Providing a computationally derived, mechanically optimised target correction during preoperative planning can improve joint contact mechanics of hip dysplasia treated with periacetabular osteotomy.

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-05-01 Epub Date: 2023-12-10 DOI:10.1177/11207000231212403
Holly D Aitken, Aspen Miller, Dominic Jl Rivas, Marcus Tatum, Robert W Westermann, Michael C Willey, Jessica E Goetz
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引用次数: 0

Abstract

Aim: Preoperative identification of acetabular corrections that optimally improve joint stability and reduce elevated contact stresses could further reduce osteoarthritis progression in patients with hip dysplasia who are treated with periacetabular osteotomy (PAO). The purpose of this study was to investigate how providing patient-specific, mechanically optimal acetabular reorientations to the surgeon during preoperative planning affected the surgically achieved correction.

Methods: Preoperative CT scans were used to create patient-specific hip models for 6 patients scheduled for PAO. A simulated acetabular fragment was extracted from the preoperative pelvis model and computationally rotated to simulate candidate acetabular reorientations. For each candidate, discrete element analysis was used to compute contact stresses during walking, which were summed over the gait cycle and scaled by patient age to obtain chronic contact stress-time exposure. The ideal patient-specific reorientation was identified using a cost function that balances minimising chronic stress exposures and achieving surgically acceptable acetabular coverage angles. The optimal reorientation angles and associated contact mechanics were provided to the surgeon preoperatively. After PAO was performed, a model of the surgically achieved correction was created from a postoperative CT scan. Radiographic coverage and contact mechanics were compared between preoperative, optimal, and surgically achieved orientations.

Results: While surgically achieved reorientations were not significantly different from optimal reorientations in radiographically measured lateral (p = 0.094) or anterior (p = 0.063) coverage, surgically achieved reorientations had significantly (p = 0.031) reduced total contact area compared to optimal reorientations. The difference in lateral coverage and peak chronic exposure between surgically achieved and optimal reorientations decreased with increasing surgeon experience using the models (R² = 0.758, R2 = 0.630, respectively).

Conclusions: Providing hip surgeons with a patient-specific, computationally optimal reorientation during preoperative planning may improve contact mechanics after PAO, which may help reduce osteoarthritis progression in patients with hip dysplasia.

在术前规划中提供计算得出的机械优化目标校正,可改善髋关节周围截骨术治疗髋关节发育不良的关节接触力学。
目的:术前确定可最佳改善关节稳定性和减少接触应力升高的髋臼矫正方法,可进一步减少接受髋臼周围截骨术(PAO)治疗的髋关节发育不良患者的骨关节炎进展。本研究的目的是探讨在术前规划期间向外科医生提供患者特异的、机械上最佳的髋臼重新定向如何影响手术达到的矫正效果:方法:使用术前 CT 扫描为 6 名计划接受 PAO 手术的患者创建患者特异性髋关节模型。从术前骨盆模型中提取模拟髋臼片段,通过计算旋转模拟候选髋臼重新定向。对于每个候选方案,均采用离散元素分析法计算行走过程中的接触应力,并在整个步态周期中进行加总,再按患者年龄进行缩放,以获得慢性接触应力时间暴露。通过成本函数,在最大限度地减少慢性应力暴露和实现手术可接受的髋臼覆盖角度之间取得平衡,从而确定患者理想的特定调整方向。术前向外科医生提供了最佳调整角度和相关的接触力学。进行 PAO 手术后,根据术后 CT 扫描结果创建手术矫正模型。比较了术前、最佳和手术达到的方向的放射覆盖率和接触力学:结果:虽然在影像学测量的侧方(p = 0.094)或前方(p = 0.063)覆盖率方面,手术达到的矫正方向与最佳矫正方向没有显著差异,但与最佳矫正方向相比,手术达到的矫正方向的总接触面积显著减少(p = 0.031)。随着外科医生使用模型经验的增加,手术实现的调整方向与最佳调整方向在侧向覆盖和慢性暴露峰值方面的差异也在减小(R² = 0.758,R2 = 0.630):结论:在术前规划中为髋关节外科医生提供针对患者的计算最佳调整方向可改善PAO后的接触力学,有助于减少髋关节发育不良患者的骨关节炎进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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