An Algorithmic Approach to Surgical Decision Making in Acetabular Retroversion

Peters, Christopher L.; Anderson, Lucas A.; Erickson, Jill; Anderson, Andrew E.; Weiss, Jeffrey A.

doi:10.3928/01477447-20101123-07

Cited by 46 publications

(64 citation statements)

References 48 publications

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“…There is only one study comparing the surgical treatments for acetabular retroversion. In this study, Peters et al [32] differentiated between the two surgical treatments analyzing two different morphologic types of acetabular retroversion: one with a deficient posterior wall and one with sufficient posterior coverage. The followup after 4 years was comparable regarding the Harris hip score.…”

Section: Discussionmentioning

confidence: 99%

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Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Zurmühle

Anwander

Albers

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Acetabular retroversion can cause impaction-type femoroacetabular impingement leading to hip pain and osteoarthritis. It can be treated by anteverting periacetabular osteotomy (PAO) or acetabular rim trimming with refixation of the labrum. There is increasing evidence that acetabular retroversion is a rotational abnormality of the entire hemipelvis and not a focal overgrowth of the anterior acetabular wall, which favors an anteverting PAO. However, it is unknown if this larger procedure would be beneficial in terms of survivorship and Merle d'Aubigné scores in a midterm followup compared with rim trimming. Questions/purposes We asked if anteverting PAO results in increased survivorship of the hip compared with rim trimming through a surgical hip dislocation in patients with symptomatic acetabular retroversion. Methods We performed a retrospective, comparative study evaluating the midterm survivorship of two matched patient groups with symptomatic acetabular retroversion undergoing either anteverting PAO or acetabular rim trimming through a surgical hip dislocation. Acetabular retroversion was defined by a concomitantly present positive crossover, posterior wall, and ischial spine sign. A total of 279 hips underwent a surgical intervention for acetabular retroversion at our center between 1997 and 2012 (166 periacetabular osteotomies, 113 rim trimmings through surgical hip dislocation). A total of 99 patients (60%) were excluded from the PAO group and 56 patients (50%) from the rim trimming group because they had any of several prespecified conditions (eg, dysplasia . A minimum followup of 2 years was required for this study. Failures were included at any time. The median followup for the anteverting PAO group was 9.5 years (range, 2-17.4 years) and 6.8 years (range, 2.2-10.5 years) for the rim trimming group (p \ 0.001). Kaplan-Meier survivorship analysis was performed using the following endpoints at 5 and 10 years: THA, radiographic One author (MT) has received funding from the Swiss National Science Foundation (SNSF). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Section: Discussionmentioning

confidence: 99%

“…Our results are not valid for hips that present with a crossover sign only. Based on the data from others [32], acetabular rim trimming may be a valid option for treatment of hips with a positive crossover sign but concomitantly sufficient posterior coverage.…”

Section: Discussionmentioning

confidence: 99%

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Zurmühle

Anwander

Albers

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Hips with retroversion often experience damage in the posterior acetabulum, which has been postulated to result from one of two mechanisms [36]. The first mechanism to consider is decreased contact area and a resulting elevated contact stress in the posterior acetabulum [7,14,15]. The preferred treatment for this mechanism of damage is periacetabular osteotomy [14,37].…”

Section: Discussionmentioning

confidence: 99%

Finite Element Predictions of Cartilage Contact Mechanics in Hips With Retroverted Acetabula

Henak

Carruth

Anderson

et al. 2013

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotran

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BACKGROUND-A contributory factor to hip osteoarthritis (OA) is abnormal cartilage mechanics. Acetabular retroversion, a version deformity of the acetabulum, has been postulated to cause OA via decreased posterior contact area and increased posterior contact stress. Although cartilage mechanics cannot be measured directly in-vivo to evaluate the causes of OA, they can be predicted using finite element (FE) modeling.OBJECTIVE-The objective of this study was to compare cartilage contact mechanics between hips with normal and retroverted acetabula using subject-specific FE modeling. METHODS: Twenty subjects were recruited and imaged: ten with normal acetabula and ten with retroverted acetabula. FE models were constructed using a validated protocol. Walking, stair ascent, stair descent and rising from a chair were simulated. Acetabular cartilage contact stress and contact area were compared between groups. RESULTS-Retroverted acetabula had superomedial cartilage contact patterns, while normal acetabula had widely distributed cartilage contact patterns. In the posterolateral acetabulum, average contact stress and contact area during walking and stair descent were 2.6 to 7.6 times larger in normal than retroverted acetabula (p ≤ 0.017). Conversely, in the superomedial

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“…There is increasing concern that failure to recognize abnormalities of acetabular morphology leads to inadequate or inappropriate treatment of hip disease [7,[11][12][13][14]16]. Consequently, the question arises whether normal coverage of the femoral head can be defined on an AP pelvis radiograph.…”

Section: Introductionmentioning

confidence: 99%

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Siebenrock

Kistler

Schwab

et al. 2012

Clinical Orthopaedics &Amp; Related Research

122

141

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Background Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. Questions/Purposes We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra-and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. MethodsWe retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Results Intra-and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Conclusions Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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An Algorithmic Approach to Surgical Decision Making in Acetabular Retroversion

Cited by 46 publications

References 48 publications

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Finite Element Predictions of Cartilage Contact Mechanics in Hips With Retroverted Acetabula

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

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