Reorientation acetabular osteotomies can correct dysplastic deformities and provide marked improvement in hip function. Deformities of the proximal femur can produce suboptimal articulation or secondary impingement after acetabular reorientation, yet the incidence and characteristics of such deformities have not been well described. To describe the proximal femoral anatomy in patients with symptomatic acetabular dysplasia, we retrospectively analyzed the radiographs of 108 hips treated with periacetabular osteotomy. The radiographic findings were compared with those in 22 control hips. In the dysplastic group, 80 hips were in women and 28 in men, and the average age was 24.8 years. Of the 108 abnormal radiographs, 44% had coxa valga and 4% coxa vara. Seventy-two percent had an aspheric or deformed femoral head and the head-neck offset was insufficient in 75% of the hips. When compared with the control hips, dysplastic hips had differences in parameters of proximal femoral anatomy that we measured. These data demonstrate a high incidence of proximal femoral abnormalities associated with acetabular dysplasia. Identifying and treating these abnormalities may optimize joint congruency and minimize secondary impingement after acetabular reorientation.
Osteoarthritis is thought to be caused by a combination of intrinsic vulnerabilities of the joint, such as anatomic shape and alignment, and environmental factors, such as body weight, injury, and overuse. It has been postulated that much of osteoarthritis is due to anatomic deformities. Advances in surgical techniques such as the periacetabular osteotomy, safe surgical dislocation of the hip, and hip arthroscopy have provided us with effective and safe tools to correct these anatomical problems. The limiting factor in treatment outcome in many mechanically compromised hips is the degree of cartilage damage which has occurred prior to treatment. In this regard, the role of imaging, utilizing plain radiographs in conjunction with magnetic resonance imaging, is becoming vitally important for the detection of these anatomic deformities and pre-radiographic arthritis. In this article, we will outline the plain radiographic features of hip deformities that can cause instability or impingement. Additionally, we will illustrate the use of MRI imaging to detect subtle anatomic abnormalities, as well as the use of biochemical imaging techniques such as dGEMRIC to guide clinical decision making.
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