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Erschienen in: Clinical Orthopaedics and Related Research® 4/2017

09.11.2016 | Symposium: 2016 Bernese Hip Symposium

Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia

verfasst von: Jeffrey J. Nepple, MD, Joel Wells, MD, MPH, James R. Ross, MD, Asheesh Bedi, MD, Perry L. Schoenecker, MD, John C. Clohisy, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 4/2017

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Abstract

Background

Detailed recognition of the three-dimensional (3-D) deformity in acetabular dysplasia is important to help guide correction at the time of reorientation during periacetabular osteotomy (PAO). Common plain radiographic parameters of acetabular dysplasia are limited in their ability to characterize acetabular deficiency precisely. The 3-D characterization of such deficiencies with low-dose CT may allow for more precise characterization.

Questions/purposes

The purposes of this study were (1) to determine the variability in 3-D acetabular deficiency in acetabular dysplasia; (2) to define subtypes of acetabular dysplasia based on 3-D morphology; (3) to determine the correlation of plain radiographic parameters with 3-D morphology; and (4) to determine the association of acetabular dysplasia subtype with patient clinical characteristics including sex, range of motion, and femoral version.

Methods

Using our hip preservation database, we identified 153 hips (148 patients) that underwent PAO from October 2013 to July 2015. Among those, we noted 103 hips in 100 patients with acetabular dysplasia (lateral center-edge angle < 20°) and who had a Tönnis grade of 0 or 1. Eighty-six patients (86%) underwent preoperative low-dose pelvic CT scans at our institution as part of the preoperative planning for PAO. It is currently our standard to obtain preoperative low-dose pelvic CT scans (0.75–1.25 mSv, equivalent to three to five AP pelvis radiographs) on all patients before undergoing PAO unless a prior CT scan was performed at an outside institution. Hips with a history of a neuromuscular disorder, prior trauma, prior surgery, radiographic evidence of joint degeneration, ischemic necrosis, or Perthes-like deformities were excluded. Fifty hips in 50 patients met inclusion criteria and had CT scans available for review. These low-dose CT scans of 50 patients with symptomatic acetabular dysplasia undergoing evaluation for surgical planning of PAO were then retrospectively studied. CT scans were analyzed quantitatively for acetabular coverage, relative to established normative data for acetabular coverage, as well as measurement of femoral version. The cohort included 45 females and five males with a mean age of 26 years (range, 13–49 years).

Results

Lateral acetabular deficiency was present in all patients, whereas anterior deficiency and posterior deficiency were variable. Three patterns of acetabular deficiency were common: anterosuperior deficiency (15 of 50 [30%]), global deficiency (18 of 50 [36%]), and posterosuperior deficiency (17 of 50 [34%]). The presence of a crossover sign or posterior wall sign was poorly predictive of the dysplasia subtype. With the numbers available, males appeared more likely to have a posterosuperior deficiency pattern (four of five [80%]) compared with females (13 of 45 [29%], p = 0.040). Hip internal rotation in flexion was significantly greater in anterosuperior deficiency (23° versus 18°, p = 0.05), whereas external rotation in flexion was significantly greater in posterosuperior deficiency (43° versus 34°, p = 0.018). Acetabular deficiency pattern did not correlate with femoral version, which was variable across all subtypes.

Conclusions

Three patterns of acetabular deficiency commonly occur among young adult patients with mild, moderate, and severe acetabular dysplasia. These patterns include anterosuperior, global, and posterosuperior deficiency and are variably observed independent of femoral version. Recognition of these distinct morphologic subtypes is important for diagnostic and surgical treatment considerations in patients with acetabular dysplasia to optimize acetabular correction and avoid femoroacetabular impingement.
Literatur
1.
Zurück zum Zitat Akiyama M, Nakashima Y, Fujii M, Sato T, Yamamoto T, Mawatari T, Motomura G, Matsuda S, Iwamoto Y. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study. Skeletal Radiol. 2012;41:1411–1418.CrossRefPubMed Akiyama M, Nakashima Y, Fujii M, Sato T, Yamamoto T, Mawatari T, Motomura G, Matsuda S, Iwamoto Y. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study. Skeletal Radiol. 2012;41:1411–1418.CrossRefPubMed
2.
Zurück zum Zitat Anda S, Terjesen T, Kvistad KA, Svenningsen S. Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr. 1991;15:115–120.CrossRefPubMed Anda S, Terjesen T, Kvistad KA, Svenningsen S. Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr. 1991;15:115–120.CrossRefPubMed
3.
Zurück zum Zitat Argenson J-NA, Flecher X, Parratte S, Aubaniac J-M. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res. 2007;465:40–45. Argenson J-NA, Flecher X, Parratte S, Aubaniac J-M. Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res. 2007;465:40–45.
4.
Zurück zum Zitat Clohisy JC, Carlisle JC, Beaulé PE, Kim Y-J, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47–66.CrossRefPubMedPubMedCentral Clohisy JC, Carlisle JC, Beaulé PE, Kim Y-J, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47–66.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br. 2008;90:1428–1434.CrossRefPubMed Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br. 2008;90:1428–1434.CrossRefPubMed
6.
Zurück zum Zitat Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.PubMed Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379.PubMed
7.
Zurück zum Zitat Haddad FS, Garbuz DS, Duncan CP, Janzen DL, Munk PL. CT evaluation of periacetabular osteotomies. J Bone Joint Surg Br. 2000;82:526–531.CrossRefPubMed Haddad FS, Garbuz DS, Duncan CP, Janzen DL, Munk PL. CT evaluation of periacetabular osteotomies. J Bone Joint Surg Br. 2000;82:526–531.CrossRefPubMed
8.
Zurück zum Zitat Janzen DL, Aippersbach SE, Munk PL, Sallomi DF, Garbuz D, Werier J, Duncan CP. Three-dimensional CT measurement of adult acetabular dysplasia: technique, preliminary results in normal subjects, and potential applications. Skeletal Radiol. 1998;27:352–358.CrossRefPubMed Janzen DL, Aippersbach SE, Munk PL, Sallomi DF, Garbuz D, Werier J, Duncan CP. Three-dimensional CT measurement of adult acetabular dysplasia: technique, preliminary results in normal subjects, and potential applications. Skeletal Radiol. 1998;27:352–358.CrossRefPubMed
9.
Zurück zum Zitat Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.PubMed Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.PubMed
10.
Zurück zum Zitat Larson CM, Moreau-Gaudry A, Kelly BT, Byrd JWT, Tonetti J, Lavallee S, Chabanas L, Barrier G, Bedi A. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res. 2015;473:1247–1254.CrossRefPubMed Larson CM, Moreau-Gaudry A, Kelly BT, Byrd JWT, Tonetti J, Lavallee S, Chabanas L, Barrier G, Bedi A. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res. 2015;473:1247–1254.CrossRefPubMed
11.
Zurück zum Zitat Lee WA, Saroki AJ, Loken S, Trindade CAC, Cram TR, Schindler BR, LaPrade RF, Philippon MJ. Radiographic identification of arthroscopically relevant acetabular structures. Am J Sports Med. 2016;44:67–73.CrossRefPubMed Lee WA, Saroki AJ, Loken S, Trindade CAC, Cram TR, Schindler BR, LaPrade RF, Philippon MJ. Radiographic identification of arthroscopically relevant acetabular structures. Am J Sports Med. 2016;44:67–73.CrossRefPubMed
12.
Zurück zum Zitat Li PLS, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–253.CrossRef Li PLS, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003;416:245–253.CrossRef
13.
Zurück zum Zitat Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.CrossRefPubMed Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.CrossRefPubMed
14.
Zurück zum Zitat Nepple JJ, Martel JM, Kim Y-J, Zaltz I, Clohisy JC; ANCHOR Study Group. Do plain radiographs correlate with CT for imaging of cam-type femoroacetabular impingement? Clin Orthop Relat Res. 2012;470:3313–3320.CrossRefPubMedPubMedCentral Nepple JJ, Martel JM, Kim Y-J, Zaltz I, Clohisy JC; ANCHOR Study Group. Do plain radiographs correlate with CT for imaging of cam-type femoroacetabular impingement? Clin Orthop Relat Res. 2012;470:3313–3320.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, Paravic V. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res. 2003;417:27–40. Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, Paravic V. Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res. 2003;417:27–40.
16.
Zurück zum Zitat Ross J, Nepple J, Philippon M, Kelly B, Larson C, Bedi A. The influence of pelvic tilt on common acetabular parameters and range of motion in patients with femoroacetabular impingement (FAI). Arthroscopy. 2013;29:e203.CrossRef Ross J, Nepple J, Philippon M, Kelly B, Larson C, Bedi A. The influence of pelvic tilt on common acetabular parameters and range of motion in patients with femoroacetabular impingement (FAI). Arthroscopy. 2013;29:e203.CrossRef
17.
Zurück zum Zitat Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. Am J Sports Med. 2014;42:2402–2409.CrossRefPubMed Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. Am J Sports Med. 2014;42:2402–2409.CrossRefPubMed
18.
Zurück zum Zitat Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA. What are the radiographic reference values for acetabular under- and overcoverage? Clin Orthop Relat Res. 2014;473:1234–1246.CrossRefPubMedCentral Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA. What are the radiographic reference values for acetabular under- and overcoverage? Clin Orthop Relat Res. 2014;473:1234–1246.CrossRefPubMedCentral
19.
20.
Zurück zum Zitat Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res. 1987;225:62–76. Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res. 1987;225:62–76.
21.
Zurück zum Zitat Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. 2013;471:2463–2470.CrossRefPubMed Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. 2013;471:2463–2470.CrossRefPubMed
Metadaten
Titel
Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia
verfasst von
Jeffrey J. Nepple, MD
Joel Wells, MD, MPH
James R. Ross, MD
Asheesh Bedi, MD
Perry L. Schoenecker, MD
John C. Clohisy, MD
Publikationsdatum
09.11.2016
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 4/2017
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-016-5150-3

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