Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

Ito, Hiroshi; Matsuno, Takeo; Hirayama, Teruhisa; Tanino, Hiromasa; Yamanaka, Yasuhiro; Minami, Akio

doi:10.1007/s00256-008-0601-x

Cited by 72 publications

(60 citation statements)

References 34 publications

(85 reference statements)

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“…These relatively small changes in the opening plane abduction and roof angles of dysplastic acetabuli indicate how sensitive femoral head coverage and stability are to changes in the superior acetabulum. We found that females with nondypslastic acetabuli were 4°more anteverted than males, similar to findings by Anda et al (3°) [2] and Tallroth and Lepistö (5°) [63]; most other studies did not specify anteversion by sex [4,27,29,30]. Acetabular anteversion for both sexes was no different with dysplastic and nondysplastic acetabuli [3,4,13,29,33,46,48,51,56].…”

Section: Discussionsupporting

confidence: 79%

“…The opening plane abduction angle, analogous to the hip abduction angle [35] but adjusted for the acetabular anteversion, was only mildly increased in dysplastic female acetabuli, reflecting the findings of others [46,51]; there was no difference measured for males in our study. In our results, the roof angle was 11°less horizontal in the dysplastic female hips and 6°l ess in males, a finding similar to that of Ito et al [27]. These relatively small changes in the opening plane abduction and roof angles of dysplastic acetabuli indicate how sensitive femoral head coverage and stability are to changes in the superior acetabulum.…”

Section: Discussionsupporting

confidence: 77%

“…Many authors have emphasized the benefits of 3-D CT in preoperative planning of reconstructive procedures for hip dysplasia [8,15,18,22,32,35,39,57]; however, controversies remain regarding how dysplastic and typical acetabuli differ in orientation and shape [5,22,27,46,51,54]. In our investigation, nondysplastic and developmentally dysplastic hips were studied using 3-D CT scans, creating a virtual mold or ''fill'' of the acetabuli.…”

Section: Introductionmentioning

confidence: 99%

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How Are Dysplastic Hips Different? A Three-dimensional CT Study

Bosse

Wedge

Babyn

2015

Clinical Orthopaedics &Amp; Related Research

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Background Surgical correction of acetabular dysplasia can postpone or prevent joint degeneration. The specific abnormalities that make up the dysplastic hip are controversial. Questions/purposes (1) What are the relative size, shape, and orientations of the typical nondysplastic hip? (2) How do these variables differ in the developmentally dysplastic hip? (3) Are there version differences between the acetabuli of dysplastic and nondysplastic hips? (4) Are there pairs of variables in which the change in one is always accompanied by a change in the other for both nondysplastic and dysplastic acetabuli? Methods Of 117 consecutive three-dimensional (3-D) CT scans performed for hip dysplasia between March 1988 and October 1995, 48 met criteria of developmentally dysplastic hips by plain radiography. These were retrospectively compared with 55 pelvic 3-D CT scans culled from 81 consecutive scans performed for reasons other than hip dysplasia (ie, hip pain, trauma, infection) that did not affect the hip or pelvic landmarks. The 3-D reconstructions were orientated anatomically for standardization of the measurements to be compared. Representative 3-D volumes of the acetabular space were constructed from which we could measure anatomic positions and dimensional information. One author performed all image orientation and measurements. Results Nondysplastic acetabuli are essentially hemispheric with height equal to width and twice the depth. The dysplastic acetabuli were elongated in females (52.4 ± 6.2 mm for dysplastic versus 46.5 ± 4.6 mm for nondysplastic (mean difference, 5.0; 95% confidence interval [CI], 1.9-8.0; p = 0.002) and shallower in both females (18.7 ± 4.9 mm for dysplastic versus 23.6 ± 4.0 mm for nondysplastic; mean difference, 6.5; 95% CI, 4.4-8.5; p \ 0.0001) and males (21.1 ± 4.8 mm for dysplastic versus 25.0 ± 4.3 mm for nondysplastic, mean difference, 5.3; 95% CI, 2.6-8.1; p = 0.0002); width was similar to that of nondysplastic hips. Acetabular openings were slightly more vertical than nondysplastic hips in females (5°; 95% CI, 1.9-8.1; p = 0.002) but not in male subjects. The dysplastic acetabuli were smaller in volume (18% in females, p = 0.002, and 19% in males, p = 0.0012) and had less space occupied by the femoral head compared with nondysplastic hips (p \ 0

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How Are Dysplastic Hips Different? A Three-dimensional CT Study

Bosse

Wedge

Babyn

2015

Clinical Orthopaedics &Amp; Related Research

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“…3). The values of the anterior and posterior ASA were used to classify the patients with DDH into four groups: anterior deficiency (anterior ASA \ 50°and posterior ASA C 90°), posterior deficiency (anterior ASA C 50°and posterior ASA \ 90°), global deficiency (anterior ASA \ 50°and posterior ASA \ 90°) and mild deficiency (anterior ASA C 50°and posterior ASA C 90°) [3,14]. Using this criteria, 57.3% (47 hips) were diagnosed with anterior deficiency, 11% (nine hips) with posterior deficiency, 28% (23 hips) with global deficiency, and 3.7% (three hips) with mild deficiency.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, this knowledge could be useful when considering the corrective maneuver to optimize the acetabular position during periacetabular osteotomy (PAO), such as those proposed by Ganz et al [10]. Previous studies using CT revealed a substantial amount of individual variety of acetabular version, deficiency type, and degree of acetabular dysplasia [14,25]. Thus, it is important to evaluate acetabular deformity three-dimensionally, and customize the correction in accordance with variations in the quantity and location of acetabular deficiencies [34].…”

Section: Introductionmentioning

confidence: 99%

Pelvic Deformity Influences Acetabular Version and Coverage in Hip Dysplasia

Fujii

Nakashima

Sato

et al. 2011

Clinical Orthopaedics &Amp; Related Research

103

118

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Background Although a wide variety of acetabular deformities in developmental dysplasia of the hip (DDH) have been reported, the morphologic features of the entire pelvis in DDH are not well characterized and their correlation with acetabular deformity is unknown. Questions/purposes We determined whether there was a rotational deformity of the entire innominate bone, and if so, whether it related to acetabular version and coverage. Patients and Methods We examined the morphologic features of the pelvis using CT for 50 patients with DDH (82 hips). Forty normal hips were used as controls. The innominate rotation angle was determined at three levels in the axial plane. The acetabular sector angle served as an indicator of acetabular coverage of the femoral head. We evaluated the association between innominate rotation angles and acetabular version and coverage. Results We observed greater internal rotation of the innominate bone in patients with DDH than in the control subjects. Internal rotation of the innominate bone was associated with increased acetabular anteversion angle and acetabular inclination angle. In hips with acetabular retroversion (nine of 82 hips; 11.0 %), the entire innominate bone was externally rotated, compared with hips with acetabular anteversion. Internal rotation of the innominate bone also was associated with decreased anterior and superior acetabular coverage. Conclusion Our observations suggest structural abnormalities exist throughout the pelvis in DDH, and the morphologic abnormalities of the acetabulum are not caused solely by local dysplasia around the hip, but are influenced by the morphologic features of the entire pelvis.

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Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion

Wassilew

Heller

Diederichs

et al. 2012

Journal Orthopaedic Research

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Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two-dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the cross-over sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion. COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT-based method using three-dimensional (3D) models was developed to measure the COS, PWS, true acetabular version, and pelvic tilt relative to the anterior pelvic plane. The new CT-based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging. A low level of agreement for COS and PWS was found between radiographs and CT scans. A positive COS strongly correlated with pelvic tilt. These results suggest that COS and PWS determined from anteroposterior radiographs are considerably limited by pelvic tilt and inherent limitations of radiographs. Their use as the sole basis for deciding whether or not surgical intervention is indicated seems questionable. Keywords: hip; femoroacetabular impingement; cross-over sign; posterior wall sign; three-dimensional analysis Femoroacetabular impingement (FAI) has been shown to be one of the primary risk factors predisposing to the early development of osteoarthritis (OA) of the hip.1 Therefore, reliable and accurate diagnosis of the anatomical features resulting in FAI is critical to initiate timely and effective treatment in early disease. There are two main forms of FAI: cam impingement, which is characterized by a reduced femoral neck/head offset, and pincer impingement, a condition in which the osseous pathologies occur mainly on the acetabular side.2 Pincer type FAI can be caused by acetabular retroversion resulting from excessive anterior coverage of the femoral head or a deficient posterior acetabular rim.3 These anatomical deformities of the anterior and posterior acetabular wall can occur in isolation or in combination, but both of these osseous pathologies influence the resulting version of the acetabulum. Reduced anteversion results in the acetabulum acting as an obstacle to joint motion at high degrees of flexion and internal rotation, predisposing to impingement and leading, over time, to lesions of the anterior labrum and adjacent cartilage.2,4 Since the identification of acetabular retroversion has important therapeutic consequences for the preservation of the natural joint, 5-7 the reliability with which acetabular anteversion can be diagnosed is critical for the clinical decision process and the success of surgical intervention. 89Numerous methods for identifying acetabular anteversion have been described, but its diagnosis in clinical practice often exclusively relies on anteroposterior (AP) radiographs of the pelvis and measurement of anteversion in two-dimensional axial computed t...

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Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

Cited by 72 publications

References 34 publications

How Are Dysplastic Hips Different? A Three-dimensional CT Study

How Are Dysplastic Hips Different? A Three-dimensional CT Study

Pelvic Deformity Influences Acetabular Version and Coverage in Hip Dysplasia

Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion

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