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      Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis

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          Abstract

          Background

          The success of Bernese periacetabular osteotomy depends significantly on how extent the acetabular fragment can be corrected to its optimal position. This study was undertaken to investigate whether correcting the acetabular fragment into the so-called radiological “normal” range is the best choice for all developmental dysplasia of the hip with different severities of dysplasia from the biomechanical view? If not, is there any correlation between the biomechanically optimal position of the acetabular fragment and the severity of dysplasia?

          Methods

          Four finite element models with different severities of dysplasia were developed. The virtual periacetabular osteotomy was performed with the acetabular fragment rotated anterolaterally to incremental center-edge angles; then, the contact area and pressure and von Mises stress in the cartilage were calculated at different correction angles.

          Results

          The optimal position of the acetabular fragment for patients 1, 2, and 3 was when the acetabular fragment rotated 17° laterally (with the lateral center-edge angle of 36° and anterior center-edge angle of 58°; both were slightly larger than the “normal” range), 25° laterally following further 5° anterior rotation (with the lateral center-edge angle of 31° and anterior center-edge angle of 51°; both were within the “normal” range), and 30° laterally following further 10° anterior rotation (with the lateral center-edge angle of 25° and anterior center-edge angle of 40°; both were less than the “normal” range), respectively.

          Conclusions

          The optimal corrective position of the acetabular fragment is severity dependent rather than within the radiological “normal” range for developmental dysplasia of the hip. We prudently proposed that the optimal correction center-edge angle of mild, moderate, and severe developmental dysplasia of the hip is slightly larger than the “normal” range, within the “normal” range, and less than the lower limit of the “normal” range, respectively.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13018-016-0445-3) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

          A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.
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            Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study.

            To test the hypothesis that individuals with patellofemoral pain (PFP) exhibit greater patellofemoral joint stress profiles compared to persons who are pain-free. Ten females with PFP and ten gender, age, and activity-matched pain-free controls participated. Patella and femur stress profiles were quantified utilizing subject-specific finite element (FE) models of the patellofemoral joint at 15° and 45° of knee flexion. Input parameters for the FE model included: (1) joint geometry, (2) quadriceps muscle forces, and (3) weight-bearing patellofemoral joint kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify each subject's patellofemoral joint stress profile during a static squatting maneuver. The patella and femur peak and mean hydrostatic pressure as well as the peak and mean octahedral shear stress for the elements representing the chondro-osseous interface were quantified. Compared to the pain-free controls, individuals with PFP consistently exhibited greater peak and mean hydrostatic pressure as well as peak and mean octahedral shear stress for the elements representing the patella and femur chondro-osseous interface across the two knee flexion angles tested (15° and 45°). The combined finding of elevated hydrostatic pressure and octahedral shear stress across the two knee flexion angles supports the premise that PFP may be associated with elevated joint stress. Therefore, treatments aimed at decreasing patellofemoral joint stress may be indicated in this patient population. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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              Bernese periacetabular osteotomy.

              Seventy-five symptomatic dysplastic hip joints (63 patients) were treated with the Bernese periacetabular osteotomy during a period of 44 months. The mean patients' age was 29 years (range, 13-56 years) and the female:male ratio was 3.4:1. Group III dysplasia according to Severin was seen in 50% and Group IV dysplasia was seen in 44% of the patients. Osteoarthritis was present in 58% of the patients. Followup was obtained at a mean of 11.3 years (range, 10-13.8 years) in 71 hip joints (95%). Radiographic measurements of the lateral center edge angle, anterior center edge angle, acetabular index, lateralization of the femoral head, and intactness of Shenton's line showed a high correction potential of this type of osteotomy. In 58 patients (82%) the hip joint was preserved at last followup with a good to excellent result in 73%. Unfavorable outcome was significantly associated with higher age of the patient, moderate to severe osteoarthritis at surgery, a labral lesion, less anterior coverage correction, and a suboptimal acetabular index. Major complications were encountered in the first 18 patients including an intraarticular cut in two, excessive lateralization in one, secondary loss of correction in two and femoral head subluxation in three patients.
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                Author and article information

                Contributors
                Wangxuyi820828@163.com
                jlu_sjtu_pku@163.com
                lidedoctor@163.com
                ZLL79790@163.com
                wanghui@163.com
                505516681@qq.com
                chenxdmd@163.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                4 October 2016
                4 October 2016
                2016
                : 11
                : 109
                Affiliations
                [1 ]Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui China
                [2 ]Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
                [3 ]Department of Biomedical Engineering, Shanghai University of Technology, Shanghai, China
                Article
                445
                10.1186/s13018-016-0445-3
                5050724
                27716351
                62fcb963-8642-43e5-a57c-b76cdf7ca7da
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 March 2016
                : 27 September 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: No.81171705
                Award Recipient :
                Funded by: National Natural Science Foundation of Youth in China
                Award ID: No.81101381
                Award Recipient :
                Funded by: Shanghai Municipal Commission of Health and Family Planning Foundation
                Award ID: No.20134002
                Award Recipient :
                Funded by: Research Foundation of Shanghai Jiaotong University Medical School
                Award ID: No.14XJ10031
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Surgery
                developmental dysplasia of the hip,finite element analysis,periacetabular osteotomy

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