In Vitro Investigation of Column Fixation Constructs for Periacetabular Osteotomy: Which Provide the Greatest Stiffness and Strength?

Background: Periacetabular osteotomy (PAO) is an effective surgical procedure for managing acetabular dysplasia. The purpose of this study was to analyze the biomechanical properties of novel PAO constructs that incorporate orthopaedic trauma techniques. We hypothesize that these fixation methods will create a stiffer construct that tolerates higher loads to failure. Methods: Twenty bio-composite hemi-pelvises underwent PAO with the following fixation configurations: Group A: 4 iliac crest (IC) screws; Group B: 3 IC screws; Group C: 2 IC screws, 1 retrograde anterior column (AC) screw, and 1 lateral compression type-2 (LC2) screw directed from the anterior inferior iliac spine to the posterior inferior iliac spine; Group D: 1 AC screw, 1 LC2 screw, 1 posterior column screw; Group E: 2 LC2 screws, 1 AC screw. Constructs were loaded to failure on a material testing hydraulic press, and ultimate strength, stiffness, and osteotomy displacement were measured. Results: The highest load to failure was seen in group D (2511 N), which was significantly more than groups A (1528 N, P = .0114) and B (1348 N, P < .0001). The stiffest construct was group E (602 N/mm) compared to groups A (315 N/mm, P = .0439) and B (243 N/mm, P = .0008). Failure occurred most often with a fracture in the posterior column. Conclusions: This study supports column fixation methods used in orthopaedic trauma for PAO as biomechanically advantageous to traditional fixation techniques. These constructs may be beneficial to patients with weight-bearing concerns or early rehabilitation needs.

Correlation Between Traditional Anteroposterior Radiographic Measurements With Lateral Radiographic Measurements Following Triplanar Correction of Hallux Valgus and With Patient-Reported Outcomes From a Prospective Multicenter Trial.

Hallux valgus (HV) is a common condition in which the first ray is deformed, leading to pain and altered joint mechanics. A variety of radiographic measurements are used to evaluate HV. Little is known about measurements used in the assessment of HV on lateral radiographs compared to anteroposterior (AP) radiographs. The primary aim of this study was to correlate lateral measurements with AP measurements pre and postoperatively. The secondary aim was to correlate lateral measurements with patient-reported outcome measures (PROMs) pre and postoperatively. One hundred eighty-three patients were initially enrolled in the study. Two fellowship-trained musculoskeletal radiologists independently performed all measurements. On AP radiographs, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. On lateral radiographs, sagittal IMA, Meary's angle, and sagittal first ray length were measured. Measurements were recorded at baseline and 6, 12, and 24 months postoperatively. Intraclass correlation coefficients (ICCs) were used for inter-reader analysis. ICCs were moderate to very strong among readers. There were significant but weak correlations between lateral measurements and AP measurements. For at least 1 timepoint, IMA correlated with sagittal IMA, sagittal first ray length, and Meary's angle. HVA only correlated with sagittal first ray length. These correlations were all weak in magnitude. There were a few significant but weak correlations between the measurements in the study and PROMs. This study showed that sagittal IMA, sagittal first ray length, and Meary's angle are not predictive of AP measurements or patient outcomes and are not useful in preoperative assessment of HV.

Artificial intelligence-generated hip radiological measurements are fast and adequate for reliable assessment of hip dysplasia : an external validation study.

AIMS: Hip dysplasia (HD) leads to premature osteoarthritis. Timely detection and correction of HD has been shown to improve pain, functional status, and hip longevity. Several time-consuming radiological measurements are currently used to confirm HD. An artificial intelligence (AI) software named HIPPO automatically locates anatomical landmarks on anteroposterior pelvis radiographs and performs the needed measurements. The primary aim of this study was to assess the reliability of this tool as compared to multi-reader evaluation in clinically proven cases of adult HD. The secondary aims were to assess the time savings achieved and evaluate inter-reader assessment. METHODS: A consecutive preoperative sample of 130 HD patients (256 hips) was used. This cohort included 82.3% females (n = 107) and 17.7% males (n = 23) with median patient age of 28.6 years (interquartile range (IQR) 22.5 to 37.2). Three trained readers' measurements were compared to AI outputs of lateral centre-edge angle (LCEA), caput-collum-diaphyseal (CCD) angle, pelvic obliquity, Tönnis angle, Sharp's angle, and femoral head coverage. Intraclass correlation coefficients (ICC) and Bland-Altman analyses were obtained. RESULTS: Among 256 hips with AI outputs, all six hip AI measurements were successfully obtained. The AI-reader correlations were generally good (ICC 0.60 to 0.74) to excellent (ICC > 0.75). There was lower agreement for CCD angle measurement. Most widely used measurements for HD diagnosis (LCEA and Tönnis angle) demonstrated good to excellent inter-method reliability (ICC 0.71 to 0.86 and 0.82 to 0.90, respectively). The median reading time for the three readers and AI was 212 (IQR 197 to 230), 131 (IQR 126 to 147), 734 (IQR 690 to 786), and 41 (IQR 38 to 44) seconds, respectively. CONCLUSION: This study showed that AI-based software demonstrated reliable radiological assessment of patients with HD with significant interpretation-related time savings.Cite this article: Bone Jt Open 2022;3(11):877-884.