Anteroposterior Pelvic X-rays Research Articles

Impact of robot assistance on restoration of limb length and offset distance in total hip arthroplasty

To analyze the impact of robot assistance on the restoration of limb length and offset distance in total hip arthroplasty (THA). A retrospective analysis was conducted on the clinical data of 316 patients who underwent unilateral primary THA between September 2019 and August 2023. Among them, 117 patients underwent robot-assisted THA (group A), and 199 patients underwent conventional THA (group B). There was no significant difference between the two groups in the gender, age, or side of the hip replacement ( P>0.05); but there was a significant difference in the preoperative diagnosis ( P<0.05). The leg length discrepancy (LLD) and global offset (GO) dfference were measured on preoperative anteroposterior pelvic X-ray films, and absolute values were used for comparison between groups. The operations in both groups were successfully completed. Postoperative imaging measurements showed that the LLD and GO dfference in group A were significantly lower than those in group B ( P<0.05). Among them, group A had 32 cases (27.4%), 5 cases (4.3%), and 0 case (0) of LLD>3 mm, >5 mm, and >10 mm, respectively, while group B had 115 cases (57.8%), 75 cases (37.7%), and 22 cases (11.1%), respectively; and the differences in above indicators between groups were significant ( P<0.05). Group A had 40 cases (34.2%), 3 cases (2.6%), and 0 case (0) of GO dfference>5 mm, >10 mm, and >20 mm, respectively; group B had 103 cases (51.8%), 54 cases (27.1%), and 7 cases (3.5%), respectively. There was no significant difference in the proportion of patients with GO>20 mm between groups ( P>0.05), while there were significant differences in other indicators between groups ( P<0.05). Compared with traditional THA, robot assisted THA has more advantages in restoration of limb length and offset distance.

Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty?

Rising costs in healthcare for total hip arthroplasty (THA) mean that new solutions must be considered, such as the use of single-use ancillaries (SUA). The goal of this study was to assess the accuracy of 2D templating in primary THA for the use of reduced-size SUA. Our hypothesis was that the accuracy of 2D templating in primary THA would be higher than 95%, give or take two sizes. This single-centre prospective study included all primary THAs performed over two years. Templating was carried out using 2D templating on anteroposterior pelvic X-rays. The template sizes were compared to the implant sizes. The primary endpoint was the rate of coincidence between digitally templated estimates and the actual implant sizes. The secondary endpoint was the difference of accuracy based on patient parameters. We analysed 512 cases of THA. Accuracy within two sizes was 96.9% for acetabular implants and 98.5% for femoral implants. Accuracy was below the 95% threshold only in patients under 55 and over 85 years old. A BMI above 30.0kg/m2 significantly reduced accuracy but did not fall below the 95% threshold. The operated hip, the type of implant, and the operative indication did not significantly influence templating accuracy. Using reduced-size SUA with five rasps and five reamers depending on template sizes means that THA can be performed in more than 95% of cases allowing the use of compact single use ancillaries.

A Study on Imaging Risk Factors for Hip Osteoarthritis.

Due to low prevalence and few studies, the morphologic risk factors for hip osteoarthritis (HOA) in Chinese population remain unknown. The purpose of this study was to investigate the relationship between 10 radiographic parameters measured via anteroposterior pelvic X-ray radiography and HOA in Chinese population. Thirty-three patients who required total hip arthroplasty for unilateral HOA (2017-2022) and 132 healthy individuals were selected for this case-control study. We measured 10 radiological parameters via anteroposterior pelvic X-ray radiography, which were sharp angle, center edge angle, sourcil angle, neck shaft angle, α angle, pelvic height, pelvic width, femoral head diameter, femoral neck width, and ratio of the femoral head diameter to the femoral neck width. After measurements were obtained, logistic regression analysis was utilized to calculate the adjusted odds ratios (ORs) for confounding variables such as age, sex, and body mass index (BMI). Receiver operating characteristic (ROC) curves were utilized to determine the proportional risk contribution (PRC) of each radiographic factor. After adjustment for confounding factors, individuals with a larger sourcil angle (SA) (OR = 4.89, 95% CI 1.66-14.42, p = 0.004), larger α angle (OR = 4.14, 95% CI 1.53-11.23, p = 0.005), and wider femoral neck (OR = 5.27, 95% CI 1.50-18.51, p = 0.01) were found to have a greater risk of developing HOA. Among all radiographic parameters, the SA demonstrated the greatest risk contribution (PRC = 13.695%). Radiographic parameters correlate with the incidence of HOA. The SA is probably the most powerful of all the parameters related to HOA.

Automated assessment of pelvic radiographs using deep learning: A reliable diagnostic tool for pelvic malalignment

Pelvic malalignment leads to general imbalance and adversely affects leg length. Timely and accurate diagnosis of pelvic alignment in patients is crucial to prevent additional complications arising from delayed treatment. Currently, doctors typically assess pelvic alignment either manually or through radiography. This study aimed to develop and assess the validity of a deep learning-based system for automatically measuring 10 radiographic parameters necessary for diagnosing pelvic displacement using standing anteroposterior pelvic X-rays. Between March 2016 and June 2021, pelvic radiographs from 1215 patients were collected. After applying specific selection criteria, 550 pelvic radiographs were chosen for analysis. These data were utilized to develop a deep learning-based system capable of automatically measuring radiographic parameters relevant to pelvic displacement diagnosis. The system's diagnostic accuracy was evaluated by comparing automatically measured values with those assessed by a clinician using 200 radiographs selected from the initial 550. The results indicated that the system exhibited high reliability, accuracy, and reproducibility, with a Pearson correlation coefficient of ≥0.9, an intra-class correlation coefficient of ≥0.9, a mean absolute error of ≤1 cm, mean square error of ≤1 cm, and root mean square error of ≤1 cm. Moreover, the system's measurement time for a single radiograph was found to be 18 to 20 times faster than that required by a clinician for manual inspection. In conclusion, our proposed deep learning-based system effectively utilizes standing anteroposterior pelvic radiographs to precisely and consistently measure radiographic parameters essential for diagnosing pelvic displacement.

Standard imaging in the emergency department in geriatric patients with immobilizing pelvic pain after low-energy trauma or without trauma: X-ray vs. computed tomography

PurposeGeriatric pelvic ring injuries, evaluated solely by X-ray, are often misclassified or even missed. This can result in prolonged immobilization and persistent pelvic pain. The aim of this study was to assess the sensitivity and specificity of X-ray imaging in patients aged ≥ 70 years with immobilizing pelvic pain. Methods107 geriatric patients (23 males, 84 females) with immobilizing pain after traumatic or atraumatic causes were included in this retrospective study. 91 patients had an anteroposterior (AP) X-ray of the pelvis and after that a computed tomography (CT) of the pelvis. All patients were treated in a level 1 trauma center from December 2018 to September 2020. The mean age was 83.07 ± 6.08 years. ResultsThe overall evaluation of the diagnostic performance of AP Pelvic X-ray imaging in the study population compared to the CT pelvis (“gold standard”) resulted in a sensitivity of (2.7 %) and a specificity of (94.4 %). Specific for pelvic ring fractures in the study population there was a sensitivity of (3.4 %) and a specificity of (94.4 %). ConclusionThe results highlights issues with the AP Pelvic X-ray as the diagnostic tool of choice in this study population, confirming the findings of previous studies on the underestimated problem of osteoporotic pelvic ring fractures in geriatric patients. This again confirms the need for a new optimized diagnostic algorithm, which takes into account the differences of the orthogeriatric patient cohort.

Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections.

A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the "gold standard" for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

Three-dimensional morphological study of the effect of false acetabulum on the femoral structure in Crowe type Ⅳ developmental dysplasia of the hip

To explore the effect of false acetabulum on the development and anatomical morphology of proximal femur in Crowe type Ⅳ developmental dysplasia of the hip (DDH), providing a theoretical basis for the development of femoral reconstruction strategy and prosthesis selection for total hip arthroplasty. The medical records of 47 patients (54 hips) with Crowe type Ⅳ DDH between February 2008 and March 2020 were retrospectively analyzed, of which 21 patients (26 hips) were Crowe type Ⅳa (type Ⅳa group) and 26 patients (28 hips) were Crowe type Ⅳb (type Ⅳb group). There was no significant difference in general data such as gender, age, height, weight, body mass index, and side between the two groups ( P>0.05), which were comparable. The height of femoral head dislocation, the height of pelvis, and the proportion of dislocation were measured based on preoperative anteroposterior pelvic X-ray film. Based on the preoperative femoral CT scan data, the anatomical parameters of the femur and femoral medullary cavity were measured after three-dimensional reconstruction using Mimics19.0 software to calculate the canal fare index; and the femoral medullary cavity parameters were matched with the modular S-ROM prosthesis parameters. The results of X-ray film measurement showed that the height of femoral head dislocation and the proportion of dislocation in type Ⅳa group were significantly higher than those in type Ⅳb group ( P<0.05). There was no significant difference in the height of pelvis between the two groups ( P>0.05). The results of CT three-dimensional reconstruction measurements showed that compared with the type Ⅳb group, the type Ⅳa group had less isthmus height, smaller femoral head, shorter femoral neck, narrower neck-shaft angle, increased anteversion angle, and higher greater trochanter, and the differences were significant ( P<0.05). There was no significant difference in the height of femoral head, femoral offset, and height difference between greater trochanter and femoral head between the two groups ( P>0.05). There was no significant difference in the mediolateral width (ML), anteroposterior width (AP), and diameter of the isthmus (Ci level) and the AP of the medullary cavity in the plane 40 mm distal to the most prominent point on the medial side of the lesser trochanter (C -40 level) ( P>0.05), and the size of medullary cavity was significantly smaller in type Ⅳa group than in type Ⅳb group at the other levels ( P<0.05). Compared with the type Ⅳb group, the difference between the outer diameter of the prosthetic sleeve and the diameter of the medullary cavity fitting circle in the plane where the center of femoral head rotation was located from the medial most prominent point of the lesser trochanter (C 0 level) in type Ⅳa group was smaller, and the proportion of negative values was greater ( P<0.05). The difference between the longest diameter of the prosthetic sleeve triangle and the ML of the medullary cavity in the plane 10 mm proximal to the most prominent point on the medial side of the lesser trochanter (C +10 level) in type Ⅳa group was smaller, and the proportion of negative values was greater ( P<0.05). False acetabulum has a significant impact on the morphology of the proximal femur and medullary cavity in patients with Crowe type Ⅳ DDH, and the application of three-dimensional reconstruction technique can accurately evaluate the femoral morphology and guide the selection of femoral prosthesis.

Cup positioning and its effect on polyethylene wear of vitamin E- and non-vitamin E-supplemented liners in total hip arthroplasty: radiographic outcome at 5-year follow-up

BackgroundAseptic loosening remains a challenging problem after total hip arthroplasty. Accurate cup placement and supplementation of antioxidants in acetabular liners might reduce material failure rates. The aim of this study is to assess the effect of the cup position on the wear behaviour of UHMWPE-XE and UHMWPE-X liners in vivo using virtual radiographs.MethodsWe conducted a prospective, randomized, controlled, multicenter trial. Clinical data of 372 probands were analyzed. Anteroposterior pelvic X-rays of 324 patients immediately postoperatively and after 1 and 5 years were evaluated by the RayMatch® analysis software regarding cup position and wear behaviour.ResultsMean cup anteversion was 20.3° (± 7.4) and inclination was 41.9° (± 7.0) postoperatively. 62.3% of all patients had an anteversion and inclination within the Lewinnek safe zone. Anterior and anterolateral approaches led to significantly higher cup anteversion compared to lateral approaches (27.3° ± 5.5; 20.9° ± 7.2; 17.5° ± 6.6; p < 0.001 and p = 0.001, respectively). Mean anteversion increased to 24.6° (± 8.0) after 1 year (p < 0.001). Only one revision occurred because of implant dislocation. Wear rates from UHMWPE-X and UHMWPE-XE did not differ significantly. Anteversion angles ≥ 25° correlated to increased polyethylene wear (23.7 µm/year ± 12.8 vs. 31.1 µm/year ± 22.8, p = 0.012) and this was amplified when inclination angles were ≥ 50° (23.6 µm/year ± 12.8 vs. 38.0 µm/year ± 22.7, p = 0.062).ConclusionAnterior approaches lead to the highest inaccuracy of cup placement, but cup positioning outside the Lewinnek safe zone does not necessarily cause higher dislocation rates. Moreover, mean anteversion increased by approximately four degrees within the first year after operation, which is expected to be functional due to a regularization of pelvic tilt after intervention. Mid-term wear rates of UHMWPE-X and UHMWPE-XE liners are comparable, but steep cup positions lead to significantly increased polyethylene wear. In summary, a re-evaluation of target zones for intraoperative cup positioning might be considered. In the long-term reduced oxidative embrittlement could lead to superior wear behaviour of vitamin E-blended liners.

Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head

To explore the feasibility and effectiveness of the modified transtrochanteric curved varus osteotomy in the treatment of osteonecrosis of the femoral head (ONFH), clarify the key points of the operation, and then explore the effectiveness of modified transtrochanteric curved varus osteotomy in the treatment of ONFH assisted by virtual reality (VR) technology. A 70-year-old adult female cadaver without formaldehyde fixation was taken. It was confirmed by anatomical study and simulated operation that the modified transtrochanteric curved varus osteotomy was suitable for type C1 (patients with involvement of the lateral column of the femoral head but partial integrity) classified by the Japanese Osteonecrosis Investigation Committee (JIC). Between October 2018 and August 2020, 11 patients (17 hips) with ONFH who met the selection criteria were treated with modified transtrochanteric curved varus osteotomy. VR technology was used to simulate varus osteotomy before operation to predict the angle of valgus of lower limbs and pronation of femoral head. Osteotomy, valgus, and pronation were performed according to the results of preoperative planning. After operation, X-ray films were used to evaluate the changes of varus and neck-shaft angle after VR assisted surgery, and Harris score was used to evaluate the hip function. The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°. The difference between VR preoperative planning and 2 days after operation was 6°-16°. All 11 patients were followed up 11-28 months, with an average of 19.2 months. All incisions healed by first intension. During the follow-up, 1 case (1 hip) developed greater trochanter fracture at 2 months after operation and was treated with open reduction and plate and screw internal fixation; 1 case (1 hip) had delayed healing at osteotomy at 4 months after operation and healed at 3 months after local injection of platelet rich plasma and oral supplementation of kidney blood-strengthening soup. At last follow-up, 17 hip osteotomies healed. The Harris score was 84.0±5.6, which was significantly higher than that before operation (57.2±5.5) ( t=-14.107, P=0.000); hip function was excellent in 2 hips, good in 13 hips, and fair in 2 hips. The modified transtrochanteric curved varus osteotomy for the treatment of ONFH is theoretically feasible, and the short-term effectiveness of this operation combined with VR technology is satisfactory.

Evaluation of the feasibility of acetabular cup pre-determination in revision total hip arthroplasty via X-ray of the bone stock of the anterosuperior acetabulum

PurposeThis study was aimed to explore (1) location on AP pelvic X-ray that displayed bone stock in anterosuperior acetabulum; (2) whether X-ray could provide enough evidence to evaluate whether bone stock could provide support for acetabular cup; (3) criteria to determine whether anterosuperior bone stock could provide sufficient support for cup on X-ray.MethodsOur study retrospectively collected 43 patients who underwent revision THA for cup loosening from 2014 to 2019. The position of anterosuperior acetabular bone stock was compared between X-ray and CT-based 3-D reconstruction. Seventy-millimeter acetabular cup was implanted simulatively to obtain the contact line between acetabular cup and superolateral remaining bone stock. The contact line length and the angle were measured. Patients were divided into cup group and cage group, and ROC curves of both contact line length and angle were drawn.ResultsThe superolateral part of acetabulum on X-ray could reflect the anterosuperior host bone stock of acetabulum according to the comparison of anteroposterior pelvic X-ray and 3-D reconstruction. Critical point was chosen when we got the highest sensitivity with a 100% specificity in ROC curves. The critical values of contact length and angle were 15.58 mm and 25.5°.ConclusionsSurgeons could assess the anterosuperior bone stock of acetabulum by AP pelvic X-ray to decide whether revision could be done merely using cup or need customized cage. Clinically, when contact line length was larger than 16 mm or contact angle was larger than 25.5°, adoption of cup could obtain primary stability in the revision surgery in most cases.

A Radiographic Study on the Effect of Menopause on Proximal Femoral Angle Parameters

Aim: In this study we aimed to investigate the effects of menopause on the femoral inclination angle (FIA) and femoral Alsberg angle (FAA) parameters in pelvic anteroposterior radiography.Methods: The FIA and FAA data were retrospectively reviewed in a total of 133 female subjects with natural menopause (the menopause group) and regular menstrual cycles (the control group) who were admitted to our orthopedics and traumatology clinic and underwent anteroposterior pelvic X-ray examination between October 2019 and June 2020.Results: There was a statistically significant difference between the menopause and control groups in terms of age (p&amp;lt;0.001), right-side FAA values (p&amp;lt;0.001), and right- and left-side FIA values (p&amp;lt;0.001 and p=0.026, respectively). Only the left-side FAA values did not differ significantly between the groups (p=0.446). All parameter measurements were higher in the menopause group.Conclusion: The finding that the FIA and FAA values were higher in the menopause group could be attributed to the fact that menopause occurs in the later decades of life and brings along changes in lifestyle. We recommend that the presence of menopause as a factor that can affect bone structure and metabolism in various ways should also be considered in studies on bone morphometry.

Model construction and application for automated measurement of CE angle on pelvis orthograph based on MASK-R-CNN algorithm

Developmental dysplasia of the hip (DDH) is a common orthopedic disease. A simple and cost-effective scientific tool for assisting the early diagnosis of DDH is urgently needed. This study proposed a new artificial intelligence (AI) model for automated measure of the CE angle to aid the diagnosis of DDH by modifying the Mask R-CNN algorithm.13228 anteroposterior pelvic x-ray images were collected from the PACS system of the second Hospital of Jilin University, of which 104 images were randomly selected as test data. The rest of x-ray images were labelled and preprocessed for model development. The new AI model was the constructed based modified Mask R-CNN model to detect key points for CE angle measurement. The performance of AI model on measuring CE angle was verified by comparing with three attending orthopaedic doctors. The mean CE angles on left and right pelvis measured by the AI model was 29.46 ± 6.98°and 27.92 ± 6.56°, respectively, while the mean CE angle measured by the three doctors was 29.85 ± 6.92°and 27.75 ± 6.45°, respectively. AI model displayed a higly consistency with the doctors in measuring CE angles. Besides, AI model showed a much high efficiency in term of measuring time-consumption. In this study, we successfully constructed a new effective model for measuring CE angle by identifying key points, which provided a new intelligent measurement tool for orthopedic image measurement and evaluation.

Acetabular Anatomical Parameters in Patients With Idiopathic Osteonecrosis of the Femoral Head

BackgroundOsteonecrosis of the femoral head (ONFH) is an increasing worldwide health problem. However, about 30% of the patients are diagnosed with idiopathic ONFH, which means no underlying etiology is identified. We hypothesized that acetabular anatomical abnormalities might be related to idiopathic ONFH. MethodsThis retrospective, 1:2 matched, case-control study included 101 patients (136 hips) with idiopathic ONFH and 202 control subjects (404 hips) matched for age, gender, and body mass index who had no apparent radiographic hip pathologies. The anteroposterior pelvic X-rays of the patients and control subjects were used to measure the anatomical parameters including the center-edge angle, the sharp angle, the acetabular depth ratio (ADR), and the acetabular head index (AHI). ResultsWe found that hips with idiopathic osteonecrosis had less acetabular coverage, lower center-edge angle (28.3° vs 32.3°, P < .001), acetabular depth ratio (298.0 vs 306.4, P = .006), and acetabular head index (82.2 vs 85.8, P < .001), and higher sharp angle (39.7° vs 38.0°, P < .001), compared with the control subjects. The incidence of acetabular dysplasia was also higher in the idiopathic ONFH group than the control group. ConclusionLess acetabular coverage was found in hips with idiopathic osteonecrosis than the control subjects. Less acetabular coverage may be associated with the development of ONFH in East Asian population.

A simple method to minimize leg length discrepancy in hip hemiarthroplasty.

PurposeWe developed a simple method to minimize leg length discrepancy (LLD) during hip arthroplasty. The purpose of this study is to evaluate the accuracy of the method.Patients and methodsA total of 47 patients who suffered from unilateral femoral neck fracture and underwent hip hemiarthroplasty between 2015 and 2018 were enrolled in this study. We measured the diameter of the contralateral femoral head (D) and the distance (L) between the center of the femoral head and the top of lesser trochanter in the antero-posterior pelvic X-ray view before the operation, the ratio (R) of D to L was calculated. During the operation, the diameter of the femoral head (d) was measured using a Vernier caliper. Then, the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter was calculated according to the contralateral ratio R.ResultsThe mean LLD was 4.4±3.2 mm (−4.0 to 11.1 mm), 80.9% of the patients had LLD <6 mm, 93.6% of the patients with LLD <10 mm, only 6.4% ≥10 mm LLD.ConclusionThis method is a simple, cost-effective, fast and accurate way to reduce the postoperative leg length discrepancy.

Is there a significant decrease in the femoral cortical bone around Furlong® stems after 18years of follow-up?

In the context of total hip arthroplasty (THA), there are several reasons that have motivated the development of short stems. It has been postulated that short stems allow a better conservation of the bone stock if compared to conventional stems. As far as we have knowledge, the quantitative loss of diaphyseal bone stock in patients with standard femoral stems has not been fully described. The aim of this study was to provide evidences about the thickness of the cortical bone at the diaphysis in patients who have undergone unilateral THA with Furlong® stems with a minimum follow-up of 18years. A retrospective study of patients who underwent THA in a single hospital was performed. The inclusion criteria were patients who had undergone a non-cemented elective THA with a Furlong® stem, minimum follow-up of 18years, and contralateral femur and hip without history of previous surgical procedures. The follow-up analysis was performed by means of radiological examinations performed at the last follow-up visit. Data related to the sex, age at surgery and adverse events registered during the follow-up were gathered. The cortical thickness index (CTI) and cortical thickness (CT) assessed at the last follow-up visit in anteroposterior pelvic X-rays were analyzed, both in the operated hip and in the non-operated hip (which was used as control). Calibration of the measurements was done by means of using the circumference of the head of the THA. The total number of patients who met the inclusion criteria was 22. There were 14 women and eight men. There were 12 left hips. The mean age at the time of surgery was 59.32 ± 6.83 (range 50-70) years. The mean follow-up was 20.86 ± 1.90 (range 18-24) years. The CTI was found to be 11.93% greater in the non-operated hips. The CT measured at 3cm and 6cm from lesser trochanter, and at 9cm from the greater trochanter, was found to be 21.64%, 15.33% and 18.73% greater in the non-operated hips, respectively. After a minimum of 18years from the implantation of a Furlong® stem, the bone density that surrounds the implant seems to involve a cortical bone ten percent less thick than the cortical bone of the non-operated contralateral side. With this stem, the cortical zones with less CT seem to be the lateral cortex at 9cm from the greater trochanter, and the medial cortex at 3 and 6cm from the lesser trochanter. III, retrospective case-control study.

Relationship of muscle morphology to hip displacement in cerebral palsy: a pilot study investigating changes intrinsic to the sarcomere

BackgroundCerebral palsy (CP) is the most common cause of childhood disability, typified by a static encephalopathy with peripheral musculoskeletal manifestations—most commonly related to spasticity—that are progressive with age. Hip displacement is one of the most common manifestations, observed to lead to painful degenerative arthritis over time. Despite the key role that spasticity-related adductor muscle contractures are thought to play in the development of hip displacement in CP, basic science research in this area to date has been limited. This study was initiated to correlate hip adductor muscle changes intrinsic to the sarcomere—specifically, titin isoforms and sarcomere length—to the severity of hip displacement in children with spastic cerebral palsy.MethodsSingle gracilis muscle biopsies were obtained from children with CP (Gross Motor Function Classification System (GMFCS) III-V; n = 10) who underwent adductor muscle release surgery for the treatment of hip displacement. Gel electrophoresis was used to estimate titin molecular weight. Sarcomere lengths were measured from muscle fascicles using laser diffraction. The severity of hip displacement was determined by measuring by Reimers migration percentage (MP) from anteroposterior pelvic x-rays. Correlation analyses between titin, sarcomere lengths, and MP were performed.ResultsThe mean molecular weight of titin was 3588 kDa. The mean sarcomere length was 3.51 μm. Increased MP was found to be associated with heavier isoforms of titin (R2 = 0.65, p < 0.05) and with increased sarcomere lengths (R2 = 0.65, p < 0.05). Heavier isoforms of titin were also associated with increased sarcomere lengths (R2 = 0.80, p < 0.05).ConclusionsOur results suggest that both larger titin isoforms and sarcomere lengths are positively correlated with increased severity of hip displacement and may represent adaptations in response to concomitant increases in spasticity and muscle shortening.Trial registrationAs this study does not report the results of a health care intervention on human participants, it has not been registered.

Assessing the Pelvic X-ray Findings of High-energy Multiple Trauma Patients in Emergency Department of Rajaee Trauma Hospital, Shiraz-October 2013 to May 2014

1. Abstract <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. Background: Because of the significance of pelvic fracture, anteroposterior pelvic X-ray (PXR) is routinely performed for all patients referring to the emergency department with multiple trauma. But routine performance of PXR may have several complications and might not be necessary in all cases. Thus, we performed PXR selectively for patients. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.2. Objectives: We aimed to assess the PXR findings in traumatized patients referring to emergency department of Rajaee Trauma Hospital, a level 1 triage center, by reviewing PXR findings of multiple trauma patients. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.3. Methods: This prospective study was conducted in Rajaee Trauma hospital of Shiraz, the level one Trauma center in south of Iran during October 2013 to May 2014. Shiraz is the center of Fars Province with the population of 2 million and 5 million for the province. Four-hundred traumatic patients were recruited for the study. PXR was performed for selected patients according to the criteria of Rajaee Trauma Hospital. Demographic data, including age, sex, type of accident, and type of hip fracture was recorded. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. Results: Most patients (80%) were men with a mean ± SD age of 36.1(17.5) years. The most frequent pelvic fractures were left superior and inferior pubic ramus (12.8 and 12.5%) followed by right inferior pubic ramus fracture (10.5%). The most frequent causes of injury included car turnover and car to pedestrian accident. Chi-square test revealed significant difference between men and women in motor to car accident, car to pedestrian accident, and car to car accident groups (P=0.02, 0.001 and 0.004, respectively). <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.5. Conclusion: <span style=font-size:10.0pt; font-family: times= new= roman,serif=>PXR is an appropriate diagnostic tool for pelvic fractures and is most proper to be selectively performed in patients with the criteria mentioned in the current study and more attention should be paid to superior and inferior pubic ramus fractures, as it was found to be the most frequent fractures observed in the present study. 2. Keywords: Emergency; Hospital; Multiple Trauma; Patients; Pelvic X-Ray; Radiography

Comparison of early effectiveness between different approaches in primary total hip arthroplasty

To compare the early effectiveness between by anterior approach via Bikini incision and by OCM approach in the primary total hip arthroplasty (THA). Between June 2015 and March 2016, 60 patients with ischemic necrosis of the femoral head who accorded with the inclusion criteria were chosen in the study, who were divided into 2 groups according to different surgical approaches. THA was performed on 30 patients by anterior approach via Bikini incision (group A), and on 30 patients by OCM approach (group B). There was no significant difference in age, gender, body mass index, side of affected hip, Steinberg stage of ischemic necrosis of femoral head, preoperative hemoglobin, preoperative Harris score, and preoperative visual analogue scale (VAS) between 2 groups ( P>0.05). The operation time, length of incision, intraoperative blood loss, transfusion rate, starting time of straight leg raising exercise, starting time of active abduction of hip, hospitalization time, the incidence of limb length discrepancy, postoperative Harris score and VAS score were recorded and compared between 2 groups. Anteroposterior pelvic X-ray films were taken to measure acetabular abduction and acetabular anteversion. Primary healing of incision was obtained in all patients of 2 groups, and there was no significant difference in complication between 2 groups ( χ2=0.144， P=0.704). All the patients of 2 groups were followed up 3 to 12 months, averaged 6 months. There was no significant difference in operation time, length of incision, intraoperative blood loss, transfusion rate, hospitalization time, and starting time of straight leg raising exercise between 2 groups ( P>0.05). Group A was significantly shorter than group B in starting time of active abduction of hip ( t=-4.591, P=0.000), and was significantly lower than group B in the incidence of limb length discrepancy ( χ2=5.455, P=0.020). After operation, neither Harris score at 2 weeks, 6 weeks, 3 months, and 6 months nor VSA score at 24 hours and 6 weeks showed significant difference between 2 groups ( P>0.05). The anteroposterior pelvic X-ray films showed that all the prostheses were in good position, and there was no femoral prosthesis subsidence, acetabular cup displacement or dislocation. No significant difference was found in acetabular abduction and acetabular anteversion at 2 days after operation between 2 groups ( t=0.887, P=0.379; t=0.652, P=0.517). Both of two approaches in THA can avoid muscle damage and achieve favorable short-term effectiveness. But, anterior approach via Bikini incision is superior to OCM approach in starting time of active abduction of hip and the incidence of limb length discrepancy.

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier's line) in Elderly Patients.

Tuffier's line is defined as the line connecting the highest points of both iliac crests, which generally passes through either the body of the fourth lumbar vertebra or the intervertebral space between fourth and fifth vertebrae. In this study, we assessed the radiological correlation of the level of Tuffier's line with changes in age and sex. In this study, antero-posterior pelvic X-rays of 590 patients aged 18 and older were retrospectively analyzed. It is revealed that Tuffier's line crosses the vertebral column at one of three levels, which are the L4 vertebral body, L4-L5 vertebral interspace and L5 vertebral body. Patients' sex, age and vertebral level of the Tuffier's line were recorded. Data was analyzed using the chi-square test. The assessment of the X-rays of 317 female patients showed that Tuffier's Line passes through the L4 vertebral body in 115 (37.8%), through the L4-L5 intervertebral space in 126 (40%) and through the L5 vertebral body in 76 (22.2%) patients. A Tuffier's line passing through the level of the L5 vertebral body was found to be statistically significant in female patients (p=0.00). No significant relevance was found between male gender and the level of Tuffier's line in 273 male patients. It is found that the height of the vertebral levels that Tuffier's line crosses does not correlate with mean age of the groups (p=0.939). It should be considered that Tuffier's line can cross at vertebral levels other than anticipated. The level of Tuffier's line should be precisely determined with supplementary radiological methods, such as AP pelvic X-ray in addition to physical examination, to reduce the complications in association with regional anaeshesia and to achieve sensorial block levels sufficient to sustain a comfortable surgery, particularly in female patients who carry higher cardiac and respiratory risks.

Sacroiliac joint involvement in psoriasis

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.