scholarly journals DIFFERENCES IN RADIOGRAPHIC MEASUREMENTS ON STANDING VERSUS SUPINE PELVIC RADIOGRAPHS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0016
Author(s):  
Andrea M. Spiker ◽  
Ryan M. Graf ◽  
Sean P. Duminie ◽  
Stephanie A. Kliethermes ◽  
David C. Goodspeed
Keyword(s):  
Clinical Importance ◽  
Posterior Wall ◽  
Joint Space ◽  
Ischial Spine ◽  
Crossover Sign ◽  
Acetabular Inclination ◽  
Pelvic Radiographs ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Posterior Wall Sign

Background: Accurate pelvic radiographic measurements is of clear clinical importance, as these measurements can drive the indications for surgery, the surgical approach utilized, and/or the degree of correction during hip preservation surgery. Currently, there are a large number of measurements available and reported on the literature when referencing anterior-posterior (AP) pelvic radiographs. However, there is no standardization of whether these pelvic radiographs are obtained in the standing or supine position. Hypothesis/Purpose: Standing vs. Supine radiographs, obtained in the same patient, will result in different value for standard radiographic measurements used in making hip pathology diagnoses. Methods: All new patients who presented for evaluation of hip pain between September 2016 and July 2018 were retrospectively reviewed. Inclusion criteria included age 18-50, no prior hip surgery/injury, and both standing and supine AP pelvis radiographs dated within 2 years of each other. Measurements were obtained on 26 radiographs (52 hips), blinded to patient demographics and standing versus supine radiograph. Measurements included minimum joint space, lateral center edge angle (LCEA), acetabular depth, acetabular inclination, Tönnis Grade, crossover sign, posterior wall sign, ischial spine sign. Results: Standing films resulted in significantly lower LCEA and acetabular depth measurements, and higher acetabular inclination. Supine measurements for crossover sign were 5.69 times more likely to be positive than standing measurements. Similarly, supine measurements for ischial spine were 7.93 times more likely to be positive (see Table 1). Conclusion: Based on our study, supine films are almost 6 times more likely to give a positive crossover sign and almost 8 times more likely to give a positive ischial spine sign than a standing film in the same patient. Additionally, LCEA, acetabular depth will be lower and acetabular inclination will be higher on standing films. As such, our recommendation is to obtain standing AP pelvis radiographs to obtain the most accurate pelvic radiographic measurements in hip preservation patients. Tables: [Table: see text]

scholarly journals The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Gerard El-Hajj ◽  
Hicham Abdel-Nour ◽  
Rami Ayoubi ◽  
Joseph Maalouly ◽  
Fouad Jabbour ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Posterior Wall ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Acetabular Version ◽  
Crossover Sign ◽  
Developmental Hip Dysplasia ◽  
Radiographic Sign ◽  
Posterior Wall Sign

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

scholarly journals Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097789
Author(s):  
Rodolfo Morales-Avalos ◽  
Adriana Tapia-Náñez ◽  
Mario Simental-Mendía ◽  
Guillermo Elizondo-Riojas ◽  
Michelle Morcos-Sandino ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Crossover Sign ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Morphological Variations ◽  
Pelvic Radiographs ◽  
Center Edge

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players

2017 ◽  
Vol 45 (7) ◽  
pp. 1633-1639 ◽  
Author(s):  
Christopher M. Larson ◽  
James R. Ross ◽  
Andrew W. Kuhn ◽  
Donnie Fuller ◽  
David M. Rowley ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Alpha Angle ◽  
Posterior Wall ◽  
Crossover Sign ◽  
Good Reliability ◽  
Hip Anatomy ◽  
Hip Abduction ◽  
Posterior Wall Sign

Background: Hip disorders in athletes have been increasingly recognized. Purpose: To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. Results: Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). Conclusion: Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.

Use of 3D Printed Models to Determine Accurate Bone Cuts during a Periacetabular Osteotomy for Developmental Hip Dysplasia

2021 ◽  
Author(s):  
Adam Driesman ◽  
Daniel Buchalter ◽  
David J. Kirby ◽  
Nicole Wake ◽  
Pablo Castaneda
Keyword(s):  
3D Printing ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Ct Scans ◽  
Acetabular Inclination ◽  
Radiographic Outcomes ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Radiographic Measurements ◽  
3D Printed

AbstractThe periacetabular osteotomy (PAO) is a powerful tool to delay the progression of hip arthritis by reorienting the acetabulum. This study aimed to use three-dimensional (3D)-printed models of the pelvis, reconstructed from the computed tomography (CT) scans of patients, to model how the level of dysplasia and its location ilium osteotomy affect radiographic outcomes following PAO. This pilot study aims to determine if preoperative 3D printing/planning can assist in predicting radiographic outcomes. We performed a retrospective review of five patients with differing levels of hip dysplasia for whom we had obtained CT scans before PAO surgery. For each patient, we printed two pelvis models that would undergo standardized cuts of the PAO procedure, with variations only in the distance of the ilium start point (one-third of the distance between the anterior superior iliac spine and anterior inferior iliac spine [AIIS] vs. two-thirds of the distance). We then mobilized the acetabular fragment into eight reproducible positions in space by moving the ilium cut a combination of 0, 1, or 2 cm anterior/lateral. Each position of the newly realigned acetabula was examined under fluoroscopy to obtain a standardized anteroposterior view, and to obtain standardized radiographic measurements in the form of lateral center edge angle (CEA), acetabular depth, Tonnis angle, and acetabular inclination. We performed 80 simulations of the PAO with varying degrees of acetabular mobilization. On average, in the models where the supra-acetabular cut was closer to the AIIS, we found more significant degrees of radiographic correction, regarding Tonnis angles (12.91 vs. 7.95, p = 0.0175), acetabular inclination (20.25 vs. 9.875, p = 0.027), and lateral CEA (11.75 vs. 2.5, p = 0.061). Patients who had greater dysplasia also had more significant degrees of radiographic Tonnis angle correction with the same mobilization movements of the acetabula (p = 0.005). When utilizing 3D printing to model PAO in dysplasia pelvises, we found that both a higher level of preoperative dysplasia and starting the supra-acetabular osteotomy closer to the AIIS were associated with more powerful corrections following smaller manipulations.

scholarly journals Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

2016 ◽  
Vol 10 (1) ◽  
pp. 404-411 ◽  
Author(s):  
R. Wejnold Jørgensen ◽  
C. Dippmann ◽  
L. Dahl ◽  
J. Stürup
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Treatment Algorithm ◽  
Posterior Wall ◽  
Hip Pain ◽  
Acetabular Retroversion ◽  
Ischial Spine ◽  
Radiographic Findings ◽  
Posterior Wall Sign ◽  
The Right

Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies.

scholarly journals Borderline Dysplasia with Acetabular Retroversion: Key Findings from a Large Hip Arthroscopy Study Group

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0043
Author(s):  
Benjamin Kivlan ◽  
Shane Nho ◽  
Andrew Wolff ◽  
John Salvo ◽  
John Christoforetti ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Arthroscopic Surgery ◽  
Acetabular Retroversion ◽  
Control Groups ◽  
Chi Square ◽  
Crossover Sign ◽  
Center Edge ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
And Control

Objectives: The radiographic crossover sign (COS) is an indicator of acetabular retroversion, classically representing anterosuperior overcoverage often treated with acetabuloplasty which could exacerbate acetabular hypovolemia in dysplasia. No prior study has investigated the prevalence of acetabular retroversion in patients with dysplasia undergoing hip arthroscopy, acetabuloplasty rates, and outcomes in this setting. Study objectives are to report the prevalence of acetabular retroversion in dysplasia, the influence of the COS on arthroscopic acetabuloplasty rates, and relative outcomes compared with control groups. Methods: A retrospective cohort study was performed from a prospectively collected multi-center database. Patients undergoing isolated hip arthroscopic surgery were assigned to dysplasia (lateral center-edge angle (LCEA) ≤ 25°) or one of two control groups: normal(LCEA 26-38°), or pincer femoroacetabular impingement (FAI)(LCEA ≥ 39°). The prevalence of COS and acetabuloplasty rates between and within study and control groups were compared (Chi square analysis). Minimum 2 year outcomes utilizing iHOT-12 were compared (analysis of variance). Results: Of 401 study patients, 64 (16%) comprised the dysplasia group, 273 (68%) normal group, and 64 (16%) pincer group. Mean LCEAs were 22.3°, 31.5°, and 42.4°, respectively (p<0.001). COS prevalence was similar between groups at 31%, 26%, and 33%, respectively (p=0.873). Acetabuloplasty rates were dependent on the amount of acetabular coverage with lowered rate in the dysplasia group(40%) and increasing rates in the normal(52%) and the pincer(90%) groups (p=0.013). Post-operative iHOT-12 scores improved in all groups (68, 74, and 77, respectively, p=0.222). Patients with a COS plus rendered acetabuloplasty reported similar scores that improved to 77, 74, and 79, respectively,(p=0.949). Patients with dysplasia with COS averaged 73.1(SD 23.3) iHOT-12 score compared to 67.1(SD: 28.7) for the patients with dysplasia without COS (p=0.466). Within the dysplasia with COS subgroup, there was no significant difference in iHOT-12 scores between the group with acetabuloplasty (77.0;SD:17.1) and without acetabuloplasty (70.4;SD:27.4,p=0.580). Conclusion: Acetabular retroversion occurs with similar prevalence in borderline dysplasia compared with non-dysplastic hips undergoing hip arthroscopy but with lower acetabuloplasty rates not influenced by the COS. Arthroscopic outcomes of dysplasia with retroversion are similarly successful and comparable with those of dysplasia and non-dysplastic hips. Although infrequently performed, acetabuloplasty did not compromise outcomes in dysplasia with retroversion.

scholarly journals Reliability and normative values of common adult radiographic parameters for hip preservation in the developing pelvis

2019 ◽  
Author(s):  
Patrick W Whitlock ◽  
Kamran F Salari ◽  
Gideon Blumstein ◽  
Bin Zhang ◽  
Alexandre Arkader ◽  
...  
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Categorical Variables ◽  
Normative Values ◽  
Crossover Sign ◽  
Good Reliability ◽  
Rater Reliability ◽  
Male And Female ◽  
Female Patients ◽  
Center Edge

AbstractAnterior–posterior (A/P) radiography of the pelvis is essential to the diagnosis and treatment of developmental dysplasia of the hip (DDH). Multiple well-defined parameters of adult hip morphology with good reliability are readily available. The purpose of this study was to determine normative values and observed reliability for 10 common adult hip parameters in the developing pelvis of male and female patients aged 6 months–16 years. One hundred and fifty-eight standardized A/P pelvic radiographs were randomly selected from an existing trauma patient database and stratified into five age groups. Mean values or presence of categorical values and the observed reliability of 10 adult hip parameters (acetabular index/angle, pelvic width index, lateral center edge angle, Tonnis angle, acetabular to femoral head distance, femoral head diameter, coxa profunda/protrusio, ischial spine sign, crossover sign and posterior wall sign) were determined. Minimal differences in all parameters were observed between male and female patients. The observed inter-rater reliability of continuous parameters was 0.77–0.99. The observed intra-rater reliability was 0.7–0.99 with a combined intra-rater reliability of 0.88–0.99. The observed inter-rater reliability of categorical variables was 0.64–1.0. The intra-rater reliability of categorical variables was 0.83–1.0. Normative values for 10 common adult hip parameters were determined for male and female patients in the developing pelvis. Reliable knowledge of these values and their relationship to the age of the patient and/or stage of pelvic development associated may provide additional information to aid the treatment of DDH.

Radiographic and Demographic Factors Can Predict the Need for Primary Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model Using 1398 Hips

2019 ◽  
Vol 48 (1) ◽  
pp. 173-180 ◽  
Author(s):  
David R. Maldonado ◽  
Jeffrey W. Chen ◽  
Rafael Walker-Santiago ◽  
Philip J. Rosinsky ◽  
Jacob Shapira ◽  
...  
Keyword(s):  
Logistic Model ◽  
Primary Repair ◽  
Arthroscopic Surgery ◽  
Alpha Angle ◽  
Labral Repair ◽  
Additional Degree ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Labral Tears ◽  
Tönnis Grade

Background: Labral tears are the most common findings in patients with symptomatic femoroacetabular impingement (FAI). The restoration of labral function is critical, and labral reconstruction has been proposed as an alternative for irreparable tears. Purpose: To compare preoperative radiographic measurements and demographics of patients who underwent primary arthroscopic labral reconstruction versus primary labral repair and to identify factors that are predictive of the need for reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: Patients who underwent their index hip arthroscopic procedure between October 2010 and November 2018 and underwent either labral reconstruction or repair were included in the study. A total of 18 variables (14 radiographic and 4 demographic) were assessed in a bivariate comparison and analyzed in a multivariate logistic model. Results: A total of 251 primary reconstruction and 1147 primary repair procedures were included. The logistic model selected age, body mass index (BMI), Tönnis grade, lateral center-edge angle (LCEA), and alpha angle. The odds of reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0 (odds ratio [OR], 2.52 [95% CI, 1.82-3.49]). Each additional degree in the LCEA was associated with a 6% increase in the odds of reconstruction (OR, 1.06 [95% CI, 1.04-1.09]) and 4% for each additional degree in the alpha angle (OR, 1.04 [95% CI, 1.03-1.05]). Higher age (per log 10 unit) and BMI also increased the likelihood of reconstruction (OR, 11.29 [95% CI, 4.23-30.10] and OR, 1.03 [95% CI, 1.00-1.06], respectively). Conclusion: In a multivariate analysis, factors identified as preoperative predictors for primary arthroscopic labral reconstruction in the setting of FAI and labral tears were Tönnis grade, LCEA, age, and BMI. These predictive factors may be useful for the clinician in determining the preoperative likelihood of primary labral reconstruction.

Pelvic rotations: a pelvic phantom study

2007 ◽  
Vol 48 (6) ◽  
pp. 650-657 ◽  
Author(s):  
O. A. Foss ◽  
J. Klaksvik ◽  
P. Benum ◽  
S. Anda
Keyword(s):  
Three Dimensional ◽  
Tilt Table ◽  
Hip Joints ◽  
Pelvic Radiographs ◽  
Radiographic Measurements ◽  
Dimensional Measurements ◽  
Radiograph Measurements ◽  
Source Of Error ◽  
Linear Correlations ◽  
Simultaneous Rotation

Background: Radiographic measurements made on standard pelvic radiographs are commonly used in studying conditions related to the hip joints. Effects caused by variations in pelvic orientation may be a source of error in comparing measurements between sequential radiographs. Purpose: To define and characterize parameters able to measure rotational differences separately around two axes and altered radiographic focusing along two axes when sequential standard anteroposterior (AP) pelvic radiographs are compared. Material and Methods: A pelvic phantom was constructed based on direct three-dimensional measurements of five defined landmarks in a pelvic model. Two ratios, the vertical and transversal rotation ratios, were defined using radiographs of the phantom. The phantom was radiographed in 33 different orientations and with 16 different radiographic focuses using a specially constructed tilt table. On each radiograph, measurements were made and the two rotation ratios were calculated using a measurement program. Results: Linear correlations between pelvic rotations around one axis and the corresponding rotation ratio were found with almost no influence of simultaneous rotation around the other axis. Also, linear correlations were found between altered radiographic focusing along one axis and the non-corresponding rotation ratio. Conclusion: Rotational differences around two axes or altered radiographic focusing along two axes can be measured independently. Effects caused by rotations cannot be distinguished from effects caused by altered radiographic focusing.

scholarly journals Is There a Significant Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Jess Mullens ◽  
Thomas Clanton ◽  
Blake Daney ◽  
Lauren Matheny
Keyword(s):  
Pearson Correlation ◽  
Joint Space ◽  
Patient Counseling ◽  
Ankle Arthritis ◽  
Tibiotalar Joint ◽  
Proper Patient Selection ◽  
Radiographic Measurements ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Ankle Function

Category: Ankle Arthritis Introduction/Purpose: The ankle joint is unique in epidemiological, anatomic, and biomechanical characteristics compared to other lower extremity joints. While primary hip and knee arthritis is common, approximately 70% of ankle arthritis is generally a result of another initiating event or underlying pathologic process. Post-traumatic arthritis is the most common indication for ankle arthrodesis and total ankle replacement. Few studies have documented the relationship between preoperative tibiotalar joint space and outcomes. Understanding this relationship may aid in preoperative patient counseling of expectations, and proper patient selection. The purpose of this study was to determine whether patients with narrow joint space (<2.0 mm vs. > 2.0 mm) preoperatively had inferior outcomes, as measured by the Foot and Ankle Ability Measure (FAAM) score, at a postoperative minimum of two years. Methods: All patients who underwent ankle surgery and a preoperative ankle radiograph were included in this study. Radiographic measurements were taken on an ankle mortise film with appropriate magnification conversions. Medial, central, and lateral measurements were completed for each patient. Of the three measurements, the lowest value was used for analysis. Patients completed a subjective questionnaire at minimum of two years following ankle surgery, which included the FAAM Activities of Daily Living (ADL) and Sport scales. All data were collected prospectively and stored in a data registry. The FAAM ADL and sport scores were compared between joint space cohorts (<2.0 mm vs. >2.0 mm) using an independent t-test. Correlations between the FAAM ADL and Sport scores and joint space were conducted using Pearson correlation coefficient. Results: There were 251 patients (145 males, 106 females) with an average age of 44.4 years included in this study. Average joint space in the <2.0 mm cohort was 0.60 mm (range 0–1.9) and 3.2 mm (range 2.0–5.3) in the >2 mm cohort. Average follow-up was 3.8 years (range 2.0–7.4). There was a significant difference in FAAM ADL and Sport scores between cohorts. Average FAAM ADL for the <2 mm cohort was 77 (37–100) and 86 (range 1–100) for the >2 mm cohort(p<.001). Average FAAM Sport for the <2 mm cohort was 43 (range 3–100) and 68 (range 0–100) for the >2 mm cohort(p<.001). There was a significant positive correlation between joint space millimeters and the FAAM ADL (?=.166, p=.009) and the FAAM Sport (?=.308, p<.001). Conclusion: It is important to counsel patients regarding their future outcome when discussing surgical procedures. Ankle radiographs are routinely performed in the clinical setting and allow quick interpretation compared to other advanced imaging modalities. In our study, patients who had joint space less than 2 mm had significantly lower ankle function as indicated by the FAAM ADL and Sport scores. There was a significant positive relationship between joint space and function. While a decreased joint space should not exclude a patient from obtaining relief from a surgical procedure, patients should be well educated on what to expect given their radiologic joint space.

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