Acetabular Dysplasia, Developmental Dysplasia of the Hip, Developmental Dysplasia of the Hip (DDH)
Conditions
Keywords
Salter osteotomy, Dega osteotomy, San Diego osteotomy, Pemberton osteotomy, Developmental dysplasia of the hip, Acetabular dysplasia, Magnetic resonance imaging, Three dimensional modeling, Acetabular morphometry, Methodological validation
Brief summary
The goal of this observational study is to learn how four acetabular osteotomy techniques change the shape of the hip socket in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia. The main questions it aims to answer are: How do virtual Salter, Dega, San Diego, and Pemberton osteotomies differ in acetabular volume and surface shape on participant-specific three-dimensional models? How closely does the virtual result of the osteotomy actually performed match the early postoperative magnetic resonance imaging (MRI)? Participants will have a three-dimensional pelvis-acetabulum model created from preoperative MRI. Researchers will perform virtual Salter, Dega, San Diego, and Pemberton osteotomies on that model and measure the resulting acetabular morphology. The virtual result of the osteotomy actually performed will then be compared with the participant's early postoperative MRI.
Detailed description
This is a single-center, prospective, observational methodological validation study in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia who are undergoing Salter, Dega, San Diego, or Pemberton acetabular osteotomy. The study has two linked analytical components. First, participant-specific three-dimensional pelvis-acetabulum models will be generated from preoperative MRI obtained within 6 weeks before surgery. Standardized virtual Salter, Dega, San Diego, and Pemberton osteotomies will then be applied on each participant's preoperative model to compare the expected effect of each technique on acetabular volume, surface area, coverage distribution, and other predefined three-dimensional morphometric parameters. Second, early postoperative MRI obtained 3 to 8 weeks after surgery will be used to derive actual postoperative three-dimensional morphology. The virtual output corresponding to the osteotomy actually performed clinically will then be compared with the postoperative MRI-derived morphology to quantify prediction accuracy using absolute difference, bias, and Bland-Altman limits of agreement. Additional analyses will compare validation performance by osteotomy type, assess interobserver and intraobserver reliability, measure workflow feasibility, and explore associations between preoperative morphometric markers and prediction error.
Interventions
PROCEDURESalter osteotomy
Redirectional innominate osteotomy performed to improve acetabular orientation and femoral head coverage in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia. The acetabulum is reoriented as a single fragment to increase primarily anterolateral coverage. The procedure is performed as routine clinical care, with technique selection based on the treating surgeon's indication and preoperative deformity pattern.
PROCEDUREDega osteotomy
Incomplete transiliac acetabuloplasty performed to reshape the acetabular roof and improve femoral head coverage in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia. The osteotomy preserves a hinge at the triradiate cartilage, allowing tailored correction of acetabular deficiency according to the morphology of the dysplastic socket. The procedure is performed as routine clinical care, with technique selection based on the treating surgeon's indication and preoperative deformity pattern.
PROCEDURESan Diego osteotomy
Incomplete transiliac acetabuloplasty performed to improve acetabular coverage in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia. The procedure preserves a triradiate cartilage hinge and allows directional correction according to the location of acetabular deficiency, including posterolateral or lateral deficiency when appropriate. The procedure is performed as routine clinical care, with technique selection based on the treating surgeon's indication and preoperative deformity pattern.
PROCEDUREPemberton osteotomy
Pericapsular acetabuloplasty performed to reshape and redirect the acetabulum in children and adolescents with developmental dysplasia of the hip or residual acetabular dysplasia. The osteotomy uses the triradiate cartilage as a hinge and increases femoral head coverage by altering acetabular shape and orientation. The procedure is performed as routine clinical care, with technique selection based on the treating surgeon's indication and preoperative deformity pattern.
Sponsors
Istanbul University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
2 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Age 2 to 18 years 2. Developmental dysplasia of the hip or residual acetabular dysplasia 3. Primary Salter, Dega, San Diego, or Pemberton acetabular osteotomy planned at Istanbul University, Istanbul Faculty of Medicine 4. Preoperative hip MRI available within 6 weeks before surgery 5. Early postoperative hip MRI available 3 to 8 weeks after surgery 6. MRI quality adequate for three-dimensional morphometric analysis 7. Unilateral or bilateral cases eligible
Exclusion criteria
1. Hip pathology not related to developmental dysplasia of the hip, including Perthes disease, slipped capital femoral epiphysis, neuromuscular dysplasia, or infection/trauma sequelae 2. Previous surgery on the same hip that significantly alters anatomy, including prior pelvic or femoral osteotomy or open reduction, or current metal implant/fusion 3. MRI contraindication or safety issue, including MR-incompatible implant/device, severe claustrophobia, or a medical barrier to sedation/anesthesia 4. MRI not compatible with protocol or inadequate for analysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Osteotomy-type differences in simulated acetabular morphometry | Baseline (preoperative MRI-based virtual simulation, within 6 weeks before surgery) | Comparison across virtual Salter, Dega, San Diego, and Pemberton osteotomies of predefined morphometric outputs on participant-specific preoperative 3-dimensional models, including acetabular volume (mm3), surface area (mm2), and angular parameters such as version and inclination (degrees). |
| Virtual-to-actual agreement of postoperative acetabular morphometry for the clinically performed osteotomy | Baseline and early postoperative MRI (3 to 8 weeks after surgery) | Agreement between the matched virtual osteotomy and the actual postoperative morphology, assessed using predefined morphometric outputs including acetabular volume (mm3), surface area (mm2), and angular parameters such as version and inclination (degrees); summarized using absolute difference, bias, and Bland-Altman limits of agreement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Osteotomy-type differences in virtual-to-actual prediction error | Baseline and early postoperative MRI (3 to 8 weeks after surgery) | Comparison of validation error among clinically performed Salter, Dega, San Diego, and Pemberton osteotomies. |
| Interobserver reliability of MRI-based segmentation and morphometric measurements | Baseline and early postoperative MRI (3 to 8 weeks after surgery) | Interobserver agreement for segmentation and morphometric measurements, reported using intraclass correlation coefficients. |
| Intraobserver reliability of MRI-based segmentation and morphometric measurements | Baseline and early postoperative MRI (3 to 8 weeks after surgery) | Intraobserver agreement for repeat measurements, reported using intraclass correlation coefficients. |
| Workflow processing time | From baseline MRI acquisition to completion of early postoperative MRI analysis, up to 14 weeks | Time required for segmentation, virtual osteotomy simulation, and morphometric analysis. |
| Workflow completion rate | From baseline MRI acquisition to completion of early postoperative MRI analysis, up to 14 weeks | Proportion of enrolled participants with a complete protocol-compatible analyzable dataset. |
Countries
Turkey (Türkiye)
Contacts
CONTACTYavuz Sağlam, M.D.
CONTACTİsmail T. Atasoy, M.D.
PRINCIPAL_INVESTIGATORYavuz Sağlam, M.D.
Istanbul University
Outcome results
None listed