Radiographically successful periacetabular osteotomy does not achieve optimal contact mechanics in dysplastic hips

Optimal correction of hip dysplasia via periacetabular osteotomy may reduce osteoarthritis development by reducing damaging contact stress. The objective of this study was to computationally determine if patient-specific acetabular corrections that optimize contact mechanics can improve upon contact...

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Bibliographic Details
Published in:Clinical biomechanics (Bristol) 2023-04, Vol.104, p.105928-105928, Article 105928
Main Authors: Aitken, Holly D., Miller, Aspen, Rivas, Dominic J.L., Tatum, Marcus, Westermann, Robert W., Willey, Michael C., Goetz, Jessica E.
Format: Article
Language:English
Subjects:
Acetabulum - diagnostic imaging
Acetabulum - surgery
Contact stress
Discrete element analysis
Hip Dislocation - diagnostic imaging
Hip Dislocation - etiology
Hip Dislocation - surgery
Hip Dislocation, Congenital - diagnostic imaging
Hip Dislocation, Congenital - etiology
Hip Dislocation, Congenital - surgery
Hip dysplasia
Humans
Optimization
Osteoarthritis
Osteotomy - methods
Periacetabular osteotomy
Retrospective Studies
Treatment Outcome
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Summary:Optimal correction of hip dysplasia via periacetabular osteotomy may reduce osteoarthritis development by reducing damaging contact stress. The objective of this study was to computationally determine if patient-specific acetabular corrections that optimize contact mechanics can improve upon contact mechanics resulting from clinically successful, surgically achieved corrections. Preoperative and postoperative hip models were retrospectively created from CT scans of 20 dysplasia patients treated with periacetabular osteotomy. A digitally extracted acetabular fragment was computationally rotated in 2-degree increments around anteroposterior and oblique axes to simulate candidate acetabular reorientations. From discrete element analysis of each patient's set of candidate reorientation models, a mechanically optimal reorientation that minimized chronic contact stress exposure and a clinically optimal reorientation that balanced improving mechanics with surgically acceptable acetabular coverage angles was selected. Radiographic coverage, contact area, peak/mean contact stress, and peak/mean chronic exposure were compared between mechanically optimal, clinically optimal, and surgically achieved orientations. Compared to actual surgical corrections, computationally derived mechanically/clinically optimal reorientations had a median[IQR] 13[4–16]/8[3–12] degrees and 16[6–26]/10[3–16] degrees more lateral and anterior coverage, respectively. Mechanically/clinically optimal reorientations had 212[143–353]/217[111–280] mm2 more contact area and 8.2[5.8–11.1]/6.4[4.5–9.3] MPa lower peak contact stresses than surgical corrections. Chronic metrics demonstrated similar findings (p ≤ 0.003 for all comparisons). Computationally selected orientations achieved a greater mechanical improvement than surgically achieved corrections; however, many predicted corrections would be considered acetabular over-coverage. Identifying patient-specific corrections that balance optimizing mechanics with clinical constraints will be necessary to reduce the risk of osteoarthritis progression after periacetabular osteotomy. •Computational optimization showed potential for improvement on surgical correction.•Computationally optimal orientations risk secondary femoroacetabular impingement.•Patient-specific optimal corrections should balance mechanics with clinical reality.
ISSN:0268-0033
1879-1271
DOI:10.1016/j.clinbiomech.2023.105928