The lateral center-edge angle as radiographic selection criteria for periacetabular osteotomy for developmental dysplasia of the hip in patients aged above 13 years

Daguang Zhang,Hong Zhang,Kai Xiao,Hui Cheng,Xin Pan,Dianzhong Luo

doi:10.1186/s12891-020-03515-8

Abstract

BackgroundThis retrospective study sought to delineate the radiographic characteristics of DDH patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy.MethodsWe enrolled patients with Hartofilakidis type I DDH without dislocation who underwent periacetabular osteotomy between August 2009 and August 2012. LCEA, anterior central edge angle (ACEA), femoral neck-shaft angle (FNSA), Shenton line and Tönnis acetabular index (AI) were evaluated by anteroposterior and 65° false⁃profile pelvic X-ray radiographs in the standing position. Femoral neck anteversion angle (FNA), labral lesion, labral inversion and cartilage lesion were evaluated by direct magnetic resonance arthrography. DDH was categorized by LCEA into four grades (grade I: 10° ≤ LCEA< 20°, grade II: 0° ≤ LCEA< 10°, grade III: -10° ≤ LCEA< 0°, grade IV: LCEA<-10) and osteoarthritis (OA) severity was assessed using Tönnis OA classification. Pearson correlation analysis was done between LCEA and other variables.ResultsTotally patients (274 hips) with a mean age of 27.3 years (range 13–47 years) were included. The mean LCEA was 3.5° (range: − 30° to 20°). Based on LCEA grades, grade I DDH was present in 104 hips, grade II in 40 hips, grade III in 76 hips, and grade IV in 54 hips. Based on Tönnis OA classification, 54.5% hips (150/274) were grade 0, 33.1% hips (91/274) grade 1, 8.4% hips (23/274) grade 2 and 4% hips (11/274) grade 3. Pearson correlation analysis showed a negative correlation between LCEA grade and Tönnis OA grades (r = 0.3987; P < 0.001). Cochran-Armitage trend test further showed a positive correlation between LCEA grades and labral lesion (P < 0.001) and interrupted Shenton line (P < 0.001).ConclusionThe LCEA classification scheme offers a simple and practical approach to categorize the level of acetabulum coverage on the femoral head, hip deformity and characteristics of DDH. Our findings could provide clinically useful guidance for orthopedic surgeons in preparation for periacetabular osteotomy in DDH patients aged above 13 years.

Highlights

This retrospective study sought to delineate the radiographic characteristics of Developmental dysplasia of the hip (DDH) patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy
The LCEA classification scheme offers a simple and practical approach to categorize the level of acetabulum coverage on the femoral head, hip deformity and characteristics of DDH
Our findings could provide clinically useful guidance for orthopedic surgeons in preparation for periacetabular osteotomy in DDH patients aged above 13 years

Summary

Introduction

This retrospective study sought to delineate the radiographic characteristics of DDH patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy. DDH is characterized by a shallow acetabulum, insufficient coverage and lateral and anterior dislocation of the femoral head [3]. Insufficient coverage of the femoral head and abnormal stress conduction exert chronic stress on the edge of the hip, leading to gradual cartilage lesion and labral tear and, eventually osteoarthritis (OA) [4]. DDH patients are usually treated conservatively or surgically, depending on factors including etiology, severity of deformity, and patient age. For patients aged over 13years, Bernese periacetabular osteotomy is an effective technique for surgical correction of a severely dysplastic acetabulum [7]

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Conclusion