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.
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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.


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