TY - JOUR
T1 - Is lateral acetabular rotation sufficient to correct anterolateral deficiency in periacetabular reorientation osteotomy? A CT-Based simulation study
AU - Iwamoto, Miho
AU - Fujii, Masanori
AU - Komiyama, Keisuke
AU - Sakemi, Yuta
AU - Shiomoto, Kyohei
AU - Kitamura, Kenji
AU - Yamaguchi, Ryosuke
AU - Nakashima, Yasuharu
N1 - Funding Information:
This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science , Grant Number JP18K09109 .
Publisher Copyright:
© 2020 The Japanese Orthopaedic Association
PY - 2020/11
Y1 - 2020/11
N2 - Background: Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. Methods: We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. Results: After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). Conclusions: Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°–15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.
AB - Background: Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. Methods: We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. Results: After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). Conclusions: Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°–15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.
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U2 - 10.1016/j.jos.2019.12.014
DO - 10.1016/j.jos.2019.12.014
M3 - Article
C2 - 32035753
AN - SCOPUS:85079000544
VL - 25
SP - 1008
EP - 1014
JO - Journal of Orthopaedic Science
JF - Journal of Orthopaedic Science
SN - 0949-2658
IS - 6
ER -