The Journal of Bone and Joint Surgery (American). 2006;88:1540-1548.
doi:10.2106/JBJS.E.00572
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 Adult Hip Reconstruction Test 21: Fall 2006 (publication date November 15, ...
CME 3: July, August, September 2006 (publication date October 5, 2006; expi...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cunningham, T.
Right arrow Articles by Kim, Y.-J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cunningham, T.
Right arrow Articles by Kim, Y.-J.
Related Collections
Right arrow Adult Hip
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage to Predict Early Failure of Bernese Periacetabular Osteotomy for Hip Dysplasia

Torin Cunningham, MD1, Rebecca Jessel, BA2, David Zurakowski, PhD2, Michael B. Millis, MD2 and Young-Jo Kim, MD, PhD2

1 Miller Children's Hospital, 2801 Atlantic Avenue, Long Beach, CA 90806
2 Children's Hospital, 300 Longwood Avenue, Harvard Medical School, Boston, MA 02115. E-mail address for Y.-J. Kim: young-jo.kim{at}childrens.harvard.edu

Investigation performed at Children's Hospital, Harvard Medical School, Boston, Massachusetts

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

In support of their research for or preparation of this manuscript, one or more of the authors received a clinical science grant from the Arthritis Foundation and a research grant from the Orthopaedic Research and Education Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. Pelvic osteotomies such as the Bernese periacetabular osteotomy can improve the mechanics of the joint, but the results are variable and appear to depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and it potentially could be used to select hips with too severe arthritis to benefit from a joint-preserving reconstructive procedure. The purpose of our study was to identify radiographic, clinical, and magnetic resonance imaging measurements that predict failure after pelvic osteotomy.

Methods: We performed a cohort study of forty-seven patients undergoing a Bernese periacetabular osteotomy for the treatment of hip dysplasia. Our goal was to identify preoperative radiographic factors, such as the grade of arthritis, joint congruency, and the dGEMRIC index, that are associated with a poor outcome after osteotomy.

Results: Hips in which the osteotomy did not fail had a significant decrease in pain compared with their status preoperatively (p < 0.0001). Hips in which the osteotomy did fail had had significantly more arthritis on preoperative radiographs (as demonstrated by the joint space width and the Tönnis grade [p = 0.01]), more subluxation (p = 0.02), and a lower dGEMRIC index (p < 0.001) than the hips in which the osteotomy did not fail. Multivariate analysis identified the dGEMRIC index as the most important predictor of failure of the osteotomy.

Conclusions: Bernese periacetabular osteotomy for the treatment of hip dysplasia can decrease pain and improve function in symptomatic dysplastic hips. The dGEMRIC index, as an early measure of osteoarthritis, appears to be useful for identifying poor candidates for a pelvic osteotomy.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
J. C. Clohisy, P. E. Beaule, A. O'Malley, M. R. Safran, and P. Schoenecker
AOA Symposium. Hip Disease in the Young Adult: Current Concepts of Etiology and Surgical Treatment
J. Bone Joint Surg. Am., October 1, 2008; 90(10): 2267 - 2281.
[Full Text] [PDF]

Home page
 JBJSHome page
E. Sharifi, H. Sharifi, S. Morshed, K. Bozic, and M. Diab
Cost-Effectiveness Analysis of Periacetabular Osteotomy
J. Bone Joint Surg. Am., July 1, 2008; 90(7): 1447 - 1456.
[Abstract] [Full Text] [PDF]