Systematic review of pre-operative planning modalities for correction of acetabular dysplasia

Acetabular dysplasia, related to developmental dysplasia of the hip, causes the abnormal distribution of hip joint forces. Surgical correction of acetabular dysplasia involves repositioning the acetabulum to achieve improved coverage of the femoral head. However, ideal placement of the acetabular fragment is challenging, and has led to an increased interest in pre-operative planning modalities. In this study, we used the PubMed and EBSCO host databases to systematically review all the modalities for pre-operative planning of acetabular dysplasia proposed in the current literature. We included all case-series, English, full-text manuscripts pertaining to pre-operative planning for congenital acetabular dysplasia. Exclusion criteria included: total hip arthroplasty (THA) planning, patient population mean age >35, and double/single case studies. A total of 12 manuscripts met our criteria for a total of 186 hips. Pre-operative planning modalities described were: Amira (Thermo Fischer Scientific; Waltham, MA, USA) 12.9%, OrthoMap (Stryker Orthopaedics; Mahwah, NJ, USA) 36.5%, Amira + Biomechanical Guidance System 5.9%, Mills et al. method 16.1%, Klaue et al. method 16.1%, Armand et al. method 6.5%, Tsumura et al. method 3.8% and Morrita et al. method 2.2%. As a whole, there was a notable lack of prospective studies demonstrating these modalities' efficacy, with small sample sizes and lack of commercial availability diminishing their applicability. Future studies are needed to comprehensively compare computer-assisted planning with traditional radiographic assessment of ideal osteotomy orientation.