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Abstract

Background

Computed tomography (CT)-derived acetabular angles are commonly used in the diagnosis of hip dysplasia, but the measurements are labor-intensive, with higher inter- and intra-operator variation, necessitating an automated method.

Purpose

To develop and validate an automatic method for segmenting the acetabular lunate surface and measure diagnostic angles using CT images to improve diagnosis and preoperative planning for patients with hip dysplasia.

Material and Methods

We developed a method to segment the acetabular lunate surface, automatically identify five landmark points (center, anterior, posterior, lateral, and medial) and calculate diagnostic angles for center-edge (CE), anterior-sector (AASA), posterior-sector (PASA), acetabular anteversion (AcAV), and acetabular-index (AI). The method was validated against repeated manual measurements by three raters on a dataset of 18 patients (36 hips).

Results

No differences between raters and the automatic method for the center (P = 0.18), anterior (P = 0.55), posterior (P = 0.18), lateral (P = 0.13), and medial (P = 0.12) landmarks. No statistically significant differences were observed between raters and the automatic method for the AASA (P = 0.01) and PASA (P = 0.08) angles. Statistically significant differences were found between the automatic method and rater 3 for the CE and AI angles, and between the automatic method and rater 2 for the AcAV angle. The ICC for all angle measurements by raters and the automated method was in the range of 0.90–0.99.

Conclusion

With similar agreement between manual and automatic measurements, the automatic method provides important information that may be used for both diagnosis and surgical planning, with the potential to greatly reduce the time used for analysis per patient.

Keywords

Hip dysplasia acetabular lunate segmentation diagnostic hip angles computed tomography

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References

Mechlenburg I, De Raedt S, Achterberg HC, et al. Morphology of the dysplastic hip and the relationship with sex and acetabular version. Clin Anat 2025;38:512–522.

Mechlenburg I, Nyengaard JR, Rømer L, et al. Changes in load-bearing area after Ganz periacetabular osteotomy evaluated by multislice CT scanning and stereology. Acta Orthop Scand 2004;75:147–153.

Aitken

Westermann

Bartschat

, et al. Chronically elevated contact stress exposure correlates with intra-articular cartilage degeneration in patients with concurrent acetabular dysplasia and femoroacetabular impingement. J Orthop Res 2022;40:2632–2645.

De Raedt S, Mechlenburg I, Stilling M, et al. Reliability of computer-assisted periacetabular osteotomy using a minimally invasive approach. Int J Comput Assist Radiol Surg 2018;13:2021–2028.

O'Brien MJ, Semciw AI, Mechlenburg I, et al. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis. Hip Int 2024;34:96–114.

Wyles

Heidenreich

Jeng

, et al. The John Charnley Award: redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement. Clin Orthop Relat Res 2017;475:336–350.

El Jashi R, Gustafson MB, Jakobsen MB, et al. The association between gender and familial prevalence of hip dysplasia in Danish patients. Hip Int 2017;27:299–304.

Simonsen PO, Hertz JM, Søballe K, et al. Association between periacetabular osteotomy and hip dysplasia among relatives: a cross-sectional study. Hip Int 2019;29:424–429.

Dembic M, van Brakel Andersen L, Larsen MJ, et al. Whole exome sequencing of 28 families of Danish descent reveals novel candidate genes and pathways in developmental dysplasia of the hip. Mol Genet Genomics 2023;298:329–42

10.

Mechlenburg I. Evaluation of Bernese periacetabular osteotomy: prospective studies examining projected load-bearing area, bone density, cartilage thickness and migration. Acta Orthop Suppl 2008;79:4–43.

11.

Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Exp., Norstedt, 1939.

12.

Tönnis

PDD

. Congenital dysplasia and dislocation of the hip in children and adults. Berlin, Heidelberg: Springer, 1987.

13.

Sepp de R, Inger M, Maiken S, et al. (eds). Automated measurement of diagnostic angles for hip dysplasia. ProcSPIE, 2013.

14.

Armiger

Armand

Tallroth

, et al. Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up. Acta Orthop 2009;80:155–161.

15.

Mechlenburg

Stilling

Rømer

, et al. Reference values and variation of acetabular angles measured by computed tomography in 170 asymptomatic hips. Acta Radiol 2019;60:895–901.

16.

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15:155–163.

17.

Clohisy

Carlisle

Trousdale

, et al. Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res 2009;467:666–675.

18.

Troelsen

Rømer

Kring

, et al. Assessment of hip dysplasia and osteoarthritis: variability of different methods. Acta Radiol 2010;51:187–193.

19.

Larson

Rabenhorst

De La Rocha

, et al. Limited intraobserver and interobserver reliability for the common measures of hip joint congruency used in dysplasia. Clin Orthop Relat Res 2012;470:1414–1420.

20.

Armiger

Armand

Lepisto

, et al. Evaluation of a computerized measurement technique for joint alignment before and during periacetabular osteotomy. Comput Aided Surg 2007;12:215–224.

21.

Ehrhardt

Handels

Plötz

, et al. Atlas-based recognition of anatomical structures and landmarks and the automatic computation of orthopedic parameters. Methods Inf Med 2004;43:391–397.

22.

Puls

Ecker

Steppacher

, et al. Automated detection of the osseous acetabular rim using three-dimensional models of the pelvis. Comput Biol Med 2011;41:285–291.

23.

Subburaj

Ravi

Agarwal

. 3D Shape reasoning for identifying anatomical landmarks. Comput Aided Des Appl 2008;5:153–160.

24.

Sovira

Jianhua

Lawrence

, et al. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation. San Diego, California, United States: ProcSPIE, 2008.

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Lunate extract: fully automatic acetabular lunate segmentation and hip angle measurements