Acetabular Angle Of Sharp Research Articles

Contralateral Neck-shaft Angle Lower Than 130° Is Associated With Clinical Failure in Nongeriatric Individuals: Analysis of the National Femoral Neck Fracture Database of 1066 Patients.

Treatment of femoral neck fractures in patients who are nongeriatric (≤ 60 years) is challenging because of high failure rates. Anatomic parameters influence the biomechanical environment for fracture healing, but their associations with clinical prognosis remains unclear. (1) Which anatomic parameter that is identifiable on pelvic radiographs shows a statistical correlation with a higher risk of clinical failure defined as nonunion, avascular necrosis (AVN), reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference) in the screw fixation of femoral neck fractures among nongeriatric patients? (2) How does the influence of anatomic parameters on clinical prognosis manifest: directly or mediated by additional mechanisms? This retrospective, multicenter study used a nationwide database in China. Between January 2014 and December 2020, we evaluated 1066 patients with femoral neck fractures with a median age of 53 years (interquartile range 46 to 56) and median follow-up period of 62 months. Anatomic parameters including femoral neck-shaft angle (NSA), femoral head radius, femoral neck width, femoral offset, acetabular center-edge angle, and acetabular sharp angle were variables of interest. The primary outcome was clinical failure including nonunion, AVN, reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference). Risk factors for failure were first filtered using the Bayesian information criterion and then assessed with multiple regression adjusting for confounders. The mediation effect was further explored using model-based causal mediation analysis with a quasi-Bayesian Monte Carlo method. Of all anatomic parameters we assessed, the contralateral NSA was associated with clinical failure, after adjusting for all potential covariates and confounding variables (adjusted odds ratio 0.92 [95% confidence interval 0.89 to 0.95]; p < 0.001). The optimal threshold for the NSA was 130°, with the highest Youden index of 0.27. Patients with an NSA < 130° (41% [441 of 1066]) demonstrated an increased occurrence of nonunion (15% [68 of 441] versus 5% [33 of 625]; p < 0.001), AVN (32% [141 of 441] versus 22% [136 of 625]; p < 0.001), functional failure (25% [110 of 441] versus 15% [93 of 625]), and reoperations (28% [122 of 441] versus 13% [79 of 625]). The impact of an NSA less than 130° on clinical failure was direct and substantially mediated by the type of displaced fracture (mediation proportion: 18.7%). In our study of screw fixations for femoral neck fractures among nongeriatric patients, we identified that a contralateral NSA < 130° correlates with an increased risk of clinical failure including nonunion, AVN, functional failure, and reoperation. The effect is either direct or mediated through displaced fracture types. This is important for surgeons in order to recognize the elevated rate of clinical failure and nature of the challenging biomechanical environment, which should guide them in refining surgical details and selecting appropriate fixation and rehabilitation plans. Approaches to managing these fractures require further validation with large-scale clinical trials. Level III, prognostic study.

Morphological Characteristics of the Vietnamese Adult Human Acetabulum Using Multiplanar Reconstruction Computed Tomography in Total Hip Replacement Surgery.

The anatomical parameters of the acetabulum vary among races and geographical regions. Multislice Computed Tomography (CT) has proven to be a practical approach to assess morphological parameters of the acetabulum. The purpose of this study was to explore morphological characteristics of the acetabulum measured by CT scans in Vietnamese adults. Thirty-five consecutive patients aged 18 years and older received indications and eligibility for total hip replacement surgery. Sixty-three acetabulum were examined with multislice computed tomographic system (CT) with multiplanar reconstruction (MPR). Measured morphometric parameters of acetabulum included acetabular inclination angle (AIA), acetabular anteversion angle (AAA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), acetabular horizontal offset (AHO), transverse acetabular ligament anteversion (TALA), transverse acetabular ligament inclination (TALI), acetabular depth (ADe), acetabular depth ratio (ADr) and acetabular diameter (ADi). The mean values of acetabular diameter, femoral head diameter, AIA, AAA, AAS, SAA, TALA, TALI, AHO, ADe, ADr were 50.22±3.56 mm, 43.54±3.68 mm, 40.27±5.09 mm, 13.30±5.54 mm, 39.46±5.41 mm, 26.38±9.01 mm, 9.49±3.92 mm, 47.70±6.73 mm, 3.06±0.37 mm, 18.62±2.95 mm and 309.60±41.87 mm. Our initial data has showed morphological characteristics of the acetabulum in Vietnamese adults, different from the populations from other parts of world. Also, significant correlation between the orientation of the acetabulum and the transverse acetabular ligament was documented.

ANTHROPOMETRIC ANALYSIS OF THE HIP JOINT IN CENTRAL INDIA POPULATION USING COMPUTED TOMOGRAPHY

Background: The presently available hip prosthesis used in hip arthroplasty are designed based on the anthropometry of Western patients. These prosthesis do not replicate the exact anatomy of Indian patients, leading to postoperative complications and requiring revision surgery for correction. If the manufacturers keep in considering the anthropometric parameters of Indians while designing the prosthesis, this may lead to better clinical and functional outcome and higher patient satisfaction. So the present study was undertaken to understand the anthropometric variables of hip joint of Central Indian population and to compare these variables with the other Indian Ethnic groups and western population using computed tomographic images. Materials And Methods: We had included 200 patients and both the left and right side hip joints were analysed. The anthropometric variables included were Neck-Shaft Angle (NSA), Head Diameter (HD), Neck Width (NW), Acetabular Angle of sharp(AA), Horizontal Offset (HO), Vertical Offset (VO), Medullary Canal Diameter at the level of Lesser Trochanter (MDLT), and Acetabular Version (AV) were measured in all these individuals. Comparison of these parameters was done between the left and right side and among the males and females and compared with various populations and statistically analyzed Result: The mean values were NSA 132.53°, NW 25.11 mm, HD 43.94 mm, AA of sharp 43.11°, HO 43.76 mm, VO 56.37 mm, MDLT 23.00 mm, and AV 19.47°. We found a large variations in these parameters among the Indian ethnic groups and western population. Significant differences were seen between the males and females. Conclusion: This study indicates that there are significant differences in anthropometric parameters of proximal femur among the Central India population compared with Western population. Even within the Indian population, the anthropometric parameters vary from region to region.

CT Based Analysis of Acetabular Morphology in Northern Indian Population: A Retrospective Study.

The acetabular morphology has shown to differ among different regions of the world. Multiplanar evaluation by computed tomography (CT) scan is the key to assess acetabular depth, version, and inclination at the same time which have been rarely explored before in the Indian population. We present an anthropometric study of the native acetabulum by CT based coronal, sagittal, and axial parameters in the Northern Indian population. The acetabular anteversion (AA), acetabular angle of sharp (AAS), sagittal acetabular angle (SAA), lateral center edge angle (LCEA), acetabular depth (AD), acetabular horizontal offset (AHO), extrusion index (EI) and acetabular depth ratio (ADR) was measured in CT scans of 122 patients (244 hips) without any bony pathologies. LCEA < 20°, ADR < 250, AD < 9mm, AAS > 43°, and EI ≥ 25% were taken as criteria for dysplastic acetabulum. There were 62 males and 60 females included in the study with a mean age of 63.8 ± 17.2years (21-98years). In this study, females were having significantly lower ADR (p = 0.002) and higher EI (p = 0.01) than males. The prevalence of dysplasia was 3.2% according to LCEA and 1.6% while combining all of the criteria. There are prominent differences in acetabular depth in the Indian population compared with the population of Western countries or other parts of Asia. Females were shown to have shallower acetabulum than males. The comparative analysis of radiographic parameters obtained from our study with the data available on different country-based studies can help better understanding the acetabular morphology of Indian as well as the worldwide population. Retrospective cross-sectional study.

Modified Salter innominate osteotomy in adults

The dysplastic acetabulum is shifted three-dimensionally outwards and forwards. Symptomatic residual hip dysplasias and hip subluxations in skeletally mature patients up to the age of 50years. Sharp's acetabular up to 60°, as an exception above 60°. Acetabular retroversion. Radiographic joint space at the lateral acetabular edge that is less than half the normal thickness for the patient's age. Relative contraindication: Elongated leg on the affected side. Ilioinguinal approach in asupine position. Division of the innominate bone. Pivoting the distal osteotomy fragment outwards and forwards with the aid of the Salter maneuver. Fixing the fragments with aguide wire. Final correction of the osteotomy fragments. Force fitting of adovetail grooved, wedge-shaped bone graft. Insertion of acannulated compression screw and two further threaded rods. Wound closure. Unloaded 3‑point walking for 4weeks. Increasing weight bearing from week4. Full weight bearing from week10-12. Atotal of 45consecutive patients (7men, 38women, 49hips) underwent surgery. Average age at surgery was 27.6years. The Sharp acetabular angle improved from preoperatively 45.7° ± 4.2° by 13.8° to 32.0° ± 6.4°; the Wiberg (LCE) angle increased from 15.4° ± 9.3° by 19.5° to 34.9° ± 10° postoperatively. The anterior center edge (ACE) angle increased from 28.9° ± 10.4° by 8.6° ± 2.3° to 37.5° ± 8.1°. Complications requiring surgical intervention occurred in 7patients.

Radiographic Analysis of the Pediatric Hip Patients With Hereditary Multiple Exostoses (HME).

This study aimed to report the radiographic presentation of involved hips in children with hereditary multiple exostoses (HME). This included radiographic hip measurements, osteochondromas location, and relationship with hip subluxation. Anteroposterior pelvis radiographs of children with HME, seen between 2003 and 2014, were retrospectively reviewed. Only patients who were skeletally immature at the first visit were included. One radiograph per patient per year was reviewed. Radiographs were examined for the presence of osteochondromas and their locations. Different parameters were evaluated: femoral neck-shaft angle, Reimer migration percentage (MP), Sharp acetabular angle, Wiberg angle, femoral head-neck ratio (coronal plane), and Shenton line. All measured radiographs were divided into 3 age groups:≤8,>8 and <13, and ≥13 years. Differences of the measured parameters with age were evaluated. Children with hip subluxation were identified and any relationship with osteochondromas locations, as well as MP changes over time, was recorded. Radiographs of children with a minimum 2-year follow-up were identified and changes of their hip measurements and osteochondromas' presence over time were recorded. A total of 51 children (102 hips) with HME were identified. In most locations, there was an overall increase of the occurrence of osteochondromas in the older age groups. However, in the medial femoral neck, a significantly less numbers of osteochondromas were found after 13 years of age (P=0.018). There was a decrease in MP with age (P<0.05). There was also an increase in Sharp and Wiberg angles in the older patients (P<0.05). Hips with broken Shenton line decreased in number with age (P 0.028). Hip subluxation was encountered in 23 hips. No specific location of osteochondromas was found to have a relationship with subluxation. Thirty-six children had a minimum follow-up of 2 years (mean age at first visit 8.5 y and at last visit 13.1 y). In these children, an increased occurrence of lesions was found in medial femoral neck and ischium (P<0.05) between the first and the last visit. In children with HME, radiographic evaluation of the hip is necessary based on the high percentage of hip involvement. When hip osteochondromas are found, radiographic surveillance is recommended to detect hip subluxation. Surgery may certainly be necessary for symptomatic osteochondromas. However, given the possibility of improvement in hip parameters with age, early surgical treatment to improve hip longevity does not seem to be warranted. Level IV-prognostic study.

The Correlation Between Hip Morphology and Hip Osteoarthritis: A Cross- Sectional Study

Background: Osteoarthritis (OA) is a highly prevalent chronic degenerative joint disease with different risk factors, which need to be investigated in order to perform more appropriate interventions in earlier phases of Osteoarthritis. Objectives: Therefore, the aim of this study was to determine the correlation between hip morphology and hip Osteoarthritis. Methods: This cross-sectional study was conducted on patients aged 15 to 60 years old with hip problems, diagnosed with hip Osteoarthritis, compared with healthy individuals as the control group. Then radiographic parameters, such as alpha angle, acetabular angle of sharp (AA), lateral center-edge angle (LCEA), femoral neck-shaft angle (FNA), coxa profunda, acetabular protrusio, crossover sign, posterior wall sign, and the ischial sign were measured by pelvic (AP) X-ray, using PACS systems in both groups. Results: This study found that alpha angle and AA were significantly greater in OA patients as compared to healthy individuals (P 0.05). By grouping studied angles, it was found that the frequency of alpha angle > 55°, AA > 38°, and LCEA > 40° were significantly higher in the OA group as compared to the control group (P < 0.05). Furthermore, the researchers observed that the frequency of acetabular protrusio (P = 0.013) and posterior wall sign were significantly higher in the OA group as compared to healthy individuals (P < 0.05). Conclusions: The current results showed that the higher Body Mass Index (BMI), greater alpha and acetabular angles, sharp, lateral center-edge angle center-edge angle, the higher rate of a posterior wall sign, and acetabular protrusio increased the risk of OA, which support that these structural changes are major contributors to OA development.

Triple osteotomy of pelvis (TOP) in children under six years with single approach: Prevention of retroversion and anterior impingement

For children under 6 years old requiring high degree correction for acetabular deficiency, we carried out periacetabular triple osteotomy of pelvis (TOP) avoiding hyper-pressure on epiphysis, anterior overcorrection and retroversion of acetabulum. TOP achieved in 11 patients (2 to 5.5 years old), 12 hips: 8 hips of DDH with important dysplasia (CEA: −14° to 15°) and 4 hips of Legg-Calvé-Perthes (Stulberg IV). Clinical examination and CT scan performed and compared the operated hip (OH) to the non-operated hip (NOH). Radiographic exams evaluated pre and post-op angles at the OH. Clinical assessment postoperatively: flexion decreased 14°, extension increased 7°, external rotation increased 5°, internal rotation decreased 5°. Radiographic assessment: acetabular sharp angle: (preop: 45.3°, postop: 37.1°), the CEA: (preop: 5.7°, postop: 38.7°) and the sourcil-slope: (preop: 22.6°, postop: 7.3°). CT-2D axial analysis: acetabular anteversion (OH: 1°, NOH: 2°), anterior coverage (OH: 37.5°, NOH: 34.7°), posterior coverage 21° (OH and NOH). CT-3D analysis: anterolateral inclination of the lip (OH: 32.7°, NOH: 52°), posterolateral inclination (OH: 48°, NOH: 66°), anterior acetabular inclination (OH: 5.5°, NOH: 15°). In children less than 6 years old, TOP performed by moving the acetabulum anteriorly (extension) and mainly laterally (adduction) as steering wheel, permitted the correction of severe acetabular deficiency, avoiding anterior overcorrection and retroversion of acetabulum, all responsible of early pain and osteoarthritis. Age should not be the only criteria to choose between Salter's osteotomy and TOP. Patients less than 6 years with severe acetabular deficiency could benefit from TOP.

Hip Morphologic Measurements in an Egyptian Population

The study of acetabular morphology has shown that there are geographic differences in the morphology and prevalence of acetabular dysplasia among different ethnic groups. However, few data exist on the shape of the acetabulum in various populations around the world. In this study, we examined samples of pelvic radiographs from Egyptian adults. Acetabular dysplasia in adults is characterized by a shallow and relatively vertical acetabulum.The aim of this study was to examine acetabular morphology to determine the prevalence of hip dysplasia in adult Egyptians. This included 244 adults, 134 men and 110 women between 18 and 60 years, who were used to measure center edge angle, acetabular Sharp angle, acetabular head index on anteroposterior radiographic views of the hip joints, and vertical center anterior margin angle on false profile views. The radiographs were taken of patients with no hip complaints at Tanta University Hospital.The results were statistically studied according to the age, height, and weight of patients. The prevalence of acetabular dysplasia was 2.25% for Egyptian men and 3.6% for women with respect to center edge angles, vertical center anterior margin angle, and acetabular head index.We concluded that gender variations in the morphology of the acetabulum and sex influences geometrical measurements of the acetabulum. Egyptian women were more dysplastic than men using the 4 parameters of hip measurements. There are also racial variations in hip morphology.

Sex differences in anatomical parameters of acetabulum among asymptomatic Serbian population

Anatomical parameters of the bony components of the hip joint are essential for better understanding of etiopathogenesis of diseases like primary osteoarthrosis of the hip joint. The aim of this reserch was to examine the normal acetabular morphometry in Serbian population and to determine whether there are sex differences in anatomical parameters of the acetabulum among asymptomatic subjects. Pelvic radiographics of 320 adult asymptomatic patients (640 hips) were analyzed in 170 men and 150 women to determine the morphology of the acetabulum in Serbian population. For each hip the center edge angle of Wiberg (CEA), the acetabular angle of Sharp (AA), acetabular depth (AD), acetabular roof obliquity (ARO) and roof angle (RA) were measured. The following average measurements for acetabulum geometry were obtained (x +/- SD): CEA - 33.5 +/- 6.5 degrees (33.6 +/- 5.8 degrees in male, 33.3 +/- 6.9 degrees in female), AA - 38.0 +/- 3.8 degrees (37.5 +/- 3.6 degrees in male, 38.5 +/- 3.9 degrees in female), AD - 11.9 +/- 2.8 mm (12.5 +/- 2.7 mm in male, 11.2 +/- 2.7 mm in female), ARO - 7.6 +/- 5.7 degrees (6.2 +/- 4.9 degrees in male, 9.0 +/- 6.0 degrees in female) and RA - 18.4 +/- 10.0 degrees (19.6 +/- 8.5 degrees in male, 17.1 +/- 9.5 degrees in female). There were significant differences in the CEA, AA, AD, ARO and RA related to gender (p < 0.01, t-test). There are significant gender differences in Serbian population for all the examined anatomical parameters of acetabulum. We found sex-related differences in acetabular morphology, female acetabulum being marginally more dysplastic than male acetabulum. There is also a clear tendency of female hips to be more dysplastic than male ones.

Medium-Term Outcome of Total Hip Replacement for Dysplastic Hips in Singapore

To review medium-term outcomes of 46 patients who underwent total hip replacement (THR) for osteoarthritis secondary to dysplastic hips. Records of 58 hips in 6 men and 40 women aged 32 to 76 (mean, 62) years who underwent THR for osteoarthritis secondary to dysplastic hips and had been followed up for a mean of 4 (range, 2-8) years were retrospectively reviewed. The hips were classified according to the Crowe's grading, Sharp's acetabular angle, and centre-edge angle. The radiological uncoverage of acetabular cup (RUAC) index was calculated. The outcomes of THR were evaluated in terms of cup inclination, RUAC index, cup migration, lysis or loosening (radiolucency), heterotopic ossification, component incorporation and positioning, thigh pain, and subsidence. 51 of the hips were Crowe's type I, 6 were type II, and one was type IV. The mean acetabular angle was 46.3 degrees and the mean centre-edge angle was 15.4 degrees. The mean cup, head, and stem sizes were 50.4 mm, 28.7 mm, and 10.9 mm, respectively. The mean RUAC index was 16.9% and the mean cup inclination was 40.7 degrees. Radiolucency of 1 mm in the acetabular zone I was observed in 16 cases, but only one failed. For cemented and uncemented stems, the most common positioning was neutral and valgus, respectively. Five patients had complications of greater trochanter fracture, aseptic loosening, split calcar, stem loosening, and/or heterotopic ossification. Conventional THR can achieve good medium-term results in low-grade dysplastic hips.

Evaluation of mid-term follow-up after Salter innominate osteotomy in developmental dysplasia of the hip

To evaluate the mid-term outcome after Salter innominate osteotomy in developmental dysplasia of the hip (DDH), and to observe the developmental characteristics of the hip after operation and the relationships between the mid-term outcome and radiographic parameters as well as age at operation. : Forty-four patients with 61 treated hips were selected. The patients were treated with Salter innominate osteotomy and followed-up for at least three years with intact serial radiographs. Radiographs taken before operation, 6 weeks, 1 year and 2 - 3 years after operation and in the latest follow-up were selected. Acetabular index (AI), Sharp acetabular angle (SAA) and center-edge angle of Wiberg (CEA) were measured and Severin classification was done according to radiographs taken in the latest follow-up. The average correction of AI was 14° postoperatively. The acetabulum remodels best at 2-3 years after operation when the average AI became very close to normal. In the latest follow-up the SAA was 41° which could be regarded as normal. Postoperative CEA was on average 23° which increased to 25° 2-3 years later. In the latest follow-up, the average CEA was 26°. The ratio of excellent and good outcomes (Severin I, II) was 84%, while the ratio of moderate and poor outcomes (Severin III, IV, V, VI) was 16%. Age at operation had a negative effect on outcomes. Although 70% patients operated after age 6 had satisfactory outcomes. The Severin I, II group showed no difference in AI from III, IV, V, VI group 6 weeks after operation, but the AI of the former obviously improved 2-3 years after operation while that of the latter deteriorated. Significant difference in SAA and the CEA could be observed in the latest follow-up. Salter innominate osteotomy focuses on normalizing the abnormal acetabular direction in DDH children as well as stimulating the remodeling of the acetabulum, which provides a satisfactory middle-term outcome. The acetabulum remodels rapidly during the first three years after operation when AI and CEA develops into normal. Interference should be adopted if these changes have not appeared in the first three years.

The measurements of normal acetabular index and Sharp acetabular angle in Chinese hips

Objective To define the normal reference values of acetabular index and Sharp angle through 2333 standard anterior-posterior pelvic radiographs. Methods In our study, 2333 normal anteriorposterior pelvic radiograph images with standard exposure were selected. All the images were diagnozed normal by two radiologists and two pediatricians according to the criteria of T(o)nnis. All subjects were without any neuromuscular diseases and congenital defoemity. The acetabular index was measure in the subjects between age 0 to 10 years, and the groups were divided monthly within 1 year and yearly between 1 to 10years. The Sharp angle was measure in the subjects after 10 years, and the groups were divided yearly in adolescence and decadely in adults. Normal values of each age groups and the correlation charts were completed according to statistical analysis. Results The mean acetabular index was 28.39° in neonates followed by a steep decrease in the first three months after born. It decreased to 22.17°in the 1st year, 12.80°in the 10th years and then kept constant. Acetabular index of the female was generally 1°-2°larger than that of the male with statistical significance. The mean Sharp angle was 46.72°in the 10th years, which decreased to 39.10°in the 18th years and 35.69°in elderly people. Another declination was observed after age 40.Generally no gender difference was observed. Conclusion Acetabular index and Sharp angle vary with age.They reflect a dramatic morphological change in the acetabulum before adulthood and stay constant afterwards. Gender difference is obvious in many age groups but not all. Normal reference ranges of both gender at all age groups should be considered in clinical evaluation. Key words: Acetabulum; X-ray film; Reference values

Hereditary Multiple Exostoses of the Hip

To assess the radiographic features of 36 hips with hereditary multiple exostoses (HME). Hip parameters of 12 males and 6 females (36 hips) aged 2 to 28 years with HME were assessed using anteroposterior radiographs. The recorded features included the sites of osteochondromas, the femoral head/neck ratio, the Reimer's migration percentage, Sharp's acetabular angle, the centre edge angle, the femoral neck-shaft angle, and degenerative changes. 15 of the 18 patients were asymptomatic; 3 complained of pain (2 underwent excision or bone biopsy); no lesion was malignant. Osteochondromas were most commonly located in the femur followed by the ilium; only one was intra-articular. 32 hips had coxa valga; 26 had an abnormal Reimer's migration percentage; 17 had an abnormal Sharp's acetabular angle; 12 had an abnormal centre edge angle; 32 had an abnormal femoral neck-shaft angle; and 6 had degenerative changes. Acetabular and femoral dysplasia as well as subluxation are common in patients with HME. Borderline subluxated hips and those with marked coxa valga and/or acetabular dysplasia should be closely monitored to determine the need for surgery in the future. Subluxated hips should be operated on early, particularly in children and symptomatic adults.

Periacetabular Osteotomy in Hip Dysplasia with Deformed Femoral Head

Purpose: To evaluate the results of a periacetabular osteotomy (PAO) combined with a femoral osteotomy (FO) for a dysplastic hip with a deformed femoral head. Materials and Methods: Thirteen hips with dysplasia and a deformed femoral head were followed up for more than 12 months. Eight hips were in the PAO group and 5 hips were in the PAO and FO group. The two groups were compared clinically according to the HHS (Harris hip score), pain and limping VAS (visual analogue scale), and radiologically according to the CEA (central edge angle of Wiberg), Tonnis angle (acetabular index of weight bearing surface), FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) and AI (acetabular index of depth to width). Results: Regarding the clinical results, the PAO group showed improvement in the HHS from 66.5 preoperatively to 90.4 postoperatively (p=0.01) and the pain VAS from 6.7 to 1.9 (p=0.01). However, there was no significant improvement in limping (p=0.39). In the PAO with FO group, the HHS was improved from 78 to 91 (p=0.04). Radiologically, the CEA, Tonnis angle, FHC, AA and AI improved significantly but there were no significant improvement in the DBSPFH in the two groups. In addition, there was no significant clinical or radiological difference between the two groups. Conclusion: Periacetabular osteotomy is recommended for dysplastic hips with deformed femoral head. A concomitant femoral osteotomy should be considered in hips with a severely deformed femoral head.

Salter Innominate Osteotomy for Treatment of Developmental Dysplasia of the Hip

To compare the results of Salter innominate osteotomy (SIO) for treatment of developmental dysplasia of the hip (DDH) in children. Between 1994 and 2002, 53 girls and 8 boys with DDH underwent open reduction and SIO; 21 were on the left side, 22 on the right side, 18 bilateral. They were divided into 2 groups: group 1 included 35 patients aged younger than 3 years (46 hips) and group 2 included 26 patients aged 3 years or older (33 hips). Clinical outcomes were assessed using the modified McKay criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic outcomes were evaluated using the Severin method to measure the Sharp acetabular angle and the centre-edge angle. Group-1 children achieved slightly better reduction and stabilisation of the hip joint empirically, but clinical and radiographic results and complication rates in the 2 groups were not significantly different. Open reduction and SIO without preoperative traction is effective for the management of DDH in children younger than 6 years.

How should the acetabular angle of Sharp be measured on a pelvic radiograph?

Four experienced orthopaedic surgeons measured the acetabular angle of Sharp (AA) in 66 hips by using two methods. In the classic method (AA-c), the lateral margin of the acetabular roof was used as the landmark. In the modified method (AA-m), the lateral margin of the sourcil (subchondral bony condensation in the acetabular roof) was used as the landmark. Mean AA-c and AA-m measurements were 44.8 degrees and 48.4 degrees, respectively. Mean intraobserver variations of AA-c and AA-m were 1.8 degrees and 2.1 degrees, respectively. Mean interobserver variations of AA-c and AA-m were 2.1 degrees and 2.6 degrees, respectively. Means obtained using AA-c of normal and defective acetabular roofs were similar, but the difference between AA-m means of different acetabular roof types was significant. The authors conclude that both AA-c and AA-m were reliable measurement methods, but clinical use of AA-m would probably produce better understanding of the radiographic hip anatomy in dysplastic hips.