A Computer Modeling-Based Target Zone for Transposition Osteotomy of the Acetabulum in Patients with Hip Dysplasia.

Kenji Kitamura,Masanori Fujii,Goro Motomura,Satoshi Hamai,Shinya Kawahara,Taishi Sato,Ryosuke Yamaguchi,Daisuke Hara,Takeshi Utsunomiya,Yasuharu Nakashima
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Abstract

BACKGROUND This study aimed to determine the acetabular position to optimize hip biomechanics after transposition osteotomy of the acetabulum (TOA), a specific form of periacetabular osteotomy, in patients with hip dysplasia. METHODS We created patient-specific finite-element models of 46 patients with hip dysplasia to simulate 12 virtual TOA scenarios: lateral rotation to achieve a lateral center-edge angle (LCEA) of 30°, 35°, and 40° combined with anterior rotation of 0°, 5°, 10°, and 15°. Joint contact pressure (CP) on the acetabular cartilage during a single-leg stance and simulated hip range of motion without osseous impingement were calculated. The optimal acetabular position was defined as satisfying both normal joint CP and the required range of motion for activities of daily living. Multivariable logistic regression analysis was used to identify preoperative morphological predictors of osseous impingement after virtual TOA with adequate acetabular correction. RESULTS The prevalence of hips in the optimal position was highest (65.2%) at an LCEA of 30°, regardless of the amount of anterior rotation. While the acetabular position minimizing peak CP varied among patients, approximately 80% exhibited normalized peak CP at an LCEA of 30° and 35° with 15° of anterior rotation, which were the 2 most favorable configurations among the 12 simulated scenarios. In this context, the preoperative head-neck offset ratio (HNOR) at the 1:30 clock position (p = 0.018) was an independent predictor of postoperative osseous impingement within the required range of motion. Specifically, an HNOR of <0.14 at the 1:30 clock position predicted limitation of required range of motion after virtual TOA (sensitivity, 57%; specificity, 81%; and area under the receiver operating characteristic curve, 0.70). CONCLUSIONS Acetabular reorientation to an LCEA of between 30° and 35° with an additional 15° of anterior rotation may serve as a biomechanics-based target zone for surgeons performing TOA in most patients with hip dysplasia. However, patients with a reduced HNOR at the 1:30 clock position may experience limited range of motion in activities of daily living postoperatively. CLINICAL RELEVANCE This study provides a biomechanics-based target for refining acetabular reorientation strategies during TOA while considering morphological factors that may limit the required range of motion.
基于计算机建模的髋关节发育不良患者髋臼移位截骨术目标区。
背景本研究旨在确定髋臼位置,以优化髋关节发育不良患者髋臼转位截骨术(TOA)(一种特殊的髋臼周围截骨术)后的髋关节生物力学。方法:我们为 46 名髋关节发育不良患者创建了患者特异性有限元模型,模拟了 12 种虚拟 TOA 情景:侧向旋转以达到 30°、35° 和 40°的外侧中心-边缘角 (LCEA),结合 0°、5°、10° 和 15°的前旋。计算了单腿站立时髋臼软骨上的关节接触压力(CP)和无骨性撞击的模拟髋关节活动范围。最佳髋臼位置被定义为同时满足正常关节接触压力和日常生活活动所需的活动范围。采用多变量逻辑回归分析确定虚拟 TOA 术后骨性撞击的术前形态学预测因素,并进行充分的髋臼矫正。结果无论前旋量如何,LCEA 为 30° 时髋关节处于最佳位置的比例最高(65.2%)。虽然使峰值 CP 最小化的髋臼位置因患者而异,但约 80% 的患者在 LCEA 为 30° 和 35° 且前旋 15° 时表现出正常化的峰值 CP,这是 12 种模拟情况中最有利的两种配置。在这种情况下,1:30 时位置的术前头颈偏移比(HNOR)(p = 0.018)是术后在所需运动范围内发生骨性撞击的独立预测因子。具体来说,1:30 时钟位置的 HNOR <0.14 预测了虚拟 TOA 后所需活动范围的限制(灵敏度为 57%;特异性为 81%;接收器操作特征曲线下面积为 0.70)。不过,1:30 时位置 HNOR 减少的患者术后在日常生活中的活动范围可能会受到限制。这项研究为在 TOA 过程中改进髋臼重新定向策略提供了基于生物力学的目标,同时考虑了可能限制所需活动范围的形态学因素。
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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