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Comparison of rotational acetabular osteotomy performed with navigation by surgeons with different levels of experience of osteotomies

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Rotational acetabular osteotomy (RAO) is used to treat developmental hip dysplasia (DDH). It requires detailed anatomical knowledge of the pelvic anatomy and three-dimensional cognitive skills. We addressed whether a computer navigation system combined with a preoperative computed tomography-based plan enabled surgeons to perform RAO safely and reliably through a mini-incision regardless of their level of experience with performing osteotomies.

Methods

We enrolled 24 patients (25 hips) with DDH (radiographic grade 0 or 1 osteoarthritic changes: Tönnis classification). Using the navigation system, four surgeons performed RAO via a mini-incision transtrochanteric approach. Two experienced surgeons treated 15 patients (16 hips). Two surgeons with low-level RAO experience treated nine patients (9 hips). Operative data and clinical and radiographic outcomes were compared. Average follow-up was 3.2 years.

Results

There were no significant differences in the (1) incision length, operation time, or intraoperative blood loss; (2) numerical pain rating scale score and Western Ontario and McMaster Universities Osteoarthritis Index Scale score at 1, 2 years, and at the latest follow-up; (3) preoperative and postoperative acetabular coverage of the femoral head, postoperative joint congruency, postoperative medial and distal femoral head displacement, or acetabular thickness; and (4) positional accuracy of iliac, pubic, and ischial osteotomy and accuracy of acetabular coverage of the femoral head.

Conclusions

Clinical and radiographic outcomes of RAO with navigation were not influenced by the surgeons’ level of osteotomy experience.

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References

  1. Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 232:26–36

    Google Scholar 

  2. Ninomiya S, Tagawa H (1984) Rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Am 66(3):430–436

    Article  CAS  PubMed  Google Scholar 

  3. Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA (2013) Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res 471(5):1602–1614. doi:10.1007/s11999-013-2799-8

    Article  PubMed  PubMed Central  Google Scholar 

  4. Klaue K, Wallin A, Ganz R (1988) CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res 232:15–25

    Google Scholar 

  5. Millis MB, Murphy SB (1992) Use of computed tomographic reconstruction in planning osteotomies of the hip. Clin Orthop Relat Res 274:154–159

    Google Scholar 

  6. Dutoit M, Zambelli PY (1999) Simplified 3D-evaluation of periacetabular osteotomy. Acta Orthop Belg 65(3):288–294

    CAS  PubMed  Google Scholar 

  7. Mechlenburg I, Nyengaard JR, Romer L, Soballe K (2004) Changes in load-bearing area after Ganz periacetabular osteotomy evaluated by multislice CT scanning and stereology. Acta Orthop Scand 75(2):147–153. doi:10.1080/00016470412331294395

    Article  PubMed  Google Scholar 

  8. Armiger RS, Armand M, Lepisto J, Minhas D, Tallroth K, Mears SC, Waites MD, Taylor RH (2007) Evaluation of a computerized measurement technique for joint alignment before and during periacetabular osteotomy. Comput Aided Surg 12(4):215–224. doi:10.3109/10929080701541855

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hipp JA, Sugano N, Millis MB, Murphy SB (1999) Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res 364:134–143

    Article  Google Scholar 

  10. Liu L, Ecker TM, Schumann S, Siebenrock KA, Zheng G (2016) Evaluation of constant thickness cartilage models versus patient specific cartilage models for an optimized computer-assisted planning of periacetabular osteotomy. PloS One 11(1):e0146452. doi:10.1371/journal.pone.0146452

    Article  PubMed  PubMed Central  Google Scholar 

  11. Langlotz F, Stucki M, Bachler R, Scheer C, Ganz R, Berlemann U, Nolte LP (1997) The first twelve cases of computer assisted periacetabular osteotomy. Comput Aided Surg 2(6):317–326. doi:10.1002/(sici)1097-0150(1997)2:6<317::aid-igs1>3.0.co;2-2

  12. Mayman DJ, Rudan J, Yach J, Ellis R (2002) The Kingston periacetabular osteotomy utilizing computer enhancement: a new technique. Comput Aided Surg 7(3):179–186. doi:10.1002/igs.10041

    Article  PubMed  Google Scholar 

  13. Nakahodo K, Sasama T, Sato Y, Sugano N, Ohzono K, Nishii T, Nishihara S, Yonenobu K, Ochi T, Tamura S (2000) Intraoperative update of 3D bone model during computer navigation of pelvic osteotomies using real-time 3D position data. In: Lemke H, Vannier M, Inamura K, Farman A, Doi K (eds) Computer assisted radiology and surgery. In: 14th International symposium and exhibition (CARS 2000), San Francisco, CA, 2000. Elsevier, Amsterdam, pp 252–256

  14. Sugano N, Takao M, Sakai T, Nishii T, Miki H (2016) Safety and accuracy of CT-based navigation for rotational acetabular osteotomy. Formos J Musculoskelet Disord 7(1):44–50. doi:10.6492/FJMD.20151007

  15. Pflugi S, Liu L, Ecker TM, Schumann S, Larissa Cullmann J, Siebenrock K, Zheng G (2016) A cost-effective surgical navigation solution for periacetabular osteotomy (PAO) surgery. Int J Comput Assist Radiol Surg 11(2):271–280. doi:10.1007/s11548-015-1267-1

  16. Murphy RJ, Armiger RS, Lepisto J, Mears SC, Taylor RH, Armand M (2015) Development of a biomechanical guidance system for periacetabular osteotomy. Int J Comput Assist Radiol Surg 10(4):497–508. doi:10.1007/s11548-014-1116-7

    Article  PubMed  Google Scholar 

  17. Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38

    Article  Google Scholar 

  18. Otsuki B, Takemoto M, Kawanabe K, Awa Y, Akiyama H, Fujibayashi S, Nakamura T, Matsuda S (2013) Developing a novel custom cutting guide for curved peri-acetabular osteotomy. Int Orthop 37(6):1033–1038. doi:10.1007/s00264-013-1873-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Azuma H, Taneda H (1989) Rotational acetabular osteotomy in congenital dysplasia of the hip. Int Orthop 13(1):21–28

    Article  CAS  PubMed  Google Scholar 

  20. Kambe T, Naito M, Asayama I, Koga K, Fujisawa M, Yamaguchi T, Yatsunami M (2003) Vascular anatomy for rotational acetabular osteotomy: cadaveric study. J Orthop Sci 8(3):323–328. doi:10.1007/s10776-002-0630-7

    Article  PubMed  Google Scholar 

  21. Matsui M, Masuhara K, Nakata K, Nishii T, Sugano N, Ochi T (1997) Early deterioration after modified rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Br 79(2):220–224

    Article  CAS  PubMed  Google Scholar 

  22. Xu K, Li YM, Zhang HF, Wang CG, Xu YO, Li ZJ (2014) Computer navigation in total hip arthroplasty: a meta-analysis of randomized controlled trials. Int J Surg (Lond, Engl) 12(5):528–533. doi:10.1016/j.ijsu.2014.02.014

    Article  Google Scholar 

  23. Akiyama H, Goto K, So K, Nakamura T (2010) Computed tomography-based navigation for curved periacetabular osteotomy. J Orthop Sci 15(6):829–833. doi:10.1007/s00776-010-1520-y

    Article  PubMed  Google Scholar 

  24. Hsieh PH, Chang YH, Shih CH (2006) Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: a randomized study of 36 patients followed for 2 years. Acta Orthop 77(4):591–597. doi:10.1080/17453670610012656

    Article  PubMed  Google Scholar 

  25. Tonnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81(12):1747–1770

    Article  CAS  PubMed  Google Scholar 

  26. Sugano N, Sasama T, Sato Y, Nakajima Y, Nishii T, Yonenobu K, Tamura S, Ochi T (2001) Accuracy evaluation of surface-based registration methods in a computer navigation system for hip surgery performed through a posterolateral approach. Comput Aided Surg 6(4):195–203. doi:10.1002/igs.10011

    Article  CAS  PubMed  Google Scholar 

  27. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA (1978) Studies with pain rating scales. Ann Rheum Dis 37(4):378–381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Bellamy N (1989) Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 18(4 Suppl 2):14–17

    Article  CAS  PubMed  Google Scholar 

  29. Wiberg G (1939) Studies on dysplastic acetabular and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Chir Scand 58(suppl):5–135

  30. Massie W, Howorth M (1950) Congenital dislocation of the hip: part 1. Method of grading results. J Bone Joint Surg [Am] 31–A:519–531

    Article  Google Scholar 

  31. Lequesne M, de Seze S (1961) The false-profile view of the hip: new radiographic method of the hip evaluation and the utility for the diagnosis of the dysplasia and different coxopathy [in French]. Rev Rhum 28:643–652

    CAS  PubMed  Google Scholar 

  32. Yasunaga Y, Ikuta Y, Kanazawa T, Takahashi K, Hisatome T (2001) The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy. J Bone Joint Surg Br 83(7):1001–1004

    Article  CAS  PubMed  Google Scholar 

  33. Hasegawa Y, Iwase T, Kitamura S, Kawasaki M, Yamaguchi J (2014) Eccentric rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: follow-up at a mean duration of twenty years. J Bone Joint Surg Am 96(23):1975–1982. doi:10.2106/jbjs.m.01563

  34. Hartig-Andreasen C, Troelsen A, Thillemann TM, Soballe K (2012) What factors predict failure 4–12 years after periacetabular osteotomy? Clin Orthop Relat Res 470(11):2978–2987. doi:10.1007/s11999-012-2386-4

  35. Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA (2015) What are the radiographic reference values for acetabular under- and over-coverage? Clin Orthop Relat Res 473(4):1234–1246. doi:10.1007/s11999-014-4038-3

    Article  PubMed  Google Scholar 

  36. Hamada H, Takao M, Nakahara I, Sakai T, Nishii T, Sugano N (2015) Hip range-of-motion (ROM) is less than normal after rotational acetabular osteotomy for developmental dysplasia of the hip: A simulated ROM analysis. J Orthop Res. doi:10.1002/jor.23024

    PubMed  Google Scholar 

  37. Yasunaga Y, Yamasaki T, Matsuo T, Ishikawa M, Adachi N, Ochi M (2010) Crossover sign after rotational acetabular osteotomy for dysplasia of the hip. J Orthop Sci 15(4):463–469. doi:10.1007/s00776-010-1489-6

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Prof. Hideki Yoshikawa and Dr. Nobuo Nakamura for their scientific advice and many insightful discussions. We did not receive any funding related this study.

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Authors and Affiliations

  1. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Masaki Takao, Takashi Nishii & Nobuhiko Sugano

  2. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Takashi Sakai

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  1. Masaki Takao
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  2. Takashi Nishii
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  4. Nobuhiko Sugano
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Correspondence to Masaki Takao.

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Takao, M., Nishii, T., Sakai, T. et al. Comparison of rotational acetabular osteotomy performed with navigation by surgeons with different levels of experience of osteotomies. Int J CARS 12, 841–853 (2017). https://doi.org/10.1007/s11548-016-1494-0

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