Abstract
Periacetabular osteotomy (PAO) is a complex surgical procedure to restore acetabular coverage in the dysplastic hip, and the amount of acetabular rotation during PAO plays a key role. Using computational simulations, this study assessed the optimal direction and amount of the acetabular rotation in three dimensions for a patient undergoing PAO. Anatomy-specific finite element (FE) models of the hip were constructed based on clinical CT images. The calculated acetabular rotation during PAO were 9.7°, 18°, and 4.3° in sagittal, coronal, and transverse planes, respectively. Based on the actual acetabular rotations, twelve postoperative FE models were generated. An optimal position was found by gradually varying the amount of the acetabular rotations in each anatomical plane. The coronal plane was found to be the principal rotational plane, which showed the strongest effects on joint contact pressure compared to other planes. It is suggested that rotation in the coronal plane of the osteotomized acetabulum is one of the primary surgical parameters to achieve the optimal clinical outcome for a given patient.
Highlights
Developmental dysplasia of the hip (DDH) manifests various morphological abnormalities including acetabular dysplasia, decreased acetabular coverage of the femoral head, excessive femoral anteversion, increased neck-shaft angle, and shortened femoral neck [1]
The focus in this paper is twofold: first, based on the Pre- and Post-OP computed tomography (CT) images to calculate the amount of actual acetabular rotation (ACR) during the Periacetabular osteotomy (PAO) and second, based on the actual ACR to guide the development of a series of Post-OP computational models of the dysplastic hip following various acetabular rotations in three dimensions
Joint contact area due to incremental increase in acetabulum rotations showed the changes of −2.9%, 4.4%, 9.4%, and −1.2% in the sagittal plane and 0.9%, 4.2%, 23.5%, and 8.1% in the coronal plane, respectively
Summary
Developmental dysplasia of the hip (DDH) manifests various morphological abnormalities including acetabular dysplasia, decreased acetabular coverage of the femoral head, excessive femoral anteversion, increased neck-shaft angle, and shortened femoral neck [1]. Patients with DDH are usually adolescents or young adults with congenital deformities. DDH can cause secondary osteoarthritis due to prolonged exposure to increased contact stresses on the articular cartilage in the hip joint [2,3,4]. Periacetabular osteotomy (PAO) is one of the preferred joint-preserving techniques known to correct multiaxial hip deformities in DDH patients [5,6,7]. Studies have shown that PAO could effectively reduce the joint load and relieve abductor muscle forces through the medial translation of the hip joint center [8]
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