Semi-automated measurement and analysis of three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Xu ^1,2 , ZHANG Henghui ¹ , HU Xumin ² , XIE Kai ¹ , KAN Tianyou ¹ , LI Bo ² , ZHANG Chi ² , AI Songtao ³ , GAO Liangbin ² ,  YAN Mengning ¹ ,  WANG Liao ¹

1. Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China;
2. Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China;
3. Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China;

Corresponding author：

YAN Mengning, Email: wang821127@163.com; WANG Liao, Email: wang821127@163.com

Keywords：

Developmental dysplasia of the hip; acetabulum; anteversion; inclination; asymptomatic population; computer-assisted imaging processing

DOI：

10.7507/1002-1892.202107112

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Objective To evaluate the three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip (DDH) using a semi-automated measurement software, which provides data for the differential diagnosis, surgical planning, surgical instrument design, and postoperative evaluation of hip related diseases. Methods Eighty-four cases of CT data in asymptomatic population (asymptomatic group) and 47 cases of CT data in DDH patients (DDH group) were collected. There was no significant difference in gender and age (including age of male and female subgroups) between the two groups (P<0.05). MaxTHA, a semi-automatic measurement software, was used to measure acetabular inclination and anteversion, including operative inclination (OI), radiographic inclination (RI), anatomic inclination (AI), operative anteversion (OA), radiographic anteversion (RA), and anatomic anteversion (AA). Comparisons were made between the two populations, between different Crowe classification subgroups, between different gender subgroups, and between left and right sides of acetabula. Results The comparison between asymptomatic group, healthy side of DDH group, and affected side of DDH group showed that there was no significant difference in acetabular orientation between asymptomatic group and healthy side of DDH group (P>0.05). The OI, RI, and AI of affected side of DDH group were significantly higher than those in healthy side of DDH group and asymptomatic group, and AA was significantly lower than that in healthy side of DDH group and asymptomatic group (P<0.05). The comparison between the normal acetabula and DDH acetabula with different Crowe classifications showed that there was no significant difference in the acetabulum orientation between Crowe Ⅰ group and the normal group (P>0.05). The OI, RI, and AI of Crowe Ⅱ, Ⅲ, and Ⅳ groups were significantly higher than those of normal group (P<0.05), the OI of Crowe Ⅲ group, RI and AI of Crowe Ⅳ group were significantly higher than those of Crowe Ⅰ group (P<0.05), the AI of Crowe Ⅳ group was significantly higher than that of Crowe Ⅱ group (P<0.05), and the OA, RA, and AA of Crowe Ⅲ group were significantly lower than other subgroups (P<0.05) except Crowe Ⅰ group. The OA, RA, and AA in asymptomatic female group, and the OA and AI in DDH female group were significantly higher than those in all male groups (P<0.05). The OI, RI, AI, and OA of the right acetabula in asymptomatic male group, and the RI and AI of the right acetabula in asymptomatic female group were significantly higher than those on the left side (P<0.05). Conclusion There were significant differences in acetabular orientation between asymptomatic and DDH populations, inter-group differences among Crowe classification subgroups, inter-gender differences among subgroups, and bilateral differences among asymptomatic individuals.

Citation： JIANG Xu, ZHANG Henghui, HU Xumin, XIE Kai, KAN Tianyou, LI Bo, ZHANG Chi, AI Songtao, GAO Liangbin, YAN Mengning, WANG Liao. Semi-automated measurement and analysis of three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1555-1562. doi: 10.7507/1002-1892.202107112 Copy

1.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
2.	Kennedy JG, Rogers WB, Soffe KE, et al. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty, 1998, 13(5): 530-534.
3.	Teeter MG, Goyal P, Yuan X, et al. Change in acetabular cup orientation from supine to standing position and its effect on wear of highly crosslinked polyethylene. J Arthroplasty, 2018, 33(1): 263-267.
4.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
5.	Song SK, Choi WK, Jung SH, et al. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations. J Orthop Res, 2021, 39(4): 806-812.
6.	Kaiser M, Renkawitz T, Benditz A, et al. Pelvic tilt impacts cup orientation on CT: how accurate is the gold standard? Acta Radiol, 2021. doi: 10.1177/02841851211009466.
7.	Davda K, Smyth N, Cobb JP, et al. 2D measurements of cup orientation are less reliable than 3D measurements. Acta Orthop, 2015, 86(4): 485-490.
8.	张恒辉, 曲扬, 陈晓军, 等. 数字化技术辅助的中国人髋臼朝向三维测量. 上海交通大学学报 (医学版), 2016, 36(9): 1311-1316.
9.	Zhang H, Wang Y, Ai S, et al. Three-dimensional acetabular orientation measurement in a reliable coordinate system among one hundred Chinese. PLoS One, 2017, 12(2): e0172297. doi: 10.1371/journal.pone.0172297.
10.	Higgins SW, Spratley EM, Boe RA, et al. A novel approach for determining three-dimensional acetabular orientation: results from two hundred subjects. J Bone Joint Surg (Am), 2014, 96(21): 1776-1784.
11.	Veilleux NJ, Kalore NV, Vossen JA, et al. Automatic characterization of pelvic and sacral measures from 200 subjects. J Bone Joint Surg (Am), 2020, 102(23): e130. doi: 10.2106/JBJS.20.00343.
12.	Wang RY, Xu WH, Kong XC, et al. Measurement of acetabular inclination and anteversion via CT generated 3D pelvic model. BMC Musculoskelet Disord, 2017, 18(1): 373. doi: 10.1186/s12891-017-1714-y.
13.	Yang Y, Zuo J, Liu T, et al. Morphological analysis of true acetabulum in hip dysplasia (Crowe classes Ⅰ-Ⅳ) via 3-d implantation simulation. J Bone Joint Surg (Am), 2017, 99(17): e92. doi: 10.2106/JBJS.16.00729.
14.	Maruyama M, Feinberg JR, Capello WN, et al. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res, 2001, (393): 52-65.
15.	Murtha PE, Hafez MA, Jaramaz B, et al. Variations in acetabular anatomy with reference to total hip replacement. J Bone Joint Surg (Br), 2008, 90(3): 308-313.
16.	Lubovsky O, Wright D, Hardisty M, et al. Acetabular orientation: anatomical and functional measurement. Int J Comput Assist Radiol Surg, 2012, 7(2): 233-240.
17.	Jóźwiak M, Rychlik M, Musielak B, et al. An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction. BMC Musculoskelet Disord, 2015, 16: 42. doi: 10.1186/s12891-015-0503-8.
18.	Lee C, Jang J, Kim HW, et al. Three-dimensional analysis of acetabular orientation using a semi-automated algorithm. Comput Assist Surg (Abingdon), 2019, 24(1): 18-25.
19.	Uemura K, Atkins PR, Peters CL, et al. The effect of pelvic tilt on three-dimensional coverage of the femoral head: A computational simulation study using patient-specific anatomy. Anat Rec (Hoboken), 2021, 304(2): 258-265.
20.	曾羿, 闵理, 赖欧杰, 等. 三维表面重建技术在高位脱位DDH患者髋臼形态评价中的应用. 四川大学学报 (医学版), 2015, 46(2): 296-300.
21.	Fujii M, Nakashima Y, Yamamoto T, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2010, 92(4): 895-903.
22.	Bernasek TL, Haidukewych GJ, Gustke KA, et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty, 2007, 22(6 Suppl 2): 145-150.
23.	Zeng Y, Wang Y, Zhu Z, et al. Differences in acetabular morphology related to side and sex in a Chinese population. J Anat, 2012, 220(3): 256-262.
24.	舒荣宝, 罗潇, 何仿. 髋臼位相与开口形态学参数及其相互关系多层螺旋CT的评价. 中国组织工程研究, 2013, 17(4): 633-638.
25.	吴昊, 王渭君, 孙明辉, 等. 髋臼相关参数在不同CT平面上的对比研究. 中华关节外科杂志 (电子版), 2016, 10(1): 20-26.
26.	杨本涛, 王振常, 徐爱德, 等. 正常成人髋臼前倾角的CT测量. 临床放射学杂志, 2000, 19(12): 814-815.
27.	金进宝, 石岩, 尚鹏, 等. 华南人髋臼前倾角测量分析及临床意义. 国际骨科学杂志, 2013, 34(6): 439-441, 448.
28.	Ma H, Han Y, Yang Q, et al. Three-dimensional computed tomography reconstruction measurements of acetabulum in Chinese adults. Anat Rec (Hoboken), 2014, 297(4): 643-649.

1. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
2. Kennedy JG, Rogers WB, Soffe KE, et al. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty, 1998, 13(5): 530-534.
3. Teeter MG, Goyal P, Yuan X, et al. Change in acetabular cup orientation from supine to standing position and its effect on wear of highly crosslinked polyethylene. J Arthroplasty, 2018, 33(1): 263-267.
4. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
5. Song SK, Choi WK, Jung SH, et al. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations. J Orthop Res, 2021, 39(4): 806-812.
6. Kaiser M, Renkawitz T, Benditz A, et al. Pelvic tilt impacts cup orientation on CT: how accurate is the gold standard? Acta Radiol, 2021. doi: 10.1177/02841851211009466.
7. Davda K, Smyth N, Cobb JP, et al. 2D measurements of cup orientation are less reliable than 3D measurements. Acta Orthop, 2015, 86(4): 485-490.
8. 张恒辉, 曲扬, 陈晓军, 等. 数字化技术辅助的中国人髋臼朝向三维测量. 上海交通大学学报 (医学版), 2016, 36(9): 1311-1316.
9. Zhang H, Wang Y, Ai S, et al. Three-dimensional acetabular orientation measurement in a reliable coordinate system among one hundred Chinese. PLoS One, 2017, 12(2): e0172297. doi: 10.1371/journal.pone.0172297.
10. Higgins SW, Spratley EM, Boe RA, et al. A novel approach for determining three-dimensional acetabular orientation: results from two hundred subjects. J Bone Joint Surg (Am), 2014, 96(21): 1776-1784.
11. Veilleux NJ, Kalore NV, Vossen JA, et al. Automatic characterization of pelvic and sacral measures from 200 subjects. J Bone Joint Surg (Am), 2020, 102(23): e130. doi: 10.2106/JBJS.20.00343.
12. Wang RY, Xu WH, Kong XC, et al. Measurement of acetabular inclination and anteversion via CT generated 3D pelvic model. BMC Musculoskelet Disord, 2017, 18(1): 373. doi: 10.1186/s12891-017-1714-y.
13. Yang Y, Zuo J, Liu T, et al. Morphological analysis of true acetabulum in hip dysplasia (Crowe classes Ⅰ-Ⅳ) via 3-d implantation simulation. J Bone Joint Surg (Am), 2017, 99(17): e92. doi: 10.2106/JBJS.16.00729.
14. Maruyama M, Feinberg JR, Capello WN, et al. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res, 2001, (393): 52-65.
15. Murtha PE, Hafez MA, Jaramaz B, et al. Variations in acetabular anatomy with reference to total hip replacement. J Bone Joint Surg (Br), 2008, 90(3): 308-313.
16. Lubovsky O, Wright D, Hardisty M, et al. Acetabular orientation: anatomical and functional measurement. Int J Comput Assist Radiol Surg, 2012, 7(2): 233-240.
17. Jóźwiak M, Rychlik M, Musielak B, et al. An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction. BMC Musculoskelet Disord, 2015, 16: 42. doi: 10.1186/s12891-015-0503-8.
18. Lee C, Jang J, Kim HW, et al. Three-dimensional analysis of acetabular orientation using a semi-automated algorithm. Comput Assist Surg (Abingdon), 2019, 24(1): 18-25.
19. Uemura K, Atkins PR, Peters CL, et al. The effect of pelvic tilt on three-dimensional coverage of the femoral head: A computational simulation study using patient-specific anatomy. Anat Rec (Hoboken), 2021, 304(2): 258-265.
20. 曾羿, 闵理, 赖欧杰, 等. 三维表面重建技术在高位脱位DDH患者髋臼形态评价中的应用. 四川大学学报 (医学版), 2015, 46(2): 296-300.
21. Fujii M, Nakashima Y, Yamamoto T, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2010, 92(4): 895-903.
22. Bernasek TL, Haidukewych GJ, Gustke KA, et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia: 5- to 14-year results. J Arthroplasty, 2007, 22(6 Suppl 2): 145-150.
23. Zeng Y, Wang Y, Zhu Z, et al. Differences in acetabular morphology related to side and sex in a Chinese population. J Anat, 2012, 220(3): 256-262.
24. 舒荣宝, 罗潇, 何仿. 髋臼位相与开口形态学参数及其相互关系多层螺旋CT的评价. 中国组织工程研究, 2013, 17(4): 633-638.
25. 吴昊, 王渭君, 孙明辉, 等. 髋臼相关参数在不同CT平面上的对比研究. 中华关节外科杂志 (电子版), 2016, 10(1): 20-26.
26. 杨本涛, 王振常, 徐爱德, 等. 正常成人髋臼前倾角的CT测量. 临床放射学杂志, 2000, 19(12): 814-815.
27. 金进宝, 石岩, 尚鹏, 等. 华南人髋臼前倾角测量分析及临床意义. 国际骨科学杂志, 2013, 34(6): 439-441, 448.
28. Ma H, Han Y, Yang Q, et al. Three-dimensional computed tomography reconstruction measurements of acetabulum in Chinese adults. Anat Rec (Hoboken), 2014, 297(4): 643-649.

Chinese Journal of Reparative and Reconstructive Surgery

Semi-automated measurement and analysis of three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip

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