A Contemporary Definition of Hip Dysplasia and Structural Instability: Toward a Comprehensive Classification for Acetabular Dysplasia

Wilkin, Geoffrey; Ibrahim, Mazen M.; Smit, Kevin; Beaulé, Paul E.

doi:10.1016/j.arth.2017.02.067

Cited by 107 publications

(102 citation statements)

References 83 publications

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“…In that regard, a more comprehensive classification for hip dysplasia was proposed based on the likely direction of instability as evidenced by the location of acetabular deficiency, the Ottawa classification (►Table 3). 123 By understanding the likely direction of instability, this classification also assists in surgical planning for redirectional acetabular osteotomies.…”

Section: Impingementmentioning

confidence: 99%

Femoroacetabular Impingement: What the Surgeon Wants to Know

Rego

Beaulé

Ayeni

et al. 2019

Semin Musculoskelet Radiol

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Femoroacetabular impingement (FAI) is increasingly recognized as a risk factor for early hip degeneration in young active patients. The diagnosis depends on clinical examination and proper imaging that should be able to identify abnormal and sometimes subtle morphological changes. Labral tears and cartilage lesions rarely occur without underlying bone abnormalities. Surgical approaches to treat FAI are increasing significantly worldwide, even without a clearly defined consensus of what should be accepted as the standard imaging diagnosis for FAI morphology.Hip abnormalities encompass many variations related to the shape, size, and spatial orientation of both sides of the joint and can be difficult to characterize if adequate imaging is not available.This article presents a comprehensive review about the information orthopaedic surgeons need to know from radiologists to plan the most rational approach to a painful hip resulting from a mechanical abnormality.

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Section: Impingementmentioning

confidence: 99%

Femoroacetabular Impingement: What the Surgeon Wants to Know

Rego

Beaulé

Ayeni

et al. 2019

Semin Musculoskelet Radiol

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“…There is no consensus on how to classify hip-related pain in young and middle-aged active adults, with prior studies focusing on classifying individual conditions, such as FAI syndrome,3 4 6–9 acetabular dysplasia,10 labral tear,8 9 chondral lesions and ligamentum teres tears 11. Each of these conditions is described in detail in online supplementary appendix 1.…”

Section: Introductionmentioning

confidence: 99%

“…Not having groin pain has been suggested to help exclude FAI syndrome and/or labral tear findings in patients with hip pain 17–19. Acetabular dysplasia refers to misalignment between the femoral head and the acetabulum secondary to changes in their shape, size and orientation,10 which may result in instability and overload of the acetabular rim during normal activities 20 21…”

Section: Introductionmentioning

confidence: 99%

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

et al. 2020

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There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

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“…To align current thinking on acetabular coverage and now having reference values for anterior and posterior coverage, we borrowed from the field of joint replacement to simplify acetabular dysplasia as a direction of instability (i.e., lack of coverage: anterior, posterior, and global/lateral). 13 Categorizing all symptomatic hips into individual categories is impossible because there will always be hips in the transitional zone (i.e., exhibiting signs of impingement and instability). Careful attention should be given to the physical examination regarding range of motion (in particular internal rotation) and muscle strength as well as other radiographic signs, such as the acetabular index 14 and ischial spine sign.…”

Section: Moving Away From the Term Borderline Toward A More Comprehenmentioning

confidence: 99%

Editorial Commentary: Quantifying Anterior and Lateral Acetabular Coverage in Hip Dysplasia: What About Posterior Coverage?

Beaulé

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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When evaluating the young adult with hip pain, proper radiographic examination and interpretation are the cornerstones of the diagnostic process because the symptomatology and physical findings can be nonspecific. Although most orthopaedic surgeons are able to identify the key radiographic parameters of acetabular dysplasia, too often the patient is categorized into the "borderline" category; unfortunately, this has led to misdiagnosis and ultimately mistreatment. Because acetabular dysplasia is a 3-dimensional deformity, the assessment of anterior and posterior coverage (i.e., anterior and posterior wall indexes) in addition to the lateral coverage (i.e., lateral center edge angle) must be integrated in our radiographic measurements.

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A Contemporary Definition of Hip Dysplasia and Structural Instability: Toward a Comprehensive Classification for Acetabular Dysplasia

Cited by 107 publications

References 83 publications

Femoroacetabular Impingement: What the Surgeon Wants to Know

Femoroacetabular Impingement: What the Surgeon Wants to Know

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018

Editorial Commentary: Quantifying Anterior and Lateral Acetabular Coverage in Hip Dysplasia: What About Posterior Coverage?

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