Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction.

Autor:	Schmaranzer F; Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Justo P; Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts., Kallini JR; Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts., Ferrer MG; Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts., Miller P; Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts., Bixby SD; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts., Novais EN; Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2024 Jan 17; Vol. 106 (2), pp. 110-119. Date of Electronic Publication: 2023 Nov 22.
DOI:	10.2106/JBJS.23.00333
Abstrakt:	Background: There is limited evidence supporting the value of morphological parameters on post-reduction magnetic resonance imaging (MRI) to predict long-term residual acetabular dysplasia (RAD) after closed or open reduction for the treatment of developmental dysplasia of the hip (DDH). Methods: We performed a retrospective study of 42 patients (47 hips) undergoing open or closed reduction with a minimum 10 years of follow-up; 39 (83%) of the hips were in female patients, and the median age at reduction was 6.3 months (interquartile range [IQR], 3.3 to 8.9 months). RAD was defined as additional surgery with an acetabular index >2 standard deviations above the age- and sex-specific population-based mean value or Severin classification grade of >2 at last follow-up. Acetabular version and depth-width ratio, coronal and axial femoroacetabular distance, cartilaginous and osseous acetabular indices, transverse ligament thickness, and the thickness of the medial and lateral (limbus) acetabular cartilage were measured on post-reduction MRI. Results: At the time of final follow-up, 24 (51%) of the hips had no RAD; 23 (49%) reached a failure end point at a median of 11.4 years (IQR, 7.6 to 15.4 years). Most post-reduction MRI measurements, with the exception of the cartilaginous acetabular index, revealed a significant distinction between the group with RAD and the group with no RAD when mean values were compared. The coronal femoroacetabular distance (area under the receiver operating characteristic curve [AUC], 0.95; 95% confidence interval [CI], 0.90 to 1.00), with a 5-mm cutoff, and limbus thickness (AUC, 0.91; 95% CI, 0.83 to 0.99), with a 4-mm cutoff, had the highest discriminatory ability. A 5-mm cutoff for the coronal femoroacetabular distance produced 96% sensitivity (95% CI, 78% to 100%), 83% specificity (95% CI, 63% to 95%), 85% positive predictive value (95% CI, 65% to 96%), and 95% negative predictive value (95% CI, 76% to 100%). A 4-mm cutoff for limbus thickness had 96% sensitivity (95% CI, 78% to 100%), 63% specificity (95% CI, 41% to 81%), 71% positive predictive value (95% CI, 52% to 86%), and 94% negative predictive value (95% CI, 70% to 100%). Conclusions: Coronal femoroacetabular distance, a quantitative metric assessing a reduction's concentricity, and limbus thickness, a quantitative metric assessing the acetabulum's cartilaginous component, help to predict hips that will have RAD in the long term after closed or open reduction. Level of Evidence: Diagnostic Level IV . See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: This work was funded in part by the Swiss National Science Foundation Grant no. 181643. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H781 ). (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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