Document Detail


Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years.
MedLine Citation:
PMID:  16156455     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Due to wide variations in acetabular structure of individuals with hip dysplasia, the measurement of the acetabular orientation may not be sufficient to predict the joint loading and pressure distribution across the joint. Addition of mechanical analysis to preoperative planning, therefore, has the potential to improve the clinical outcome. We analyzed the effect of periacetabular osteotomy on hip dysplasia using computer-aided simulation of joint contact pressure on regular AP radiographs. The results were compared with the results of surgery based on realignment of acetabular angles to the normal hip.
PATIENTS AND METHODS: We studied 12 consecutive periacetabular osteotomies with no femoral head deformity. The median age of patients, all females, was 35 (20-50) years. The median follow-up was 2 years (1.3-2.2). Patient outcome was measured with the total score of a self-administered questionnaire (q-score) and with the Harris hip score. The pre- and postoperative orientation of the acetabulum was defined using reconstructed 3D CT-slices to measure angles in the three anatomical planes. Peak contact pressure, weight-bearing area, and the centroid of the contact pressure distribution (CP-ratio) were calculated.
RESULTS: While 9 of 12 cases showed decreased peak pressure after surgery, the mean changes in weight-bearing area and peak contact pressure were not statistically significant. However, CP-ratio changed (p < 0.001, paired t-test) with surgery. For the optimal range of CP-ratio (within its mid-range 40-60%), the mechanical outcome improved significantly.
INTERPRETATION: Verifying the correlation between the optimal CP-ratio and the outcome of the surgery requires additional studies on more patients. Moreover, the anatomically measured angles were not correlated with the ranges of CP-ratio, suggesting that they do not always associate with objective mechanical goals of realignment osteotomy. Mechanical analysis, therefore, can be a valuable tool in assessing two-dimensional radiographs in hip dysplasia.
Authors:
Mehran Armand; Jyri Lepistö; Kaj Tallroth; John Elias; Edmund Chao
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Acta orthopaedica     Volume:  76     ISSN:  1745-3674     ISO Abbreviation:  Acta Orthop     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-09-13     Completed Date:  2005-09-14     Revised Date:  2011-09-26    
Medline Journal Info:
Nlm Unique ID:  101231512     Medline TA:  Acta Orthop     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  303-13     Citation Subset:  IM    
Affiliation:
Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA. mehran.armand@jhuapl.edu
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MeSH Terms
Descriptor/Qualifier:
Acetabulum / physiopathology,  radiography,  surgery*
Adult
Biomechanics
Female
Follow-Up Studies
Hip Dislocation / physiopathology,  radiography,  surgery*
Hip Joint / physiopathology,  radiography,  surgery*
Humans
Imaging, Three-Dimensional
Middle Aged
Osteotomy* / methods
Pressure
Tomography, X-Ray Computed
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R21 EB002881-01/EB/NIBIB NIH HHS; R21 EB002881-01/EB/NIBIB NIH HHS; R21 EB002881-02/EB/NIBIB NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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