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John C Clohisy - One of the best experts on this subject based on the ideXlab platform.
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lateral center Edge Angle is not predictive of acetabular articular cartilage surface area anatomic variation of the lunate fossa
American Journal of Sports Medicine, 2020Co-Authors: Thai Q Trinh, John C Clohisy, Jeffrey J Nepple, Michael Leunig, Christopher M Larson, Ira Zaltz, Bryan T Kelly, Micah Naimark, Asheesh BediAbstract:Background:Surgical treatment of symptomatic femoroacetabular impingement (FAI) and dysplasia requires careful characterization of acetabular morphology. The lateral center-Edge Angle (LCEA) is oft...
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do changes in pelvic rotation and tilt affect measurement of the anterior center Edge Angle on false profile radiographs a cadaveric study
Clinical Orthopaedics and Related Research, 2019Co-Authors: Sara M Putnam, John C Clohisy, Jeffrey J NeppleAbstract:BACKGROUND The false profile radiograph assesses acetabular coverage in prearthritic hip conditions. Precise rotation of this radiograph is difficult to obtain, so the clinician must interpret radiographs with nonstandard pelvic rotation or tilt, despite limited evidence of how this may affect the anterior center Edge Angle measurement. QUESTIONS/PURPOSES (1) Does pelvic rotation alter the measurement of the anterior center Edge Angle on false profile views? (2) Does pelvic tilt alter the measurement of the anterior center Edge Angle on false profile views? (3) Is there an objective way to assess appropriate pelvic rotation for the false profile view? METHODS Eight cadaver hips (four female, four male; one hip randomly selected per pelvis) were included in the study. Hips with degenerative changes, evidence of previous fracture or trauma, or previous surgical intervention were excluded. Specimens were between 68 to 92 years of age (median, 76 years). The specimens were fixed to a custom jig, and radiographs were taken at 5° intervals of rotation (45-85°) and 5° intervals of pelvic tilt (+10° to -10°). The primary outcome variable, anterior center Edge Angle, was measured for each rotation and tilt. RESULTS Every degree increase in pelvic rotation toward a true lateral resulted in 0.18° increase in the anterior center Edge Angle (95% confidence interval [CI], 0.07-0.29; p = 0.002). For every degree increase in pelvic tilt, the anterior center Edge Angle increased 0.65° (95% CI, 0.5-0.8; p < 0.001). We verified that standard pelvic rotation of 65° for a false profile radiograph was present when the space between the femoral heads is 66% to 100% of the diameter of the femoral head being imaged. CONCLUSIONS This study shows that the anterior center Edge Angle increases as pelvic tilt increases, with a 6° increase in anterior center Edge Angle for each 10° increase in pelvic tilt. Since the false profile radiograph is obtained standing, the patient should be counseled to avoid adopting a forced posture, ensuring the radiograph remains an accurate functional representation of the patient's anatomy. In contrast, pelvic rotation did not influence the anterior center Edge Angle by an important margin, and while we recommend that radiographs continue to be obtained with standardized pelvic rotation, aberrant pelvic rotation will likely not result in a clinically meaningful difference in anterior center Edge Angle measurements. In the future, studies to identify the specific regions of acetabular anatomy that constitute the radiographic measurement of the anterior center Edge Angle would enhance current understanding of the associated radiographic anatomy, and consequently improve the ability of the surgeon to treat the specific area of pathology. CLINICAL RELEVANCE In practice, the clinician should pay close attention to pelvic tilt, as a 10° change in tilt may cause 6° of change in the anterior center Edge Angle. However, false profile radiographs obtained within ± 20° of the targeted 65° of rotation will result in less than 4° change in the anterior center Edge Angle.
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borderline acetabular dysplasia independent predictors of hip instability versus impingement
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Jeffrey J Nepple, Elizabeth Graesser, Joel Wells, John C ClohisyAbstract:Background:Hips with borderline acetabular dysplasia (lateral center-Edge Angle, LCEA, between 20° and 25°) are challenging in terms of diagnostic and treatment decision-making. It is accepted that...
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surgical treatment of adolescent acetabular dysplasia with a periacetabular osteotomy does obesity increase the risk of complications
Journal of Pediatric Orthopaedics, 2015Co-Authors: Eduardo N Novais, John C Clohisy, Youngjo Kim, Gorden D Potter, Rafael J Sierra, Perry L Schoenecker, Robert T Trousdale, Patrick M Carry, Michael B MillisAbstract:Background: The Bernese periacetabular osteotomy (PAO) is frequently used to treat symptomatic acetabular dysplasia in the adolescent age group. Despite encouraging results, factors predictive of the development of postoperative complications remain poorly understood. The purpose of this study was to investigate whether obesity is a risk factor for complications following PAO in adolescents. Methods: A retrospective cohort study design was used to collect data from 3 different institutions. Children and adolescents (below 19 y of age) who underwent PAO and were followed for minimum of 12 months were included. Obesity was defined as a body mass index ≥95 percentile. The modified Clavien-Dindo classification was used to grade complications. A logistic regression analysis was used to identify factors related to the development of a complication that required treatment outside of routine postoperative care (complication grades II to V). Changes in radiographic parameters including Tonnis acetabular roof Angle, anterior center-Edge Angle, and lateral center-Edge Angle among obese versus nonobese subjects were also evaluated. Results: The mean age at surgery among the 84 adolescents included in the study was 16.5 years (range, 12 to 19 y). A total of 11% of the population was considered obese. Obesity (P=0.0047) was the only variable significantly associated with the development of a complication. After controlling for study site, the odds of an obese subject developing a complication were 10 [95% confidence interval (CI), 1.89-59.8] times the odds of a nonobese subject developing a complication. There was no difference in the magnitude of change in anterior center-Edge Angle (P=0.1251), lateral center-Edge Angle (P=0.9774), or Tonnis (P=0.5770) angular correction that was achieved among the obese versus nonobese subjects following surgery. Conclusions: The Bernese PAO allows for adequate radiographic correction of acetabular dysplasia among obese and nonobese adolescents. However, the hip preservation surgeon should be aware of the higher risk of complications among obese adolescents undergoing PAO for the treatment of symptomatic acetabular dysplasia. Level of Evidence: Level III—retrospective study.
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a systematic approach to the plain radiographic evaluation of the young adult hip
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: John C Clohisy, Michael Leunig, Youngjo Kim, Rafael J Sierra, Perry L Schoenecker, Robert T Trousdale, John C Carlisle, Paul E Beaule, Michael B MillisAbstract:Orthopaedic evaluation of hip pain in the young adult population has undergone a rapid evolution over the past decade1,2. This is in large part due to enhanced awareness of structural hip disorders, including developmental dysplasia of the hip and femoroacetabular impingement1-5. Surgical treatment for these disorders continues to be refined6-9, and our ability to identify patients along the spectrum of disease continues to improve10-15. Yet, despite our advances, obtaining an accurate diagnosis can remain challenging, especially in the setting of mild structural abnormalities. Therefore, radiographic examination is a critical component of the diagnostic evaluation and treatment decision-making process. It is essential that physicians have common and reliable radiographic views as well as parameters for plain radiographic assessment that can serve as a foundation for accurate diagnosis, disease classification, and surgical decision-making. Many different radiographic measurements have been described as indicators of structural disease. In particular, measurements such as the lateral center-Edge Angle of Wiberg16, the anterior center-Edge Angle of Lequesne17, the ac-etabular index of depth to width described by Heyman and Herndon18, the femoral head extrusion index19, and the Tonnis Angle20 have been used as markers for acetabular dysplasia. Similarly, measurements of acetabular version21, the head-neck offset (initially described by Eijer)3,22, and the alpha Angle19 have been used in the diagnosis of femoroacetabular impingement. Nevertheless, there is limited literature that provides comprehensive information regarding the details of radiographic evaluation in the young patient with hip symptoms. This paper summarizes the recommendations of the ANCHOR (Academic Network for Conservational Hip Outcomes Research) study group regarding the most important aspects of radiographic technique and image interpretation to evaluate the symptomatic, skeletally mature hip.
Michael P Mcclincy - One of the best experts on this subject based on the ideXlab platform.
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evaluation and treatment of borderline dysplasia moving beyond the lateral center Edge Angle
Current Reviews in Musculoskeletal Medicine, 2020Co-Authors: Nicholas J Vaudreuil, Michael P McclincyAbstract:The purpose of this manuscript is to 1 define the features associated with borderline acetabular dysplasia and 2 review current status of diagnostic algorithms and treatment options for borderline dysplasia. Acetabular dysplasia is a common cause of hip pain secondary to insufficient coverage of the femoral head by the bony acetabulum. Historical classification of acetabular dysplasia has utilized the lateral center Edge Angle (LCEA); values above 25° are normal and below 20° are considered pathologic. Borderline dysplasia describes hips with LCEA between 20 and 25o; treatment of these patients is controversial. While many studies utilize LCEA in classification of borderline dysplasia, isolated reliance on measurement of lateral femoral head coverage to define severity of undercoverage will continue to mislabel morphology. Thorough assessment of the characteristics of mild acetabular undercoverage is necessary for future studies, which will allow effective comparisons of results between hip arthroscopy and periacetabular osteotomy.
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mild or borderline hip dysplasia are we characterizing hips with a lateral center Edge Angle between 18 and 25 appropriately
American Journal of Sports Medicine, 2019Co-Authors: Michael P Mcclincy, James D Wylie, Yimeng Yen, Eduardo N NovaisAbstract:Background:Controversy surrounds the classification and treatment of hips with a lateral center-Edge Angle (LCEA) between 18° and 25°. It remains undetermined as to whether periacetabular osteotomy...
Harish S Hosalkar - One of the best experts on this subject based on the ideXlab platform.
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lateral center Edge Angle on conventional radiography and computed tomography
Clinical Orthopaedics and Related Research, 2013Co-Authors: Shafagh Monazzam, James D Bomar, Krishna R Cidambi, Peter Kruk, Harish S HosalkarAbstract:Background Lateral center-Edge Angle (LCEA), originally described and validated on AP radiographs, has been used increasingly in CT-based studies, but it is unclear whether the measure is reliable and whether it correlates with that on AP radiographs.
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does femoral rotation influence anteroposterior alpha Angle lateral center Edge Angle and medial proximal femoral Angle a pilot study
Clinical Orthopaedics and Related Research, 2013Co-Authors: Shafagh Monazzam, James D Bomar, Mandar Agashe, Harish S HosalkarAbstract:Background Femoral rotation on AP radiographs affects several parameters used to assess morphologic features of the proximal femur but its effect on femoroacetabular impingement parameters remains unknown.
Jeffrey J Nepple - One of the best experts on this subject based on the ideXlab platform.
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lateral center Edge Angle is not predictive of acetabular articular cartilage surface area anatomic variation of the lunate fossa
American Journal of Sports Medicine, 2020Co-Authors: Thai Q Trinh, John C Clohisy, Jeffrey J Nepple, Michael Leunig, Christopher M Larson, Ira Zaltz, Bryan T Kelly, Micah Naimark, Asheesh BediAbstract:Background:Surgical treatment of symptomatic femoroacetabular impingement (FAI) and dysplasia requires careful characterization of acetabular morphology. The lateral center-Edge Angle (LCEA) is oft...
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do changes in pelvic rotation and tilt affect measurement of the anterior center Edge Angle on false profile radiographs a cadaveric study
Clinical Orthopaedics and Related Research, 2019Co-Authors: Sara M Putnam, John C Clohisy, Jeffrey J NeppleAbstract:BACKGROUND The false profile radiograph assesses acetabular coverage in prearthritic hip conditions. Precise rotation of this radiograph is difficult to obtain, so the clinician must interpret radiographs with nonstandard pelvic rotation or tilt, despite limited evidence of how this may affect the anterior center Edge Angle measurement. QUESTIONS/PURPOSES (1) Does pelvic rotation alter the measurement of the anterior center Edge Angle on false profile views? (2) Does pelvic tilt alter the measurement of the anterior center Edge Angle on false profile views? (3) Is there an objective way to assess appropriate pelvic rotation for the false profile view? METHODS Eight cadaver hips (four female, four male; one hip randomly selected per pelvis) were included in the study. Hips with degenerative changes, evidence of previous fracture or trauma, or previous surgical intervention were excluded. Specimens were between 68 to 92 years of age (median, 76 years). The specimens were fixed to a custom jig, and radiographs were taken at 5° intervals of rotation (45-85°) and 5° intervals of pelvic tilt (+10° to -10°). The primary outcome variable, anterior center Edge Angle, was measured for each rotation and tilt. RESULTS Every degree increase in pelvic rotation toward a true lateral resulted in 0.18° increase in the anterior center Edge Angle (95% confidence interval [CI], 0.07-0.29; p = 0.002). For every degree increase in pelvic tilt, the anterior center Edge Angle increased 0.65° (95% CI, 0.5-0.8; p < 0.001). We verified that standard pelvic rotation of 65° for a false profile radiograph was present when the space between the femoral heads is 66% to 100% of the diameter of the femoral head being imaged. CONCLUSIONS This study shows that the anterior center Edge Angle increases as pelvic tilt increases, with a 6° increase in anterior center Edge Angle for each 10° increase in pelvic tilt. Since the false profile radiograph is obtained standing, the patient should be counseled to avoid adopting a forced posture, ensuring the radiograph remains an accurate functional representation of the patient's anatomy. In contrast, pelvic rotation did not influence the anterior center Edge Angle by an important margin, and while we recommend that radiographs continue to be obtained with standardized pelvic rotation, aberrant pelvic rotation will likely not result in a clinically meaningful difference in anterior center Edge Angle measurements. In the future, studies to identify the specific regions of acetabular anatomy that constitute the radiographic measurement of the anterior center Edge Angle would enhance current understanding of the associated radiographic anatomy, and consequently improve the ability of the surgeon to treat the specific area of pathology. CLINICAL RELEVANCE In practice, the clinician should pay close attention to pelvic tilt, as a 10° change in tilt may cause 6° of change in the anterior center Edge Angle. However, false profile radiographs obtained within ± 20° of the targeted 65° of rotation will result in less than 4° change in the anterior center Edge Angle.
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borderline acetabular dysplasia independent predictors of hip instability versus impingement
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Jeffrey J Nepple, Elizabeth Graesser, Joel Wells, John C ClohisyAbstract:Background:Hips with borderline acetabular dysplasia (lateral center-Edge Angle, LCEA, between 20° and 25°) are challenging in terms of diagnostic and treatment decision-making. It is accepted that...
Bryan T Kelly - One of the best experts on this subject based on the ideXlab platform.
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lateral center Edge Angle is not predictive of acetabular articular cartilage surface area anatomic variation of the lunate fossa
American Journal of Sports Medicine, 2020Co-Authors: Thai Q Trinh, John C Clohisy, Jeffrey J Nepple, Michael Leunig, Christopher M Larson, Ira Zaltz, Bryan T Kelly, Micah Naimark, Asheesh BediAbstract:Background:Surgical treatment of symptomatic femoroacetabular impingement (FAI) and dysplasia requires careful characterization of acetabular morphology. The lateral center-Edge Angle (LCEA) is oft...
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outcomes after arthroscopic treatment of femoroacetabular impingement for patients with borderline hip dysplasia
American Journal of Sports Medicine, 2016Co-Authors: Danyal H Nawabi, Ryan M Degen, Kara G Fields, Alexander S Mclawhorn, Anil S Ranawat, Ernest L Sink, Bryan T KellyAbstract:Background:The outcomes of hip arthroscopy in the treatment of dysplasia are variable. Historically, arthroscopic treatment of severe dysplasia (lateral center-Edge Angle [LCEA] <18°) resulted in poor outcomes and iatrogenic instability. However, in milder forms of dysplasia, favorable outcomes have been reported.Purpose:To compare outcomes after hip arthroscopy for femoroacetabular impingement (FAI) in borderline dysplastic (BD) patients compared with a control group of nondysplastic patients.Study Design:Cohort study; Level of evidence, 3Methods:Between March 2009 and July 2012, a BD group (LCEA, 18°-25°) of 46 patients (55 hips) was identified. An age- and sex-matched control group of 131 patients (152 hips) was also identified (LCEA, 25°-40°). Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected preoperatively and...
