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"Pendahuluan: Teknik reaming posteroinferior-superioanterior (PISA) pada total hip arthroplasty (THA) pasien displasia panggul dewasa memiliki banyak keuntungan dibandingkan asetabuloplasti. Akan tetapi, kegagalan reaming PISA dapat meningkatkan biaya serta memperpanjang waktu operasi karena dokter harus melakukan asetabuloplasti sebagai alternatif. Tujuan: Mengeksplorasi parameter radiografi panggul preoperatif dalam memprediksi keberhasilan preparasi asetabulum dengan teknik reaming PISA pada pasien displasia panggul dewasa. Metode: Kohort retrospektif ini menggunakan data sekunder rekam medis seluruh pasien displasia panggul yang menjalani prosedur THA di Rumah Sakit dr. Cipto Mangunkusumo (Jakarta, Indonesia) pada Januari 2015–Agustus 2024. Parameter radiografi panggul preoperatif berupa acetabular depth rasio (ADR), acetabular inclination (AI), lateral center-edge angle (LCEA), serta Tönnis angle diukur dengan menggunakan PACS Viewer. Hasil: Sebanyak 36 pasien (72,2% perempuan, usia rerata 46,5415,02 tahun) dianalisis. Sebanyak 24 pasien berhasil dilakukan preparasi asetabulum dengan teknik reaming PISA, sementara sisanya harus menjalani asetabuloplasti. Tidak ada perbedaan jenis kelamin, usia atau keterlibatan sisi pada kelompok PISA dan asetabuloplasti. Kelompok Crowe III-IV memiliki odds 55 kali lipat lebih besar untuk menjalani asetabuloplasti (odds ratio [OR] 55, interval kepercayaan [IK] 95%: 5,45–554,96; p<0,001). Nilai ADR, AI, LCEA dan Tönnis angle secara berturut-turut adalah 33,2911,44%, 52,357,81 , 23,92(7,70–62,73) dan 9,61(0,79–44,81) . Kelompok reaming PISA memiliki ADR yang lebih tinggi dan AI yang lebih rendah dibandingkan kelompok asetabuloplasti (p<0,001). Tidak terdapat perbedaan LCEA (p=0,198) dan Tönnis angle (p=0,251) pada kedua kelompok. Analisis regresi logistik dengan mengontrol ADR, AI, dan LCEA menunjukkan bahwa ADR (adjusted OR 0,85; IK 95%: 0,75–0,95) dan AI (adjusted OR 1,11; IK 95%: 1,03–1,19) berhubungan dengan dilakukannya asetabuloplasti. Probabilitas dilakukan asetabuloplasti dapat diprediksi dengan rumus ln p/(1-p) = - 0,169(ADR)+0,104(AI)-0,040(LCEA). Model ini memiliki ketepatan 88,9% dengan diskriminasi yang sangat baik (area under the curve=0,913 (IK 95%: 0,800–1)). Simpulan: Angka ADR dan AI preoperatif dapat memprediksi keberhasilan reaming PISA dengan diskriminasi yang sangat baik. Studi prospektif lebih lanjut dapat dilakukan dengan sampel dan parameter radiografi yang lebih banyak untuk memvalidasi temuan ini.

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Introduction: The posteroinferior-superioanterior (PISA) reaming technique in total hip arthroplasty (THA) in adult hip dysplasia patients has many advantages over acetabuloplasty. However, failure of PISA reaming could increase costs and prolong surgery time because doctors must perform acetabuloplasty as an alternative. Purpose: To examine preoperative pelvic radiographic parameters in predicting the success of acetabular preparation with the PISA reaming technique in adult hip dysplasia patients. Methods: This retrospective cohort used secondary data from medical records of all adult patients with hip dysplasia who underwent THA procedures at Dr. Cipto Mangunkusumo Hospital (Jakarta, Indonesia) from January 2015 to August 2024. Preoperative pelvic radiographic parameters such as acetabular depth ratio (ADR), acetabular inclination (AI), lateral center-edge angle (LCEA), and Tönnis angle were measured using PACS Viewer. Results: Thirty-six patients (72.2% female, mean age 46.54±15.02 years) were analyzed. Twenty four patients had successful acetabular preparation by using reaming PISA technique, while the rest underwent acetabuloplasty. There was no difference in gender, age, or site of involvement between patients in reaming PISA and acetabuloplasty groups. The Crowe III-IV group had 55-fold greater odds of undergoing acetabuloplasty (odds ratio [OR] 55, 95% confidence interval [CI]: 5.45–554.96; p<0.001). The ADR, AI, LCEA, and Tönnis angle values were 33.29±11.44%, 52.35±7.8, 23.92 (7.70–62.73) , and 9.61 (0.79–44.81) respectively. The reaming PISA group had a higher ADR and lower AI than the acetabuloplasty group (p<0.001). Both groups had no difference in LCEA (p=0.198) and Tönnis angle (p=0.251). Logistic regression analysis controlling ADR, AI, and LCEA showed that ADR (adjusted OR 0.85; 95% CI: 0.75–0.95) and AI (adjusted OR 1.11; 95% CI: 1.03–1.19) were associated with acetabuloplasty. The probability of acetabuloplasty can be predicted by the formula ln p/(1-p) = - 0.169(ADR)+0.104(AI)-0.040(LCEA). This model has an accuracy of 88.9% with excellent discrimination (area under the curve=0.913 (95% CI: 0.800–1)). Conclusion: Preoperative ADR and AI values can predict the success of reaming PISA with excellent discrimination. Further prospective studies with more samples and radiological parameters should be done to validate these findings."

"Latar Belakang: Acetabuloplasty dengan bone graft merupakan salah satu tatalaksana adult congenital hip disease. Tindakan ini bertujuan memperbaiki defisiensi dinding acetabulum dan meningkatkan stabilitas implant. Namun, terdapat variasi dalam teknik, lokasi, dan jenis implant yang dapat dipasang. Oleh karena itu, penelitian ini bertujuan membandingkan kekuatan konstruksi acetabuloplasty dengan pelbagai screw pada teknik bone graft kepala femur. Metode: Model pelvis 3D dibuat dengan simulasi defek containment 30% pada sisi antero-superior acetabulum. Rekonstruksi acetabuloplasty dibuat tulang kepala femur berbentuk angka 7 difiksasi dengan screw, diikuti uji finite element untuk menilai distribusi stres. Konstruk acetabuloplasty diaplikasikan pada tiga kelompok uji: A (2 screw cannulated ukuran 6.5 mm), B (2 screw cortical ukuran 4.5 mm), C (1 screw cannulated 6.5 mm + 1 screw cortical 4.5 mm). Spesimen diberi beban dari 50 hingga 750 N dengan peningkatan sebesar 100 N/detik sebagai simulasi single leg stance. FGM pada beban 750 N diukur menggunakan kamera. Kemudian dilakukan uji load to failure. Hasil: Kelompok sampel cannulated ukuran 6.5 mm lebih unggul secara significant pada uji load to failure dengan titik patah 2 kali lipat lebih besar dibandingkan kelompok lainnya (2191 N v 1206 N v 1065 N; p<0.01). Uji loading dengan 750 Newton juga menunjukkan bahwa kelompok A unggul dengan rerata pergeseran, peregangan, dan tilting terkecil di semua posisi marking kecuali pada tilting marking posterior superior. Sampel cannulated ukuran 6.5mm juga memiliki titik yield dan titik kekuatan maksimum terbesar. Sementara itu, kelompok B dan C memiliki hasil uji yang serupa satu sama lain. Tetapi, temuan ini tidak bermakna secara statistik (p>0.05) Kesimpulan: Acetabuloplasty dengan bone graft adalah metode biomekanik yang aman untuk terapi definitif pada congenital adult hip disease. Pemilihan screw cannulated dengan ukuran diameter screw lebih besar memiliki keunggulan biomekanik bila dibandingkan dengan kelompok uji screw cortical maupun kombinasi antara kedua screw.

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Background: Acetabuloplasty using bone grafts is one of the treatment options for adult congenital hip disease. It aims to correct acetabular wall deficiencies and enhance pelvic implant stability. However, there are variations in the positions, types, and techniques of screw placements, leaving the fixation strength unknown. Therefore, this study aims to evaluate the structural strength of acetabuloplasty with screws in femoral head bone graft techniques. Methods: A 3D pelvis model was created to simulate a 30% containment defect on the antero-superior aspect of the acetabulum. Acetabuloplasty reconstruction utilized a femoral head bone graft shaped like a "7," which was fixed with screws, followed by finite element analysis to assess stress distribution. The acetabuloplasty construct was applied to three test groups: A (2 cannulated screws - 6.5 mm), B (2 cortical screws - 4.5 mm), and C (1 cannulated screw - 6.5 mm + 1 non-cannulated screw - 4.5 mm). Specimens were subjected to loads ranging from 50 to 750 N, with increments of 100 N/sec to simulate single-leg stance. FGM at 750 N were measured using a camera. Then the specimens were subjected to loading until implant failure. Results: Group A with cannulated 6.5 mm screws are shown to be significantly better in the load-to-failure test with a mean breaking point twice larger than the other two groups (2191 N v 1206 N v 1065 N; p<0.01). Group A also shows superior results in the single- leg stance in all marking positions with the smallest displacement, stretch, and tilting -bar the posterior superior tilt. Group A also has the largest yield and maximum strength point. In comparison, groups B and C had similarly inferior results. However, the findings are statistically insignificant (p>0.05). Conclusion: Acetabuloplasty with bone graft is a biomechanically safe method for definitive treatment of adult congenital hip disease. Larger cannulated screws are shown to have a biomechanical advantage compared to cortical smaller screws or a combination of both screws."