Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia

Abstract In recent years, there has been a controversial discussion about whether borderline dysplastic hips should be treated with an arthroscopic procedure or rather with an acetabular reorientation. New research suggests that a classification into stable and unstable hips may be helpful. The aim...

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Autores principales:	A. Zimmerer, J. Löchel, J. Schoon, V. Janz, G. I. Wassilew
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/be58f1769dea4fbb86a5dcb0e49d7a01
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spelling	oai:doaj.org-article:be58f1769dea4fbb86a5dcb0e49d7a012021-12-02T17:18:22ZDefining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia10.1038/s41598-021-99011-72045-2322https://doaj.org/article/be58f1769dea4fbb86a5dcb0e49d7a012021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99011-7https://doaj.org/toc/2045-2322Abstract In recent years, there has been a controversial discussion about whether borderline dysplastic hips should be treated with an arthroscopic procedure or rather with an acetabular reorientation. New research suggests that a classification into stable and unstable hips may be helpful. The aim of the study was to validate (1) the intra- and interobserver reliability of a newly defined radiographic parameter named the Gothic, (2) the association between the GAA and previously existing measurements used to define severity of acetabular dysplasia, and (3) the correlation between radiographic measurements of acetabular dysplasia with MRI findings previously suggestive of hip instability. We defined and validated the GAA in 10 standardized radiographs of asymptomatic hips by two observers and calculated intra- and interobserver coefficients at two individual dates. Subsequently, a consecutive series of 100 patients with dysplastic hips (LCEA < 25°, Toennis grade ≤ 1) were evaluated for signs of instability on anteroposterior (a.p.) pelvic radiographs and direct MR arthrography and were divided in two groups: stable and unstable. In these patients the LCEA, the AI, the FEAR index and the GAA were radiographically evaluated. Correlation analyses and a logistic regression analysis was performed to identify the predictive value of instability for each radiographic parameter. Cutoff probabilities analysis was performed using standard receiver operating characteristic (ROC) curves to rate the predictive efficiency value of the GAA. The GAA showed excellent inter- and intraobserver reliability. A correlation was found between GAA and FEAR index. A logistic regression analysis showed that LCEA, FEAR index and GAA are distinct predictors of instability in hip dysplasia. The GAA showed the largest area under the curve (AUC 0.96), indicating it to be the best predictor of instability with an optimal cutoff value of 90° (sensitivity, 0.95; specificity, 0.93). The GAA is a new available indicator for instability and is thus suggested to be used as a future radiographic parameter for the stability of dysplastic hips. Further studies are needed to understand how this parameter might additionally predict clinical outcome in the treatment of hip dysplasia. Level of evidence: Level III, diagnostic study.A. ZimmererJ. LöchelJ. SchoonV. JanzG. I. WassilewNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q A. Zimmerer J. Löchel J. Schoon V. Janz G. I. Wassilew Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
description	Abstract In recent years, there has been a controversial discussion about whether borderline dysplastic hips should be treated with an arthroscopic procedure or rather with an acetabular reorientation. New research suggests that a classification into stable and unstable hips may be helpful. The aim of the study was to validate (1) the intra- and interobserver reliability of a newly defined radiographic parameter named the Gothic, (2) the association between the GAA and previously existing measurements used to define severity of acetabular dysplasia, and (3) the correlation between radiographic measurements of acetabular dysplasia with MRI findings previously suggestive of hip instability. We defined and validated the GAA in 10 standardized radiographs of asymptomatic hips by two observers and calculated intra- and interobserver coefficients at two individual dates. Subsequently, a consecutive series of 100 patients with dysplastic hips (LCEA < 25°, Toennis grade ≤ 1) were evaluated for signs of instability on anteroposterior (a.p.) pelvic radiographs and direct MR arthrography and were divided in two groups: stable and unstable. In these patients the LCEA, the AI, the FEAR index and the GAA were radiographically evaluated. Correlation analyses and a logistic regression analysis was performed to identify the predictive value of instability for each radiographic parameter. Cutoff probabilities analysis was performed using standard receiver operating characteristic (ROC) curves to rate the predictive efficiency value of the GAA. The GAA showed excellent inter- and intraobserver reliability. A correlation was found between GAA and FEAR index. A logistic regression analysis showed that LCEA, FEAR index and GAA are distinct predictors of instability in hip dysplasia. The GAA showed the largest area under the curve (AUC 0.96), indicating it to be the best predictor of instability with an optimal cutoff value of 90° (sensitivity, 0.95; specificity, 0.93). The GAA is a new available indicator for instability and is thus suggested to be used as a future radiographic parameter for the stability of dysplastic hips. Further studies are needed to understand how this parameter might additionally predict clinical outcome in the treatment of hip dysplasia. Level of evidence: Level III, diagnostic study.
format	article
author	A. Zimmerer J. Löchel J. Schoon V. Janz G. I. Wassilew
author_facet	A. Zimmerer J. Löchel J. Schoon V. Janz G. I. Wassilew
author_sort	A. Zimmerer
title	Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
title_short	Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
title_full	Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
title_fullStr	Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
title_full_unstemmed	Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia
title_sort	defining the gothic arch angle (gaa) as a radiographic diagnostic tool for instability in hip dysplasia
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/be58f1769dea4fbb86a5dcb0e49d7a01
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Defining the Gothic Arch Angle (GAA) as a radiographic diagnostic tool for instability in hip dysplasia

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