Change in Early Patient-Reported Sexual Function After Periacetabular Osteotomy: A Study Utilizing the UK Non-Arthroplasty Hip Registry.

Background: Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI; principally acetabular retroversion) in adults who are commonly of reproductive age.

Purpose: To describe the effect of PAO on patient-reported sexual function (SF) using data from the UK Non-Arthroplasty Hip Registry (NAHR).

Study Design: Cohort study: Level of evidence, 3.

Functional pelvic tilt frequently differs from the anterior pelvic plane in non-arthritic hip disorders : implications for 3D motion analysis.

Aims: Hip preservation surgeons are increasingly using commercially available 3D motion analysis software to investigate areas of impingement and quantify femoral head coverage. Variations in functional pelvic tilt will affect the position of the acetabular rim and projected femoral head coverage, but currently the majority of available software standardizes sagittal rotation to the anterior pelvic plane (APP). The study hypothesis was that the APP does not correlate well with patient-specific pelvic position.

Does total hip arthroplasty benefit patients with minimal radiological osteoarthritis?

Aims: The effectiveness of total hip arthroplasty (THA) for patients with no or minimal radiological signs of osteoarthritis (OA) is unclear. In this study, we aimed to: 1) assess the outcome of such patients; 2) identify patient comorbidities and CT or MRI findings which predicted outcome; and 3) compare their outcome to the expected outcome of THA for hip OA.

Methods: Adult patients undergoing THA for hip pain, with no or minimal radiological features of OA (Tönnis grading scale ≤ 1), were identified from a consecutive series of 1,925 THAs.

Acetabular retroversion: functional or anatomical?

Aims: The aim of this study is to evaluate whether acetabular retroversion (AR) represents a structural anatomical abnormality of the pelvis or is a functional phenomenon of pelvic positioning in the sagittal plane, and to what extent the changes that result from patient-specific functional position affect the extent of AR.

Methods: A comparative radiological study of 19 patients (38 hips) with AR were compared with a control group of 30 asymptomatic patients (60 hips). CT scans were corrected for rotation in the axial and coronal planes, and the sagittal plane was then aligned to the anterior pelvic plane.

Comparison of Acetabular Measurements Between 2 Validated Software Programs Used in Hip Preservation Surgery.

Background: Validated software tools (Clinical Graphics [CG] and HipNorm) permit measurement of the percentage of femoral head coverage (%FHC), which aids in morphological classification and prediction of outcome after hip preservation surgery.

Purpose: (1) To assess whether acetabular parameter measurements determined from 2 commonly used software systems are comparable. (2) To determine which parameters influence the correlation or differences between software outputs and measurements.

Pelvic tilt from supine to standing in patients with symptomatic acetabular retroversion of the hip.

Aims: Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion.

Methods: Supine and standing anteroposterior (AP) pelvic radiographs were retrospectively analyzed in 69 patients treated for symptomatic acetabular retroversion.

Do acetabular parameters measured on 2D imaging correlate with CT, and can lateral centre-edge angle predict femoral head coverage?

Aims: The lateral centre-edge angle (LCEA) is a plain radiological measure of superolateral cover of the femoral head. This study aims to establish the correlation between 2D radiological and 3D CT measurements of acetabular morphology, and to describe the relationship between LCEA and femoral head cover (FHC).

Methods: This retrospective study included 353 periacetabular osteotomies (PAOs) performed between January 2014 and December 2017.

Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?

Background: In addition to the relative size of the acetabular rim and how the pelvis is positioned in space, the plane in which the acetabular version is calculated also affects its measurement.

Purpose: To determine the relative contribution of pelvic and acetabular characteristics on morphological version (measured relative to the anterior pelvic plane angle [APPA]) and functional version (measured relative to the horizontal table).

Study Design: Cross-sectional study; Level of evidence, 3.

Is a periacetabular osteotomy as efficacious in retroversion as it is in dysplasia? : The role of femoral anteversion on outcome.

Aims: Periacetabular osteotomy (PAO) is an established treatment for acetabular dysplasia. It has also been proposed as a treatment for patients with acetabular retroversion. By reviewing a large cohort, we aimed to test whether outcome is equivalent for both types of morphology and identify factors that influenced outcome.

What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

To quantify the pelvic tilt (PT) in patients with symptomatic acetabular dysplasia and determine if it represents a compensatory mechanism to improve femoral head coverage, we studied a cohort of 16 patients undergoing 32 bilateral staged PAOs for acetabular dysplasia and compared this to a matched cohort of 32 patients undergoing PAO for unilateral acetabular dysplasia all with >1 year follow-up. The change in PT was determined with two validated methods, namely, the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac index (PS-SI). Despite an improvement in the lateral centre-edge and Tönnis angles to within normal limits following PAO, patients with unilateral and bilateral acetabular dysplasia have similar PT pre-operatively (8° ± 5°) and post-operatively (9° ± 5°).

A minimally invasive periacetabular osteotomy technique: minimizing intraoperative risks.

The periacetabular osteotomy (PAO) is an extensive surgical procedure associated with potential risk to the adjacent neurovascular structures. A steep learning curve exists, with surgeon experience an important factor in outcome. Little detail exists of the osteotomies themselves, and how to make them safe and reproducible.

Hypermobility, age 40 years or older and BMI >30 kg m increase the risk of complications following peri-acetabular osteotomy.

The peri-acetabular osteotomy (PAO) is a powerful surgical procedure for correcting symptomatic acetabular dysplasia, but it carries the potential for significant surgical complications. This study aims to determine the complication profile of PAO in a series performed by an experienced single surgeon. This was as retrospective review of 223 hips in 200 patients (23 bilateral, 22 males and 201 females).

Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?

Background: Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring).

3 generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study.

Introduction: 3 generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings. The purpose of our study was to investigate the long-term clinical and radiographic results of 3 generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture.

Hip arthroscopy: Indications, outcomes and complications.

Hip arthroscopy has recently occupied an important place in the armamentarium of General Orthopedic and especially hip surgeons. It is an effective and innovative procedure with rapidly expanding indications. Advancements in surgical tools and refinement in techniques has revolutionalized modern Hip arthroscopy.

3rd generation ceramic-on-ceramic cementless total hip arthroplasty: a minimum 10-year follow-up study.

Introduction: 3rd generation ceramic bearings were introduced in total hip arthroplasty (THA) with the potential to have better mechanical strength and wear properties than their predecessors. At present, there are few studies looking at the long-term results of this latest generation of ceramic bearings.The purpose of our study was to investigate the long-term clinical and radiographic results of 3rd generation ceramic-on-ceramic THA and the incidence of ceramic specific complications such as squeaking and bearing surface fracture.

Reliability in the diagnosis of femoroacetabular impingement and dysplasia among hip surgeons: role of surgeon volume and experience.

Purpose: To evaluate the degree of inter-rater agreement in identifying important radiographic features of femoroacetabular impingement (FAI) and hip dysplasia. In addition, the effect of supplementary investigations (CT and/or MRI) and clinical experience of the observer was determined.

Methods: During the British Hip Society meeting 2013 participants were asked to remark on various radiological parameters of FAI and dysplasia, make a diagnosis, and recommended treatment.

The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis.

The orientation of the pelvis influences that of the acetabulum. In particular, pelvic tilt in the sagittal plane may lead to inaccurate interpretation of plain pelvic radiographs. We therefore quantified the relationship between this pelvic tilt and acetabular orientation in native hips, and determined whether pelvic tilt affects femoral head cover.

Trochanteric fixation using a third-generation cable device--minimum follow-up of 3 years.

Third-generation trochanteric fixation cable systems are designed to overcome implant breakage, nonunion, and bony escape. The study prospectively assessed the functional and radiologic outcomes using such an implant. Forty-seven trochanteric fixations in 46 patients were performed over 4 years at 2 institutions using the Accord Cable Plate system (Smith and Nephew, Memphis, Tenn).

Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements.

Objective: To compare two-dimensional (2D) axial with three-dimensional (3D) computerized tomography (CT) measurements of acetabular version in native hips.

Materials And Methods: CT scans of 34 hips in 17 consecutive patients being investigated for femoroacetabular impingement were analyzed. Acetabular version was measured using 2D CT at two different axial levels, one cranial (slice 2) and the other at the equator (slice 3).

Anterior approaches to the hip for the treatment of femoro-acetabular impingement: a cadaveric study.

Femoroacetabular impingement (FAI) may be a cause of early osteoarthritis of the hip. The aim of surgical treatment is to improve the head-neck offset in the presence of a cam lesion and to perform acetabular rim resection when pincer impingement is evident, either by open surgery or arthroscopically. We investigated two mini anterior approaches to the hip joint based on the Heuter and direct anterior approach to assess their potential for treating FAI.

Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty.

Background: Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used.