Preprint
Radiographically Successful Periacetabular Osteotomy Does Not Achieve Optimal Contact Mechanics in Dysplastic Hips
medRxiv
Cold Spring Harbor Laboratory
04/01/2023
DOI: 10.1101/2022.05.26.22275634
Abstract
ABSTRACTIntroductionOptimal correction of hip dysplasia deformity with periacetabular osteotomy (PAO) that minimizes elevated contact stresses may reduce osteoarthritis (OA) development.Questions/PurposesWe used a computational approach based on discrete element analysis (DEA) to determine (1) if computational optimization can identify patient-specific acetabular corrections that optimize joint contact mechanics, (2) whether a strictly mechanically optimal correction is clinically feasible, and (3) whether the contact mechanics of optimal corrections differ from those of surgically achieved corrections.MethodsPreoperative and postoperative hip models were created from CT scans of a retrospective cohort (n=20) who underwent PAO to treat hip dysplasia. A digitally extracted acetabular fragment was computationally rotated in two-degree increments of lateral and anterior coverage to simulate candidate PAO reorientations. DEA-computed contact stress for each candidate reorientation model was used to select a purely mechanically optimal reorientation that minimized chronic contact stress exposures above damaging thresholds and a clinically optimal reorientation that balanced reducing chronic exposures with achieving clinically realistic acetabular orientations. Radiographic coverage, contact area, peak/mean contact stress, and peak/mean cumulative exposure were compared between preoperative, mechanically optimal, clinically optimal, and surgically achieved acetabular orientations.ResultsComputationally optimal reorientations had significantly (p<0.001) more lateral and anterior coverage than surgically achieved PAO corrections. The mechanically/clinically optimal reorientations also had significantly more contact area (p<0.001/p=0.001) and significantly lower peak contact stress (p<0.001/p<0.001), mean contact stress (p<0.001/p=0.001), peak chronic exposure (p=0.001/p=0.003), and mean chronic exposure (p<0.001/p=0.001) than the surgically achieved corrections.ConclusionsThis computational approach identified patient-specific mechanically optimal and clinically optimal acetabular reorientations. Surgically achieved reorientations did not reduce contact stress exposure to the extent achieved with computed optimal reorientations. However, optimal orientations identified for many patients risk secondary femoroacetabular impingement. Identifying patient-specific corrections that balance optimizing mechanics with clinical reality is necessary to reduce the risk of OA progression after PAO.
Details
- Title: Subtitle
- Radiographically Successful Periacetabular Osteotomy Does Not Achieve Optimal Contact Mechanics in Dysplastic Hips
- Creators
- Holly D. AitkenAspen Miller - University of IowaDominic J.L. Rivas - University of IowaMarcus Tatum - University of IowaRobert W. Westermann - University of IowaMichael C. Willey - University of IowaJessica E. Goetz - University of Iowa
- Resource Type
- Preprint
- Publication Details
- medRxiv
- DOI
- 10.1101/2022.05.26.22275634
- Publisher
- Cold Spring Harbor Laboratory
- Language
- English
- Date posted
- 04/01/2023
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering; Injury Prevention Research Center; Athletic Training Program
- Record Identifier
- 9984530398102771
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