia. Nevertheless, coverage of the femoral head by excessive anterior displacement may increase the incidence of postoperative FAI.…”

Section: Discussionmentioning

confidence: 99%

Anterior coverage after eccentric rotational acetabular osteotomy for the treatment of developmental dysplasia of the hip

Imai

Kamada

Takeba

et al. 2014

Journal of Orthopaedic Science

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BackgroundIn periacetabular osteotomy for the treatment of developmental dysplasia of the hip, impairments in ADL due to limitations in hip flexion can occur when anterior displacement is added to lateral displacement in order to obtain sufficient femoral head coverage. This study was conducted to determine, by the range of motion (ROM) simulation based on CT images, the minimum angle of hip flexion and internal rotation at 90° of flexion that is necessary to avoid ADL impairments after eccentric rotational acetabular osteotomy (ERAO) and to estimate the angles of anterior femoral head coverage on plain radiography that enable the above flexion.MethodsOf 47 hips treated with ERAO at our hospital from December 2007 to May 2012, 27 hips without progressive osteoarthritis which could be CT scanned were examined and included. The mean age at the time of surgery was 40.7 years (SD 1.8). The postoperative follow-up period was 30.2 months (SD 3.6). Two hips were in male patients and 25 hips were in female patients. The disease stage prior to surgery was pre-osteoarthritis in 5 hips, early in 11 hips, and progressive in 11 hips. We checked whether the patients were capable of activities that require deep hip flexion for the evaluation of postoperative ADL. Radiographic examination was performed before and one year after surgery to calculate LCE angle, Sharp angle, AHI, and VCA angle. The angle at which impingement of the displaced fragment of the bone and the femur appeared was measured using 3D CAD software, and the relationship between this angle and the physical findings, ADL impairment, or radiographic findings, were also examined.Results22 out of 27 hips that were capable of 116° or more of flexion or 42° or more of internal rotation at 90° of flexion in ROM simulation showed the absence of ADL impairment and a postoperative VCA angle ≤42°, whereas 5 hips with 110° or less of flexion or 40° or less of internal rotation at 90° of flexion in ROM simulation had ADL impairments associated with limitations in hip flexion and a postoperative VCA angle ≥46°.ConclusionsAnterior and lateral coverage requires a postoperative VCA angle of ≥20° to achieve anterior structural stability and an LCE angle of >25° to obtain adequate superior lateral coverage of the femoral head. A VCA angle ≤42° is required to avoid impingement during deep flexion. A VCA angle ≥46° is a probable risk factor for pincer FAI syndrome after ERAO.

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“…Proper acetabular reorientation is essential to avoid FAI after PAO, although the most important purpose of acetabular osteotomy is reorienting the acetabulum into a normal position [10]. Suh et al reported that only lateral rotation of the osteotomized acetabular fragments improved anterior coverage as well as lateral coverage [11]. Hamada et al also reported, in a three-dimensional (3D)-computed tomography (CT) simulation study, that only lateral rotation of the acetabulum to achieve a lateral center-edge (CE) angle of 30°resulted in larger anterior coverage than that of normal hips in half of the DDH cases, and a wide variation of anterior coverage was seen after lateral rotation of the acetabulum [12].…”

Section: Introductionmentioning

confidence: 99%

Preoperative anterior coverage of the medial acetabulum can predict postoperative anterior coverage and range of motion after periacetabular osteotomy: a cohort study

et al. 2020

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Background: We hypothesized that preoperative pelvic morphology may affect postoperative anterior coverage and postoperative clinical range of motion (ROM) leading to postoperative pincer type femoroacetabular impingement (FAI). The aim of this study was to evaluate the relationships between preoperative bone morphology and postoperative ROMs to prevent postoperative FAI after periacetabular osteotomy. Methods: Sixty-eight patients (71 hips) with hip dysplasia participated in this study and underwent curved PAO. The acetabular fragment was usually moved only by lateral rotation of the acetabulum, without intraoperative anterior or posterior rotation. The pre-and postoperative three-dimensional center-edge (CE) angles were measured and compared to the postoperative ROM. Results: Preoperative medial anterior CE angle was significantly associated with postoperative anterior CE angle, and the correlation coefficient of medial anterior CE and postoperative anterior CE was higher than the coefficient of preoperative anterior CE and postoperative anterior CE (preoperative anterior CE, rr = 0.27, p = 0.020; preoperative medial anterior CE, rr = 0.54, p < 0.001). Femoral anteversion correlated with postoperative internal rotation angle at 90°f lexion (r = 0.32, p = 0.021). In multiple linear regressions, postoperative internal rotation angle at 90°flexion angle was significantly affected by both medial CE angle through the medial one fourth of femoral head and femoral anteversion. Conclusions: Preoperative medial anterior acetabular coverage was associated with postoperative anterior acetabular coverage. Further, the combination with preoperative medial anterior acetabular coverage and femoral anteversion can predict postoperative internal rotation at 90°flexion. Therefore, the direction of acetabular reorientation should be carefully considered when the patients have high preoperative medial anterior CE angle and small femoral anteversion.

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Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia

Cited by 7 publications

References 21 publications

Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia

Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia

Anterior coverage after eccentric rotational acetabular osteotomy for the treatment of developmental dysplasia of the hip

Preoperative anterior coverage of the medial acetabulum can predict postoperative anterior coverage and range of motion after periacetabular osteotomy: a cohort study

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