Periacetabular osteotomy (PAO) is a complex surgical procedure to restore acetabular coverage in the dysplastic hip, and the\namount of acetabular rotation during PAO plays a key role. Using computational simulations, this study assessed the optimal\ndirection and amount of the acetabular rotation in three dimensions for a patient undergoing PAO. Anatomy-specific finite\nelement (FE) models of the hip were constructed based on clinical CT images. The calculated acetabular rotation during PAO\nwere 9.7�°, 18 �° , and 4.3�° in sagittal, coronal, and transverse planes, respectively. Based on the actual acetabular rotations, twelve\npostoperative FE models were generated. An optimal position was found by gradually varying the amount of the acetabular\nrotations in each anatomical plane. The coronal plane was found to be the principal rotational plane, which showed the\nstrongest effects on joint contact pressure compared to other planes. It is suggested that rotation in the coronal plane of the\nosteotomized acetabulum is one of the primary surgical parameters to achieve the optimal clinical outcome for a given patient.
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