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. 2023 Jul;143(7):3715-3723.
doi: 10.1007/s00402-022-04568-1. Epub 2022 Aug 10.

Acetabular orientation in triple pelvic osteotomy: is intraoperative fluoroscopy reliable?

Affiliations

Acetabular orientation in triple pelvic osteotomy: is intraoperative fluoroscopy reliable?

Daniel Dornacher et al. Arch Orthop Trauma Surg. 2023 Jul.

Abstract

Purpose: In pelvic osteotomies, unfavorable balancing of the anterior and posterior acetabular wall can affect the longevity of the natural joint. This raises the question, whether intraoperative fluoroscopy is sufficiently accurate. The objective was to assess the correlation between acetabular parameters [lateral center edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI)] acquired on intraoperative fluoroscopic images and postoperative pelvic radiographs and to analyze intra- and interobserver reliability of these parameters.

Methods: A retrospective examination was conducted on 206 consecutive cases (176 patients) after triple pelvic osteotomy (TPO). Every patient received a pre- and postoperative pelvic radiograph in supine position in exactly the same technique. A highly standardized surgical sequence allowed consistent intraoperative fluoroscopic imaging. LCAE, AI, PWI and AWI were measured by an experienced orthopedic surgeon and an orthopedic surgeon in training. Statistics comprised a priori power analysis, Bland-Altman analysis and intraclass correlation coefficient (ICC).

Results: A total of 165 cases were included. ICC between the parameters of the fluoroscopic images and postoperative radiographs was for LCEA: 0.935, AI: 0.936, AWI: 0.725 and PWI: 0.878. Intraobserver ICC for all parameters ranged from 0.953 to 0.989, interobserver ICC from 0.798 to 0.968, respectively.

Conclusion: In the surgical treatment of hip dysplasia by means of TPO, intraoperative fluoroscopic imaging has proven to be reliable and accurate. Intraobserver correlation was excellent for all parameters. The correlation between the intraoperative fluoroscopic images and postoperative radiographs ranged from good to excellent, with the lowest values for the acetabular wall indices (AWI and PWI).

Keywords: Hip dysplasia; Hip joint preservation; Intraoperative fluoroscopy; Surgery; Triple pelvic osteotomy.

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Conflict of interest statement

The authors have no financial or non-financial interest to disclose.

Figures

Fig. 1
Fig. 1
a Preoperative radiograph of a 16-year-old female, performed in supine position with the purpose of deformity analysis. In this example, LCEA is 17°, AI is 13°. b Magnified view of the right hip from the same radiograph, measurement of the anterior and posterior wall index (AWI, PWI). c The measuring procedure was repeated on the intraoperatively acquired fluoroscopic images and the postoperative pelvic radiograph. For the sake of clarity, the measurement lines for AWI and PWI are not presented
Fig. 2
Fig. 2
a and b Bland–Altman diagrams: the y-axis displays the differences of the two paired measurements, the x-axis shows the mean of the paired measurements. The upper and lower horizontal lines represent the limits of agreement, the horizontal line in the middle the mean difference, respectively. Fig. 2a Bland–Altman diagram of the AI (representing the angular measurements). Fig. 2b Bland–Altman diagram of the AWI (representing the index values). 95% of the data points lie within the limits of agreement (± 2 standard deviation of the mean difference). Mean difference of the AI was calculated 0.20°, of the AWI − 0.053, respectively
Fig. 3
Fig. 3
a Scatterplot of the parameters LCEA and AI, measured on the intraoperative fluoroscopic images and the postoperative radiographs. For these parameters, correlation between the intraoperative and postoperative imaging was excellent (ICC: LCEA = 0.935, AI = 0.936). b Scatterplot of the parameters AWI and PWI, measured on the intraoperative fluoroscopic images and the postoperative radiographs. For these parameters, correlation between the intraoperative and postoperative imaging was good for AWI and excellent for PWI (ICC: AWI = 0.725, PWI = 0.878)

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