Developmental dysplasia of the hip: Is acetabular retroversion a crucial factor?

Nehme, Alexandre; Trousdale, Robert T.; Tannous, Ziad; Maalouf, Ghassan; Puget, J.; N, Telmont

doi:10.1016/j.otsr.2009.06.006

Cited by 43 publications

(23 citation statements)

References 22 publications

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“…Isolated open or arthroscopic management with an aggressive anterior rim decompression may fail to address the overall deformity and result in iatrogenic anterior and posterior wall deficiency. An “anteverting” periacetabular osteotomy to provide anteversion correction of the acetabulum and improve mechanics between the femoral head-neck junction and the acetabular rim may be more appropriate in this setting [31] [32]. …”

Section: Discussionmentioning

confidence: 99%

Gender and Racial Differences in Focal and Global Acetabular Version

Tannenbaum

Kopydlowski

Smith

et al. 2014

The Journal of Arthroplasty

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The purpose of this study was to compare the acetabular version between male and female pelvises. We hypothesized that female acetabula would demonstrate more retroversion because Pincer-type femoroacetabular impingement (FAI) is associated with acetabular retroversion, which is more commonly observed in females. 120 bony pelvic specimens were randomly collected. The version was measured at three different axial sections of each acetabuli: cranial, central, and caudal. Males demonstrated significantly less anteversion than females in every section. The global version (the average of all three measurements) was also significantly different between males and females (16°±7° and 19°±8° respectively, p<0.001). Of the 240 examined acetabuli, 21 demonstrated cranial retroversion (16 males & 5 females). The data showed no significant difference (p=0.353) between global version of African Americans (18°±9°) and Caucasians (17°±7°). The results of this study suggest that symptomatic FAI in the female population likely reflects a complex interplay of femoral and acetabular dysmorphology and cannot be explained by differences in acetabular version alone.

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Section: Discussionmentioning

confidence: 99%

Gender and Racial Differences in Focal and Global Acetabular Version

Tannenbaum

Kopydlowski

Smith

et al. 2014

The Journal of Arthroplasty

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“…Although it generally is believed that anteversion of the acetabulum is associated with developmental dysplasia of the hip, there has been controversy regarding whether this actually is seen. Several studies have shown some dysplastic hips tend to be retroverted [4,14,15,19]. It remains unclear whether developmentally dysplastic hips should be discussed separately.…”

Section: Discussionmentioning

confidence: 99%

“…Some quantitative radiographic indices for acetabular retroversion have been reported [7,9,19,24,30]. Nehme et al [19], focusing on the crossover point, observed the anterior wall crossing the posterior wall, and calculated a ratio of the distance between the acetabular lateral edge and the crossover point divided by the total length of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…Nehme et al [19], focusing on the crossover point, observed the anterior wall crossing the posterior wall, and calculated a ratio of the distance between the acetabular lateral edge and the crossover point divided by the total length of the acetabulum. This ratio was easily measured, but it depended on the morphologic features of the anterolateral acetabular rim because of use of the crossover point.…”

Section: Discussionmentioning

confidence: 99%

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New Radiographic Index for Evaluating Acetabular Version

Koyama

Hoshino

Suzuki

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Several qualitative radiographic signs have been described to assess acetabular retroversion. However, quantitative assessment of acetabular version would be useful for more rigorous research purposes and perhaps to diagnose and treat hip disorders. Questions/purposes We developed a new quantitative index for acetabular version (p/a ratio). We determined the average p/a, compared it with previous radiographic signs for acetabular retroversion, and evaluated its relationship with anatomic acetabular version. Methods We calculated the p/a ratio by measuring p (distance from acetabular articular surface to posterior wall) and a (distance from acetabular articular surface to anterior wall) on plain hip AP radiographs and dividing p by a. P and a were assessed on the perpendicular bisector of the line between the teardrop and the lateral edge of the acetabulum. Using 185 hip radiographs from patients with suspected idiopathic osteonecrosis, we measured p/a and compared it with previous qualitative signs for acetabular retroversion. Using 62 hip CT images from patients with no osteoarthritis, we measured the anatomic anteversion at the height of the central femoral head and investigated its relationship with p/a. Results The average p/a was 2.05 in 185 hips, and most patients with a p/a greater than 2.05 had a negative qualitative retroversion sign. A correlation was observed between central anteversion and p/a (r = 0.84). Conclusions We believe this ratio can be considered a simple quantitative parameter to assess acetabular version using plain AP radiographs.

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“…1). 7 The ARI is a quotient between the length of overlap of the anterior rim in comparison with the entire length of the lateral acetabular opening (Fig. 1d).…”

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confidence: 99%

The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement

Díaz-Ledezma

Novack

Marin-Peña

et al. 2013

The Bone & Joint Journal

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Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI.

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Developmental dysplasia of the hip: Is acetabular retroversion a crucial factor?

Abstract: Level IV, retrospective diagnostic study.

Cited by 43 publications

References 22 publications

Gender and Racial Differences in Focal and Global Acetabular Version

Gender and Racial Differences in Focal and Global Acetabular Version

New Radiographic Index for Evaluating Acetabular Version

The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement

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