Effect of Pelvic Tilt on Acetabular Retroversion: A Study of Pelves From Cadavers

Siebenrock, Klaus A.; Kalbermatten, Daniel F.; Ganz, Reinhold

doi:10.1097/00003086-200302000-00033

Cited by 590 publications

(551 citation statements)

References 12 publications

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“…The concept of osteoarthritis of the hip as an end result of hip impingement (which developed as a result of abnormal anatomy of the proximal femur and acetabulum) has been supported by several reports [1,[4][5][6]. Anatomic variations in femoral head-neck offset, acetabular retroversion, and femoral anteversion are postulated to lead to abnormal hip mechanics with subsequent abutment, labral tears, and the development of early arthrosis [2,3,[6][7][8][9]. Similarly, the posteromedial displacement of the epiphysis in a typical SCFE places the metaphysis in a pathologic anterolateral position [1,10].…”

Section: Introductionmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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Section: Introductionmentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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“…This may be done supine or erect, however, the importance of having a well-centered radiograph with the elimination of excessive pelvic tilt cannot be overemphasized [7,42]. The standing AP radiograph also provides an estimate of the limb length discrepancy.…”

Section: Plain Radiographsmentioning

confidence: 99%

Imaging in the Surgical Management of Developmental Dislocation of the Hip

Grissom

Harcke

Thacker

2008

Clinical Orthopaedics &Amp; Related Research

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Although the use of ultrasound in the diagnosis and early treatment of developmental dysplasia of the hip (DDH) has reduced the number of patients diagnosed late and decreased the number of operative procedures, surgical treatment is still needed in some patients. Late cases continue to occur as a result of missing the screening examination, being normal at initial screening and missing followup. Dysplasia may persist despite appropriate nonoperative or operative treatment. Many of these patients subsequently undergo closed or open reduction and femoral or acetabular reconstruction. Ultrasound of the hips is generally used up to 6 or 8 months of age, during which time the hips are largely cartilaginous, and radiographs after that time when bony development is more complete. Options to supplement ultrasound and radiography include arthrography, computed tomography, and magnetic resonance imaging. Several advances have been made in the imaging of DDH and its complications including acetabular labral pathology and of femoroacetabular impingement (FAI). We review imaging techniques other than ultrasound used in the management of DDH.

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“…A common radiographic finding related to focal acetabular overcoverage is referred to as the crossover sign (figure-of-eight) and exists when the lateral projection of the anterior wall crosses the posterior wall of the acetabular rim [11]. However, the degree of pelvic tilt and rotation changes the amount (or apparent existence) of crossover in patients, making it difficult to quantify on AP radiographs alone [9,12,17,20,22]. Moreover, the xray beam divergence in AP pelvis radiographs produces an overestimation of acetabular version by 4° [9].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, defining the anterior and posterior rims on AP radiographs can be difficult [12]. Several methods [3,17,23] have been proposed to eliminate the effect of pelvic tilt on the appearance of the crossover sign. Dandachli et al [4] showed the crossover sign has a high predictive value, although a low specificity, for depicting acetabular version when compared with 3-D CT data.…”

Section: Introductionmentioning

confidence: 99%

“…Orthopaedic surgeons currently rely on their experience and subjective observations made from radiographs, clinical evaluation, and MRI to preoperatively estimate the amount of bone to resect. Siebenrock et al [17] suggested a technique for preoperative analysis and planning that uses the ratio of the distance measured on an AP radiograph from the superolateral edge of the acetabulum to the point of crossover to the total diameter of the acetabulum. However, such measurements on plain radiographs are subject to projectional distortions and positioning variability.…”

Section: Introductionmentioning

confidence: 99%

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A Quantitative Method to Assess Focal Acetabular Overcoverage Resulting From Pincer Deformity Using CT Data

Murphy

Subhawong

Chhabra

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Current assessment techniques for focal acetabular overcoverage are neither consistent nor quantitatively accurate. Questions/purposes We propose: (1) a method to precisely quantify the amount of focal acetabular overcoverage in a patient's pincer deformity based on CT data; (2) to evaluate the consistency of this method; and (3) to compare the method with conventional radiographic assessments.Methods We developed a method to assess focal acetabular overcoverage using points selected from CT scans along the acetabular rim after realigning the pelvis into a neutral position. Using four resampled and segmented pelvic CT scans of cadaveric specimens with virtually induced impingement, two observers independently tested the algorithm's consistency. Our algorithm assessed the amount of focal acetabular overcoverage using CT data and projected data from reconstructed radiographs. Results (1) We successfully showed the feasibility of the software to produce consistent, quantitative measurements. (2) Testing showed the average difference between observers in aligning the pelvis was 0.42°, indicative of a consistent approach. (3) Differences between measurements on three-dimensional (3-D) CT and simulated radiographs were significant. Conclusions The proposed method represents a new avenue in consistently quantifying focal acetabular overcoverage using CT models while correcting for pelvic tilt and rotation. Our analysis confirms AP hip radiograph simulations overestimate the amount of overhanging acetabular rim in a pincer deformity. Clinical Relevance This technique has potential to improve preoperative diagnostic accuracy and enhance surgical planning for correction of a pincer deformity resulting from focal acetabular overcoverage.

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Effect of Pelvic Tilt on Acetabular Retroversion: A Study of Pelves From Cadavers

Cited by 590 publications

References 12 publications

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Imaging in the Surgical Management of Developmental Dislocation of the Hip

A Quantitative Method to Assess Focal Acetabular Overcoverage Resulting From Pincer Deformity Using CT Data

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