1. JFIM
2013:
The
pelvis:
An
anatomical
comparison
in
animal
species
and
evolu=on
Jean-­‐Denis
Laredo
MSK
radiologist
Denis
Diderot
Paris
University
And
CNRS
7051

2. Age
of
the
world
and
animals
•
•
•
•
•
•
•
•
•
•
•
•
Universe:
13.8
billion
years
(«
Big
bang
»)
Earth:
4.54
billion
years
Vertebrates
:
500
million
years
(aqua=c
first)
Dinosaurus:
100-­‐50
million
years
Mammalians:
50
million
years
Primates
35
million
years
Hominidae-­‐Big
Monkeys
(Apes)
10-­‐15
million
years
Common
ancestor
to
big
monkeys
and
humans:
7
million
years
Australopithecus:
3
million
years
Homo
Habilis:
1.8
million
years
Homo
sapiens:
1
million
years
Homo
sapiens
sapiens:
100,000
years

3. Primates=
simiens
&
prosimiens
Hominoïdes
Catarrhiniens
Cercopithécoïdes
Simiens
Platyrrhiniens
Babouin,
Macaque

4. Hominoïdes
Gibbons
Tall
Monkeys
(grands
singes)
«
Apes
»:
Orang-­‐
outan,
Chimpanzé,
Gorille
Hominides
Australopithecus
Homo

5. Hominides
history
Foot
steps
in
Laetoli
(Tanzania)
Australopithecus
afarensis
(Lucy),
3
million
years

7. Rie
valley
&
Yves
Copens
theory

9. Primate
habitat
• Most
primates
have
their
natural
environment
in
the
trees

10. Primates
habitat
&
locomo=on
Tree
Brachia=on
Tree
Quadrupeds
Bonobo
(chimpanzee)
Gibbons
(hylobates)
Ground
quadrupeds
Big
monkeys
Bonobo
(chimpanzee)
Ground
bipeds
Hominidae

11. Tree
brachia=on
versus
quadrupedalism
Gibbons
(hylobates)
Bonobo
(pan
paniscus,
small
chimpanzee)

12. Human
(Bipeds)
anatomic
characteris=cs?

13. Bipeds
characteris=cs
• Hand
and
opposing
thumb
allowing
hand
grip?

14. Human
(Bipeds)
anatomic
characteris=cs
• Hand
and
opposing
thumb
allowing
hand
grip:
No!

15. Human
(Bipeds)
anatomic
characteris=cs
1. Foot!
Humans
have
a
specific
foot
anatomy
The
Bonobo
has
4
hands
Homo
Homo
:
M1-­‐M2
joint

16. Human
(Bipeds)
anatomic
characteris=cs
1. Foot!
highly
specialised
in
bipeds
Bonobo
Homo,
hallux
valgus

17. Foot
steps
in
Laetoli
(Tanzania)
Australopithecus
afarensis
(Lucy),
3
million
years

18. Human
(Bipeds)
anatomic
characteris=cs
1. Foot!
highly
specialised
in
bipeds
2. Long
femoral
neck
Cow
Bonobo
Lucy(Australopithecus)
Homo
habilis
Homo
sapiens

19. Human
femur
• Femoral
head:
2/3
of
a
sphere
• Weight-­‐bearing

20. Human
femur
• Femoral
head:
2/3
of
a
sphere
• Weight-­‐bearing
Propensity
to
subchondral
fracture

22. Human
femur
• Femoral
head:
2/3
of
a
sphere
(extended
car=lage)
• Poor
vascularisa=on
Propensity
to
avascular
necrosis

23. Human
(Bipeds)
anatomic
characteris=cs
1. Foot!
highly
specialised
in
bipeds
2. Femoral
neck
3. Pelvis

28. Human
(Bipeds)
anatomic
characteris=cs
1. Foot!
highly
specialised
in
bipeds
2. Femoral
neck
3. Pelvis
Quadrupeds
Cow
Bonobo
Bipeds
Lucy
Homo
sapiens

29. Pelvis
muscles
abdominal
wall
muscles
Lumbar
spine
extensionL.
Pelvis
equilibrium
Thigh
muscles

31. Homo
Lucy

32. Homo
Lucy

33. Hip
joint
• Any
joint
is
a
compromise
between
mobility
and
stability
• Tree
quadrupeds
(Monkeys):
Mobility
>>
stability

34. Human
hip
joint
• Ground
bipeds
(homo):
ü Shoulder
:
mobility
>>
stability
ü Hip
joint
:
weight-­‐bearing
stability
>>
mobility
high
joint
congruence

36. Human
hip
joint
• Weight-­‐bearing
• High
congruence
• High
fric=on
Propensity
to
wearing
:
hip
osteoarthri=s

37. Human
(Bipeds)
anatomic
characteris=cs
1.
2.
3.
Foot
Femoral
neck
Pelvis
4. Lumbar
Lordosis
5. Shorter
upper
limb
(70%
of
the
lower
limb)
Symphalangius
Chimpanzee
Homo
sapiens

39. Human
(Bipeds)
anatomic
characteris=cs
1.
2.
3.
Foot
Femoral
neck
Pelvis
4. Lumbar
Lordosis
5. Shorter
upper
limb
6. Foramen
magnum
below
the
skull
Homo
sapiens
Orang

40. The
standing
posi=on
La
sta=on
debout

42. Georges
Charpak
discovery:
Highly
sensi=ve
X-­‐ray
detector
in
a
gazeous
phase
Low
dose
simultaneous
standing
AP
&
lateral
full
body
radiographs

43. Human
pelvis
is
submired
to
high
compression
forces

44. How
to
resist
to
these
compression
forces
?

45. G.
Morvan

46. C7 Plumb line
Economic equilibrium:
• Lumbar lordosis
• Thoracic kyphosis
• C7 Plumb Line

47. Pelvic
anteversion,
lumbar
lordosis
&
thoracic
kyphosis
allow
adapta=on
to
anterior
trunk
bending

50. Pelvic
incidence
(Duval-­‐Beaupère)

51. How
to
resist
to
these
compression
forces
?
Pelvic
incidence:
mean
55°
(35-­‐70)

52. How
to
resist
to
these
compression
forces
?
G.
Morvan

55. Surgical
treatment
of
degenera=ve
sta=c
malalignements
of
the
spine
• Pierre
Guigui
Chief
of
Orthopaedic
surgery
Denis
Diderot
Paris
University

56. 1994
1994
1995

57. 2001

58. 2001
2001

59. 2001
2001

60. Extension
2001
2002
Flexion

61. Extension
2001
2002
Flexion

62. Extension
2001
2002
Flexion

65. Importance
du
grand
cliché

68. Locomo=on

69. Motion
Life
is
mo=on
«
Mo5on
is
at
the
root
of
all
ac5ons
»
E"enne
Jules
Marey
(1830
–
1904)
«
Le
mouvement
est
l’acte
le
plus
important
en
ce
sens
que
toutes
les
fonc5ons
empruntent
son
concours
pour
s’accomplir.
»

70. Primate
locomo=on
Tree
Brachia=on
Tree
Quadrupeds
Ground
quadrupeds
Big
monkeys
Ground
bipeds
Hominidae

71. Bipedalism
locomo=on

72. Homo
is
not
the
only
animal
using
bipedalism
La
bipédie
n’est
pas
le
propre
de
l’homme

73. Foot
steps
in
Laetoli
(Tanzania)
Australopithecus
afarensis
(Lucy),
3
million
years

77. Big
monkeys:
quadrupeds
in
trees
and
on
the
ground
Occasionnal
bipeds

78. Tree
brachia=on
versus
quadrupedalism
Gibbons
(hylobates)
Bonobo
(pan
paniscus,
small
chimpanzee)

82. Hallux
rigidus

83. Humanoïde
Robot
J e a n -­‐ P a u l
L a u m o n d

85. En guise de conclusion
Faire
marcher
un
robot
Synergie
sciences
de
la
vie
et
robo=que

86. HRP2
Capteurs
et
ac=onneurs
4
caméras
Gyroscope
30
moteurs
DC Motor with Ironless Rotor
Accéléromètres
Pulley
Harmonic Drive Gear
Timing Belt
Pulley
4
Capteurs
d’effort

87. La marche : niveau cognitif
La
marche
d’HRP2

88. Sous–actionnement : la marche
La
marche
d’HRP2
Centre
de
pression
Centre
de
masse
Kajita
et
al,
IEEE
ICRA,
2003

89. Locomotion
Robot
and
human:
two
different
models
Kajita
et
al,
IEEE
ICRA,
2003
A.
Berthoz,
T.
Pozzo,
Posture
and
Gaits
,Elsevier,
1988
E"enne
Jules
Marey
©
Cinémathèque
Française

90. VALUE
OF
BILATERAL
STANDING
OBLIQUE
RADIOGRAPHS
(«
FAUX
PROFIL
DE
LEQUESNE
»)
IN
THE
DIAGNOSIS
OF
HIP
OSTEOARTHRITIS

91. The
acetabulum
can
be
described
as
a
croissant
Apical
Roof
Posterior
Horn
Anterior
Roof
Anterior
Horn

92. However,
the
AP
radiograph
only
profiles
the
apical
roof
of
the
acetabulum.
Apical
Roof

93. Standing
oblique
of
the
hip
«
faux-­‐profil
»
de
Lequesne
X-­‐Ray
Target
hip
65°
Lequesne,
M.G.Laredo,
J.D.
The
faux
profil
(oblique
view)
of
the
hip
in
the
standing
posi5on.
Contribu5on
to
the
evalua5on
of
osteoarthri5s
of
the
adult
hip.
Ann
Rheum
Dis,
1998

94.
The
SO
view
profiles
the
posterior
horn,
apical
roof
and
anterior
roof
of
the
hip
in
contact
with
the
radiographic
table,
the
“target”
hip.
Anterior
Roof
Anterior
Roof
Apical
Roof
Posterior
Horn
Target
Hip
Right
Hip

96. The
Lequesne
Standing
Oblique
is
more
sensi=ve
than
the
AP
Pelvis
view
for
the
diagnosis
of
early
OA
Lequesne
M.
ARD
1998
Conrozier
T.
O&C
1998
Vignon
E.
J
Rheumatol
2004
Normal
OA

97. Pa=ent
posi=oning
in
Lyon
Schuss
(1)
Cassere,
(2)
feet
cushion,
(3)
Fluoroscopy

98.
The
SO
view
profiles
the
posterior
horn,
apical
roof
and
anterior
roof
of
the
hip
in
contact
with
the
radiographic
table,
the
“target”
hip.
Anterior
Roof
Anterior
Roof
Apical
Roof
Posterior
Horn
Target
Hip
Right
Hip

99. Double
oblique
de
profil
Contre-­‐
Faux-­‐
Profil:
Non-­‐target
Hip
Corne
antérieure
Faux-­‐
Profil:
Target
Hip
Corne
postérieure
65°
Lequesne,
M.G.Laredo,
J.D.
The
faux
profil
(oblique
view)
of
the
hip
in
the
standing
posi5on.
Contribu5on
to
the
evalua5on
of
osteoarthri5s
of
the
adult
hip.
Ann
Rheum
Dis,
1998
Laredo,
J.D.,
Le
contre-­‐faux-­‐profil
de
hanche.
en
cours
de
publica=on

100. The
SO
view
profiles
the
apical
roof,
anterior
roof
and
anterior
horn
of
the
contralateral
hip,
distant
from
the
table,
the
“non-­‐target”
hip.
Apical
Roof
Anterior
Roof
Anterior
Horn
Non-­‐target
Hip
Right
Hip

101. Bilateral
standing
oblique
(SO)
radiographs
of
the
pelvis
profile
the
full
hip
joint
space.
Anterior
Roof
Apical
Roof
Anterior
Roof
Apical
Roof
Anterior
Horn
Posterior
Horn
Target
Hip
Non-­‐target
Hip
Right
Hip

102.
Anterior
Roof
Apical
Anterior
Roof
Roof
Apical
Roof
Anterior
Horn
Posterior
Horn
Anterior
Roof
Target
Hip
Non-­‐target
Hip
Apical
Roof
Anterior
Roof
Anterior
Horn
Posterior
Horn
Right
Hip

103. Results
1:
AP
view
Normal
JSW
measurements:
JSW
gradient
Vap
L
Mean
mm ± sd
5.02 ± 0.74
Vap
4.65 ± 1.1
M
AP
view
Measurement
Point
L
M
4.28 ± 1.09

104. Results
1:
Standing
Oblique
Normal
JSW
measurements:
JSW
gradient
Measurement
Point
AR
PH
SO
view
:
Target
Hip
5.18± 1.2
4.43± 0.92
PS
3.69± 0.69
PH
3± 0.55
AR/PH ratio
PS
Mean mm
±sd
Vct
AR
Vct
1.77± 0.48

105. Results
1:
Descrip=ve
results
Contralateral
Standing
Oblique
Normal
JSW
measurements
Measurement
Point
Mean
mm ± sd
IAH
3.83 ± 0.23
SAH
5.34 ± 1.04
Vdt
Vdt
SAH
5.39 ± 1.14
IAH
SO
view
:
Non-­‐target
Hip

106. Results
2
ANOVA:
Overt
OA
versus
Controls
Vap
0.00458*
Vct
0.00029*
AR/PH ratio
0.00007*
IAH
0.00969*
SAH
0.0112*
AP View
Standing
Oblique
Target Hip
Standing
Oblique
Non-target Hip
PH
SO
view:
Target
Hip
Vdt
M
PS
0.0375*
PH
AR
Vct
0.0322*
AR
Vap
L
SAH
IAH
AP
SO
view:
Non-­‐target
Hip

107.
Results
2
AR
Vct
ANOVA:
Incipient
OA
versus
Controls
Standing Oblique
Target Hip
PH
0.00446*
IAH
0.00128*
SAH
0.0687
PH
0.02004*
AR/PH ratio
Standing Oblique
Target Hip
SO
view:
Target
Hip
Vdt
M
Vap
PS
L
SAH
IAH
AP
SO
view:
Non-­‐target
Hip

108. Results
3
Logis=c
regression
analysis
View
Logistic Regression
to predict
Incipient OA
versus Controls
OR[95%CI]
Antero-Posterior View
Measurement
Point
-
-
Standing
Oblique
Contact
Hip
PH
2.405 [1.184 ; 4.886]
AR/PH ratio
0.273 [0.095 ; 0.787]
SAH
0.556 [0.345 ; 0.894]
Standing
Oblique
Distant
Hip
AR
Vct
Vdt
SAH
PS
IAH
PH
SO
view:
Target
Hip
SO
view:
Non-­‐target
Hip

109. Results
4
Thresholds
that
maximalize
accuracy
Threshold that
maximizes accuracy
(mm)
AR
View
Measurement
Point
4.4
Target
Hip
SO
view
Non-target
Hip
SO view
SAH
IAH
1
4,04
Specificity
PPV
NPV
34,78
100
100
58.1
(16.38-57.27) (87.66-100) (63,06-100) (44.8-70.5)
50
(30.6-69.4)
PH
AR/PH ratio
Sensitivity
91.9
82.4
70.8
(78.1-98.3) (56.6-96.2) (55.9-83)
ACCURACY
59.7
(47-71.5)
73.8
(61.5-84)
91,67
67,92
72,31
39,29
97,3
(61,52-99,7 (53,68-80,0 (59,81-82,69
(21,5-59,42) (85,84-99,03)
9)
8)
)
80
66,67
41,38
91,89
69,7
(51,91-95,6 (52,08-79,2
(23,52-61,06) (78,09-98,3)
(57,15-41)
7)
4)
75
(34.9-96.8)
100
(71.5-100)
100
84.6
89.5
(54.1-100) (54.6-98.1) (66.9-98.7)

110. Conclusions
• JSW
measurements
on
bilateral
SO
radiographs
allow
diagnosis
of
early
hip
OA
not
shown
by
the
standing
AP
pelvis
radiograph.
• Measurement
of
the
AR/PH
JSW
ra=o
provides
the
best
diagnos=c
performances.
AR
Vct
Vdt
SAH
PS
IAH
PH
SO
view:
Target
Hip
SO
view:
Non-­‐target
Hip

114. • Three different anatomical types of hip osteoarthriti
anterosuperolateral OA
Avant
posteroinfero-medial
OA
anterosuperomedial OA