Radiographically successful periacetabular osteotomy does not achieve optimal contact mechanics in dysplastic hips

Abstract

BackgroundOptimal correction of hip dysplasia via periacetabular osteotomy may reduce osteoarthritis development by reducing damaging contact stress. The objective of this study was to computationally determine if patient-specific acetabular corrections that optimize contact mechanics can improve upon contact mechanics resulting from clinically successful, surgically achieved corrections. MethodsPreoperative and postoperative hip models were retrospectively created from CT scans of 20 dysplasia patients treated with periacetabular osteotomy. A digitally extracted acetabular fragment was computationally rotated in 2-degree increments around anteroposterior and oblique axes to simulate candidate acetabular reorientations. From discrete element analysis of each patient's set of candidate reorientation models, a mechanically optimal reorientation that minimized chronic contact stress exposure and a clinically optimal reorientation that balanced improving mechanics with surgically acceptable acetabular coverage angles was selected. Radiographic coverage, contact area, peak/mean contact stress, and peak/mean chronic exposure were compared between mechanically optimal, clinically optimal, and surgically achieved orientations. FindingsCompared to actual surgical corrections, computationally derived mechanically/clinically optimal reorientations had a median[IQR] 13[4–16]/8[3–12] degrees and 16[6–26]/10[3–16] degrees more lateral and anterior coverage, respectively. Mechanically/clinically optimal reorientations had 212[143–353]/217[111–280] mm2 more contact area and 8.2[5.8–11.1]/6.4[4.5–9.3] MPa lower peak contact stresses than surgical corrections. Chronic metrics demonstrated similar findings (p ≤ 0.003 for all comparisons). InterpretationComputationally selected orientations achieved a greater mechanical improvement than surgically achieved corrections; however, many predicted corrections would be considered acetabular over-coverage. Identifying patient-specific corrections that balance optimizing mechanics with clinical constraints will be necessary to reduce the risk of osteoarthritis progression after periacetabular osteotomy.