Marek Jóźwiak

An accurate method of radiological assessment of acetabular volume and orientation in computed tomography spatial reconstruction

BackgroundTwo-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim. We present an objective, highly reliable and accurate, axis-based approach to acetabular anthropometry in the measurement of acetabular volume and spatial orientation in both normal and pathologic hips. This was done using reference planes based on the sacral base (SB) and true acetabular axis in 3D computed tomography (CT) pelvic reconstruction.MethodsRadiological examinations of 30 physiologic pelves (60 acetabula) were included in the study. Reliability and accuracy of the method were verified by comparing acetabular angles in 2D pelvic scans with 3D reconstructions. We also applied the method to two pathologic acetabula.ResultsComparison of axis position in the horizontal plane revealed significant positive correlations between 2D angle measurements (acetabular anteversion angle [AAA] and anterior acetabular index [AAI]) and 3D measurement of anteversion angle (p < 0.001 and p = 0.012, respectively). In the frontal plane, there was no difference between abduction angle, measured on topogram, and inclination angle, obtained from a 3D model (p = 0.517). In the sagittal plane, there was a significant negative correlation between AAA and acetabular tilt (p < 0.001). Inter- and intra-observer reproducibility was excellent for determination of the sacral-base plane and assessment of volume, with Fleiss κ coefficients of 0.850 and 0.783, respectively, and intraclass correlation coefficients of 0.900 and 0.950, respectively. Inter-observer reproducibility for evaluation of acetabular axis ranged from 0.783 to 0.883, and intra-rater reliability ranged from 0.850 to 0.900 for all 3D angles.ConclusionsOur method is a new, reliable diagnostic tool for assessing the acetabula in both normal and pathologic hip joints. The sacral-base plane can be used as a stable reference that takes the relationship of the acetabulum to the spinopelvic unit into consideration.

Hip joint pain in spastic dislocation: aetiological aspects

Aim  Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP.

The effect of a hippotherapy session on spatiotemporal parameters of gait in children with cerebral palsy - pilot study.

BACKGROUND Hippotherapy has been shown to produce beneficial effects by improving the most difficult motor functions, such as sitting, running, jumping, coordination, as well as balance and muscle strength in children with motor developmental delays. The aim of this study was to analyze the effect of hippotherapy on spatiotemporal parameters of gait in cerebrally palsied children. MATERIAL AND METHODS 16 ambulatory cerebrally palsied children (GMFCS Level I-III; Female: 10, Male: 6; Age: 5.7-17.5 years old) qualified for hippotherapy were investigated. Basic spatiotemporal parameters of gait, including walking speed, cadence, step length, stride length and the left-right symmetry, were collected using a three-dimensional accelerometer device (DynaPort MiniMod) before and immediately after a hippotherapy session. The Wilcoxon test was used to verify the differences between pre- and post-session results. RESULTS Changes of walking speed were statistically significant. With the exception of step length, all spatiotemporal parameters improved, i.e. were closer to the respective reference ranges after the session. However, these changes were not statistically significant. CONCLUSION One session of hippotherapy may have a significant effect on the spatiotemporal parameters of gait in cerebrally palsied children.

Evolution of the term and definition of dysplasia of the hip – a review of the literature

There is no consensus on the definition of dysplasia of the hip (DH). Past and present concepts used to describe DH do not form a complete view of the pathology. Moreover, some authors still present the disease as congenital, not developmental. This prompted authors to analyze the evolution of the definition of DH. Based on the biomedical databases 500 articles and books in the field of hip dysplasia were found and analyzed. Fifteen definitions of hip dysplasia met inclusion criteria, subsequently were analyzed and presented in chronological order. The analysis revealed that currently there is no single, universal definition of hip dysplasia in the aspect of morphological, clinical, and radiological studies. Despite the widely-used term of DH, it is described imprecisely and in different ways. Therefore, it is necessary to develop a multidisciplinary definition of this pathology covering all aspects of hip disorders considered valid in modern orthopaedics.

Hip joint pain in children with cerebral palsy and developmental dysplasia of the hip: why are the differences so huge?

BackgroundsNon-traumatic hip dislocation in children is most often observed in the course of developmental dysplasia of the hip (DDH) and infantile cerebral palsy. The risk of pain sensations from dislocated hip joint differentiates the discussed groups of patients. Will every painless hip joint in children with cerebral palsy painful in the future?MethodsMaterial included 34 samples of joint capsule and 34 femoral head ligaments, collected during open hip joint reduction from 19 children with CP, GMFCS level V and from 15 children with DDH and unilateral hip dislocation. All the children were surgically treated.The density of nociceptive fibres was compared between the children with CP and DDH, using S-100 and substance P monoclonal antibodies.ResultsMore frequent positive immunohistochemical reaction to S-100 protein concerned structures of the femoral head ligaments in children with CP and cartilage losses on the femoral head, when compared to the same structures in children with DDH (p = 0.010). More frequent were found positive immunohistochemical reactions for S-100 protein in the joint capsules of children with cartilage losses (p = 0.031) and pain ailments vs. the children with DDH (p = 0.027). More frequent positive reaction to substance P concerned in femoral head ligaments in CP children and cartilage lesions (p = 0.002) or with pain ailments (p = 0.001) vs. the DDH children.ConclusionsSurgical treatment of hip joint dislocation should be regarded as a prophylactics of pain sensations, induced by tissue sensitisation, inflammatory process development or articular cartilage defects.

Dymorfizm płciowy w budowie panewki stawu biodrowego na podstawie badań 3D tomografii komputerowej miednic

BACKGROUND The study aimed to compare sex differences in the morphology and spatial orientation of pelvic acetabula to advance the understanding of hip anatomy. MATERIAL AND METHODS The study was based on three-dimensional reconstructions of computed tomography images of 50 female and 50 male acetabula. The images were used for spatial analysis of hip acetabula relative to the base of the sacral bone as the plane of reference. Statistical analysis was performed to compare angles relevant to the actual axis of the acetabulum (inclination angle, anteversion angle, tilt angle) as well as the volume and inner surface area of the acetabulum. RESULTS Both the inclination and tilt angles of the acetabulum did not differ significantly between the groups, the respective values being: 68.61° and 26.53° in females and 70.56° and 30.19° in males (p>0.05). The anteversion angle was significantly larger for female acetabula (38.27° compared to 32.05° in men, with p=0.0008), while the volume and the inner surface area were significantly smaller in women (p=0.0007 and 0.0001 respectively). CONCLUSIONS 1. Acetabular orientation is sex-specific, with female acetabula being more forward-oriented than those of men. 2. The volume and inner surface area of acetabula also differ between the sexes, being smaller in women. 3. Regardless of the plane of reference, sexual dimorphism of the acetabulum is constant. 4. Awareness of the above sex-dependent differences is necessary for preoperative planning before orthopaedic surgeries (such as hip arthroplasty or operative treatment of FAI).BACKGROUND The study aimed to compare sex differences in the morphology and spatial orientation of pelvic acetabula to advance the understanding of hip anatomy. MATERIAL AND METHODS The study was based on three-dimensional reconstructions of computed tomography images of 50 female and 50 male acetabula. The images were used for spatial analysis of hip acetabula relative to the base of the sacral bone as the plane of reference. Statistical analysis was performed to compare angles relevant to the actual axis of the acetabulum (inclination angle, anteversion angle, tilt angle) as well as the volume and inner surface area of the acetabulum. RESULTS Both the inclination and tilt angles of the acetabulum did not differ significantly between the groups, the respective values being: 68.61° and 26.53° in females and 70.56° and 30.19° in males (p>0.05). The anteversion angle was significantly larger for female acetabula (38.27° compared to 32.05° in men, with p=0.0008), while the volume and the inner surface area were significantly smaller in women (p=0.0007 and 0.0001 respectively). CONCLUSIONS 1. Acetabular orientation is sex-specific, with female acetabula being more forward-oriented than those of men. 2. The volume and inner surface area of acetabula also differ between the sexes, being smaller in women. 3. Regardless of the plane of reference, sexual dimorphism of the acetabulum is constant. 4. Awareness of the above sex-dependent differences is necessary for preoperative planning before orthopaedic surgeries (such as hip arthroplasty or operative treatment of FAI).

Does hemipelvis structure and position influence acetabulum orientation

BackgroundAlthough acetabulum orientation is well established anatomically and radiographically, its relation to the innominate bone has rarely been addressed. If explored, it could open the discussion on patomechanisms of such complex disorders as femoroacetabular impingement (FAI). We therefore evaluated the influence of pelvic bone position and structure on acetabular spatial orientation. We describe this relation and its clinical implications.MethodsThis retrospective study was based on computed tomography scanning of three-dimensional models of 31 consecutive male pelvises (62 acetabulums). All measurements were based on CT spatial reconstruction with the use of highly specialized software (Rhinoceros). Relations between acetabular orientation (inclination, tilt, anteversion angles) and pelvic structure were evaluated. The following parameters were evaluated to assess the pelvic structure: iliac opening angle, iliac tilt angle, interspinous distance (ISD), intertuberous distance (ITD), height of the pelvis (HP), and the ISD/ITD/HP ratio. The linear and nonlinear dependence of the acetabular angles and hemipelvic measurements were examined with Pearson’s product − moment correlation and Spearman’s rank correlation coefficient. Correlations different from 0 with p < 0.05 were considered statistically significant.ResultsComparison of the axis position with pelvis structure with orientation in the horizontal plane revealed a significant positive correlation between the acetabular anteversion angle and the iliac opening angle (p = 0.041 and 0.008, respectively). In the frontal plane, there was a positive correlation between the acetabular inclination angle and the iliac tilt angle (p = 0.025 and 0.014, respectively) and the acetabular inclination angle and the ISD/ITD/HP ratio (both p = 0.048).ConclusionsThere is a significant correlation of the hemipelvic structure and acetabular orientation under anatomic conditions, especially in the frontal and horizontal planes. In the anteroposterior view, the more tilted-down innominate bone causes a more caudally oriented acetabulum axis, whereas in the horizontal view this relation is reversed. This study may serve as a basis for the discussion on the role of the pelvis in common disorders of the hip.

The role of exaggerated patellar tendon reflex in knee joint position sense in patients with cerebral palsy.

The aim of this pilot study was to determine if exaggerated patellar tendon jerk affects knee joint position sense (JPS) in cerebral palsy (CP) patients, by comparing JPS of the knee between participants with normal and exaggerated reflexes. The thresholds for reflex classification were based upon the data from able-bodied volunteers. JPS was measured as the ability of a subject (with eyes closed) to replicate a knee joint position demonstrated by an examiner. Tendon jerk was measured as the moment of force in response to patellar tendon taps. Data was collected from 27 limbs of CP patients (N=14) and 36 limbs of able-bodied volunteers (N=18). JPS was less accurate (p=0.014) in limbs with non-exaggerated reflexes (50.28±43.63%) than in control limbs (11.84±10.85%). There was no significant difference (p=0.08) in JPS accuracy between limbs with exaggerated reflexes (18.66±15.50%) and control limbs. Our data suggests that one component of sensorimotor impairment, JPS, is not as commonly affected in CP patients as previously reported. JPS of the knee is reduced in limbs with non-exaggerated reflexes; however in limbs with exaggerated reflexes which is seen in the majority of CP patients, JPS is not affected.

Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures

This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78–86%, 65% (Spastic); 1.5–6%, 9% (Dyskinetic); 6.5–9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40–51%, 47% (Level I + II); 14–19%, 12% (Level III); 34–41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general publics point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly.

The gait pattern in post-menopausal women. Pilot study.

BACKGROUND Aging brings about a number of degenerative changes in the body. The aging process in-creases its pace after the menopause. Women notice functional limitations in their daily lives, including mobility problems, as early as in their forties. Gait is one of the most reliable parameters reflecting the bodys overall function and condition. The aim of this study was to determine the effect of menopause on gait patterns in healthy women. MATERIAL AND METHODS The study involved a group of 48 healthy women (divided into Group A of pre-menopausal women and Group B of post-menopausal women). Gait parameters were acquired by a DynaPort MiniMod accelerometer. The pre- and post-menopausal womens gait data, including spatio-temporal parameters, gait cycle phases and the variability, were analysed. RESULTS There were no significant differences between Group A and B in walking speed, step length, cadence, and gait phase duration. Significant differences were only noted in gait cycle phases with regard to the onset of single-support of the right limb, the 1st double-support of the right limb and the 2nd double-support of the left limb. Gait variability did not show any significant differences between the groups. CONCLUSIONS 1. A prolonged stance phase during the gait cycle observed in the post-menopausal women in this study is a typical finding in aged people. 2. However, stride-to-stride variability of gait was not affected in the study.