Prevalence of Focal (Superior) and Global (Central) Acetabular Retroversion in 538 Patients with Symptomatic Femoroacetabular Impingement and Hip Dysplasia

Aims The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version? Methods A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction. Results PI and PT were significantly decreased comparing AR (PI 42° (SD 10°), PT 4° (SD 5°)) with dysplastic hips (PI 55° (SD 12°), PT 10° (SD 6°)) and with the control group (PI 51° (SD 9°) and PT 13° (SD 7°)) (p < 0.001). External rotation of the iliac wing was significantly increased comparing AR (29° (SD 4°)) with dysplastic hips (20°(SD 5°)) and with the control group (25° (SD 5°)) (p < 0.001). Correlation between external rotation of the iliac wing and acetabular version was significant and strong (r = 0.81; p < 0.001). Correlation between PT and acetabular version was significant and moderate (r = 0.58; p < 0.001). Conclusion These findings could contribute to a better understanding of hip pain in a sitting position and extra-articular subspine FAI of patients with AR. These patients have increased iliac external rotation, a rotational abnormality of the iliac wing. This has implications for surgical therapy with hip arthroscopy and acetabular rim trimming or anteverting periacetabular osteotomy (PAO). Cite this article: Bone Jt Open 2021;2(10):813–824.

Download Full-text

Prevalence of Focal (Superior) and Global (Central) Acetabular Retroversion in 538 Patients with Symptomatic Femoroacetabular Impingement and Hip dysplasia

10.26226/morressier.5ee7788d8ba89b7c87c300e0 ◽

2020 ◽

Author(s):

Till Lerch ◽

Florian Schmaranzer

Keyword(s):

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Acetabular Retroversion

Download Full-text

Multifactorial pathomechanism of hip dysplasia and femoroacetabular impingement in young adults: the diamond concept

Anthropologischer Anzeiger ◽

10.1127/anthranz/2021/1434 ◽

2021 ◽

Author(s):

Jennyfer A. Mitterer ◽

Gilbert M. Schwarz ◽

Alexander Aichmair ◽

Jochen G. Hofstaetter

Keyword(s):

Young Adults ◽

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Diamond Concept

Download Full-text

The Bernese Periacetabular Osteotomy for Hip Dysplasia and Acetabular Retroversion

Techniques in Hip Arthroscopy and Joint Preservation Surgery ◽

10.1016/b978-1-4160-5642-3.00026-8 ◽

2011 ◽

pp. 214-224

Author(s):

Martin Beck ◽

Reinhold Ganz

Keyword(s):

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Acetabular Retroversion

Download Full-text

The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

Advances in Orthopedics ◽

10.1155/2020/1826952 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Gerard El-Hajj ◽

Hicham Abdel-Nour ◽

Rami Ayoubi ◽

Joseph Maalouly ◽

Fouad Jabbour ◽

...

Keyword(s):

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Posterior Wall ◽

Acetabular Retroversion ◽

Ischial Spine ◽

Acetabular Version ◽

Crossover Sign ◽

Developmental Hip Dysplasia ◽

Radiographic Sign ◽

Posterior Wall Sign

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

Download Full-text

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

The Journal of Hip Surgery ◽

10.1055/s-0038-1676307 ◽

2018 ◽

Vol 02 (04) ◽

pp. 156-166

Author(s):

Tai Holland ◽

Holly Thomas-Aitken ◽

Jessica Goetz ◽

Michael Willey

Keyword(s):

Surgical Treatment ◽

Hip Dysplasia ◽

Groin Pain ◽

Periacetabular Osteotomy ◽

Hip Pain ◽

Acetabular Retroversion ◽

Short Term ◽

Radiographic Findings ◽

Lateral Hip Pain

AbstractBorderline hip dysplasia and acetabular retroversion are common radiographic findings in young individuals with and without hip pain. Orthopaedic surgeons should be knowledgeable about the radiographic findings, diagnosis, and appropriate nonsurgical and surgical treatment of these conditions. Borderline hip dysplasia is generally defined by a lateral center edge angle of Wiberg from 20 to 25° (some define as 18–25°) and is a cause of joint microinstability. The degree of soft tissue laxity can have significant implications for joint stability in patients with borderline hip dysplasia. The most common presenting symptoms are groin pain and lateral hip pain. Acetabular retroversion is defined by radiographic findings of crossover sign, ischial spine sign, and posterior wall sign. Individuals with symptomatic retroversion have a clinical presentation consistent with impingement, groin pain with flexion activities, and less commonly lateral hip pain. Physical therapy has been shown to improve symptoms in a subset of individuals with these conditions. There are multiple recent publications about arthroscopic treatment of patients with borderline hip dysplasia. These reports generally find that good short-term outcomes can be expected when using arthroscopic techniques that include labral preservation/repair and capsular plication. There are limited reports of periacetabular osteotomy as a treatment for borderline hip dysplasia. Publications focusing specifically on surgical treatment of acetabular retroversion are also infrequent. Periacetabular osteotomy has been shown to have superior long-term clinical outcomes to surgical hip dislocation with anterior rim trimming in patients with all three radiographic findings of retroversion. Arthroscopic treatment has been shown to have good short-term outcomes. Future work in the areas of borderline hip dysplasia and acetabular retroversion should focus on reporting long-term clinical follow-up of these surgical treatments and using computation techniques as a tool to determine appropriate surgical and nonsurgical treatment for each individual patient.

Download Full-text