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Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection

INTRODUCTION: After pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthri...

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Autores principales: Dornacher, Daniel, Lutz, Bernd, Fuchs, Michael, Zippelius, Timo, Reichel, Heiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491512/
https://www.ncbi.nlm.nih.gov/pubmed/37272987
http://dx.doi.org/10.1007/s00402-023-04920-z
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author Dornacher, Daniel
Lutz, Bernd
Fuchs, Michael
Zippelius, Timo
Reichel, Heiko
author_facet Dornacher, Daniel
Lutz, Bernd
Fuchs, Michael
Zippelius, Timo
Reichel, Heiko
author_sort Dornacher, Daniel
collection PubMed
description INTRODUCTION: After pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthritis. There is evidence that acetabula in the borderline range, defined by a lateral center edge angle (LCEA) between 18° and 25°, are more delicate to be orientated physiologically. The aim of this study was to assess the quality of acetabular orientation by triple pelvic osteotomy (TPO), established by Tönnis and Kalchschmidt, especially with respect to acetabular overcorrection. MATERIALS AND METHODS: A retrospective examination on 368 consecutive hips treated with TPOs was conducted. On the preoperative pelvic radiograph and the radiographic control 5 days after surgery, LCEA, acetabular index (AI), and anterior (AWI) and posterior wall index (PWI) were measured. According to the above-mentioned definition, the hips were divided into a borderline (n = 196) and a dysplastic (n = 172) group. Acetabular overcorrection was defined as when LCEA exceeded 35°, AI was below 0° and AWI exceeded 0.60, postoperatively. The postoperative occurrence of a relevant femoroacetabular impingement was correlated to these thresholds. Statistics comprised a priori power analysis, correlation analyses and receiver operating characteristics (ROC). RESULTS: In the borderline group, in 64 hips (32.7%), LCEA and AI indicated lateral overcorrection. In the dysplastic group, in 14 hips (8.1%), solely AI indicated overcorrection. In none of the hips, relevant anterior overcorrection was detected since AWI never exceeded 0.60. Chi-square test demonstrated a significant correlation between the occurrence of a postoperative femoroacetabular impingement and LCEA exceeding 35°, as well as AI below 0° (p < 0.001, resp.). Bravais–Pearson’s analysis showed a significant correlation between the pre- and postoperative values of all parameters in the borderline and the dysplasia group (p < 0.001). Thus, ROC analysis could be performed and provided preoperative cutoff values for LCEA (23°) and AI (12.5°), hinting at postoperative overcorrection. CONCLUSION: The comparison of radiographic parameters after TPO showed a considerably greater percentage of laterally overcorrected acetabula in the borderline hips than in the dysplastic hips. According to the wall indices, anterior overcorrection was not observed. ROC analysis anticipated unfavorable lateral overcorrection when preoperative LCEA was above 23° and AI below 12.5°. These findings should sensitize the surgeon to the delicate acetabular correction in borderline dysplastic hips.
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spelling pubmed-104915122023-09-10 Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection Dornacher, Daniel Lutz, Bernd Fuchs, Michael Zippelius, Timo Reichel, Heiko Arch Orthop Trauma Surg Orthopaedic Surgery INTRODUCTION: After pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthritis. There is evidence that acetabula in the borderline range, defined by a lateral center edge angle (LCEA) between 18° and 25°, are more delicate to be orientated physiologically. The aim of this study was to assess the quality of acetabular orientation by triple pelvic osteotomy (TPO), established by Tönnis and Kalchschmidt, especially with respect to acetabular overcorrection. MATERIALS AND METHODS: A retrospective examination on 368 consecutive hips treated with TPOs was conducted. On the preoperative pelvic radiograph and the radiographic control 5 days after surgery, LCEA, acetabular index (AI), and anterior (AWI) and posterior wall index (PWI) were measured. According to the above-mentioned definition, the hips were divided into a borderline (n = 196) and a dysplastic (n = 172) group. Acetabular overcorrection was defined as when LCEA exceeded 35°, AI was below 0° and AWI exceeded 0.60, postoperatively. The postoperative occurrence of a relevant femoroacetabular impingement was correlated to these thresholds. Statistics comprised a priori power analysis, correlation analyses and receiver operating characteristics (ROC). RESULTS: In the borderline group, in 64 hips (32.7%), LCEA and AI indicated lateral overcorrection. In the dysplastic group, in 14 hips (8.1%), solely AI indicated overcorrection. In none of the hips, relevant anterior overcorrection was detected since AWI never exceeded 0.60. Chi-square test demonstrated a significant correlation between the occurrence of a postoperative femoroacetabular impingement and LCEA exceeding 35°, as well as AI below 0° (p < 0.001, resp.). Bravais–Pearson’s analysis showed a significant correlation between the pre- and postoperative values of all parameters in the borderline and the dysplasia group (p < 0.001). Thus, ROC analysis could be performed and provided preoperative cutoff values for LCEA (23°) and AI (12.5°), hinting at postoperative overcorrection. CONCLUSION: The comparison of radiographic parameters after TPO showed a considerably greater percentage of laterally overcorrected acetabula in the borderline hips than in the dysplastic hips. According to the wall indices, anterior overcorrection was not observed. ROC analysis anticipated unfavorable lateral overcorrection when preoperative LCEA was above 23° and AI below 12.5°. These findings should sensitize the surgeon to the delicate acetabular correction in borderline dysplastic hips. Springer Berlin Heidelberg 2023-06-05 2023 /pmc/articles/PMC10491512/ /pubmed/37272987 http://dx.doi.org/10.1007/s00402-023-04920-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Orthopaedic Surgery
Dornacher, Daniel
Lutz, Bernd
Fuchs, Michael
Zippelius, Timo
Reichel, Heiko
Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title_full Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title_fullStr Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title_full_unstemmed Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title_short Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
title_sort treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection
topic Orthopaedic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491512/
https://www.ncbi.nlm.nih.gov/pubmed/37272987
http://dx.doi.org/10.1007/s00402-023-04920-z
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