1450 Relationship between Spinopelvic Parameters and Symptomatic Femoroacetabular Impingment: A Scoping Review

Abstract Aim Reports have shown that spinopelvic mobility influences the outcome following total hip arthroplasty. The aim of this scoping review was to investigate the relationship between spinopelvic parameters (SPP) and symptomatic femoroacetabluar impingement (FAI). Method A systematic computer search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies that investigated the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, deviations in acetabular version, decreases in pain-free hip range of motion (ROM) on dynamic hip movements and radiological signs of FAI. Results The literature search identified 46 papers out of 1168 investigating the link between SPPs and pathological processes characteristic of FAI. Anteior pelvic tilt was associated with radiographic over-coverage parameters of FAI. Three studies associated FAI pathology with a greater pelvic incidence (PI), while four associated it with a smaller PI. In dynamic movements, decreased posterior pelvic tilt and reduced saggital pelvic ROM was found in symptomatic FAI patients during hip flexion. Conclusions Our study shows that spinopelvic parameters can influence radiological and clinical manifestations of FAI, with pelvic incidence, acetabular version and muscular imbalances being aetiologically implicated. Individual spinopelvic mobility may predispose to the development of FAI, which may be amenable to non-surgical management. If FAI pathoanatomy already exists however, sagittal pelvic parameters can influence whether FAI symptoms develop, and the extent to which they do so.

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Anatomical Variation of the Psoas Valley: A Scoping Review

10.21203/rs.3.rs-16684/v2 ◽

2020 ◽

Author(s):

Yuichi Kuroda ◽

Ankit Rai ◽

Masayoshi Saito ◽

Vikas Khanduja

Keyword(s):

Scoping Review ◽

Case Reports ◽

Anatomical Variation ◽

Case Series ◽

Anatomical Variations ◽

Anterior Wall ◽

Computer Search ◽

Retrospective Case ◽

Cross Sectional ◽

Acetabular Rim

Abstract Background: This scoping review aimed to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications. Methods: A systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded. Results: Of the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, a notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analyzed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately 3 o'clock on the acetabular rim which may have implications with labral pathology. Conclusion: This review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.

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Spine, Pelvis and Hip Kinematics—Characterizing the Axial Plane in Healthy and Osteoarthritic Hips

Applied Sciences ◽

10.3390/app11219921 ◽

2021 ◽

Vol 11 (21) ◽

pp. 9921

Author(s):

Danilo S. Catelli ◽

Brendan Cotter ◽

Mario Lamontagne ◽

George Grammatopoulos

Keyword(s):

Pelvic Tilt ◽

Hip Osteoarthritis ◽

Axial Plane ◽

Sacral Slope ◽

Healthy Individuals ◽

Spinopelvic Parameters ◽

Dynamic Motion ◽

Hip Disease ◽

Hip Kinematics ◽

Hip Flexion

Abnormal spinopelvic movements are associated with inferior outcomes following total hip arthroplasty (THA). This study aims to (1) characterize the agreement between dynamic motion and radiographic sagittal assessments of the spine, pelvis, and hip; (2) determine the effect of hip osteoarthritis (OA) on kinematics by comparing healthy individuals with pre-THA patients suffering from uni- or bilateral hip OA. Twenty-four OA patients pre-THA and eight healthy controls underwent lateral spinopelvic radiographs in standing and seated bend-and-reach (SBR) positions. Lumbar-lordosis (LL), sacral-slope (SS), and pelvic–femoral (PFA) angles were measured in both positions, and the differences (Δ) between SBR and standing were computed to assess spine flexion (SF), pelvic tilt (PT), and hip flexion (HF), respectively. Dynamic SBR and seated maximal trunk rotation (STR) tasks were performed at the biomechanics laboratory. Peak sagittal and axial kinematics for spine, pelvis, and hip, and range of motion (ROM), were calculated for SBR and STR. Radiograph readings correlated with sagittal kinematics during SBR for ΔLL and SFmax (r = 0.66, p < 0.001), ΔPT and PTmax (r = 0.44, p = 0.014), and ΔPFA and HFmax (r = 0.70, p < 0.001), with a satisfactory agreement in Bland–Altman analyses. Sagittal SBR spinal (r = 0.33, p = 0.022) and pelvic (r =0.35, p = 0.018) flexions correlated with the axial STR rotations. All axial spinopelvic parameters were different between the OA patients and controls, with the latter exhibiting significantly greater mobility and less variability. Bilaterally affected patients exhibited lower peak and ROM compared to controls. The biomechanics laboratory performed reliable assessments of spinopelvic and hip characteristics, in which the axial plane can be included. The sagittal and axial pelvic kinematics correlate, illustrating that pelvic rotation abnormalities are likely also contributing to the inferior outcomes seen in patients with abnormal spinopelvic flexion characteristics. Axial rotations of the pelvis and spine were least in patients with bilateral hip disease, further emphasizing the importance of the hip–pelvic–spine interaction.

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Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2284.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 59-65

Author(s):

Daniel N. Bracey ◽

Vishal Hegde ◽

Andrew J. Shimmin ◽

Jason M. Jennings ◽

Jim W. Pierrepont ◽

...

Keyword(s):

Ct Scan ◽

Acetabular Component ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Ct Scans ◽

Acetabular Anteversion ◽

Spinopelvic Parameters ◽

Advanced Imaging ◽

Pelvic Movement ◽

Tilt Change

Aims Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy. Methods THA patients (n = 47; 27 males, 20 females; mean age 62.9 years (SD 6.95)) with preoperative spinopelvic mobility, radiological analysis, and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on postoperative CTL radiographs and CT scans using 3D reconstructions of the pelvis. Two cohorts were identified based on a CTL-CT error of ≥ 10° (n = 11) or < 10° (n = 36). Spinopelvic mobility parameters were compared using independent-samples t-tests. Correlation between error and mobility parameters were assessed with Pearson’s coefficient. Results Patients with CTL error > 10° (10° to 14°) had stiffer lumbar spines with less mean lumbar flexion (38.9°(SD 11.6°) vs 47.4° (SD 13.1°); p = 0.030), different sagittal balance measured by pelvic incidence-lumbar lordosis mismatch (5.9° (SD 18.8°) vs -1.7° (SD 9.8°); p = 0.042), more pelvic extension when seated (pelvic tilt -9.7° (SD 14.1°) vs -2.2° (SD 13.2°); p = 0.050), and greater change in pelvic tilt between supine and seated positions (12.6° (SD 12.1°) vs 4.7° (SD 12.5°); p = 0.036). The CTL measurement error showed a positive correlation with increased CTL anteversion ( r = 0.5; p = 0.001), standing lordosis ( r = 0.23; p = 0.050), seated lordosis ( r = 0.4; p = 0.009), and pelvic tilt change between supine and step-up positions ( r = 0.34; p = 0.010). Conclusion Differences in spinopelvic mobility may explain the variability of acetabular anteversion measurements made on CTL radiographs. Patients with stiff spines and increased compensatory pelvic movement have less accurate measurements on CTL radiographs. Flexion of the contralateral hip is required to obtain clear CTL radiographs. In patients with lumbar stiffness, this movement may extend the pelvis and increase anteversion of the acetabulum on CTL views. Reliable analysis of acetabular component anteversion in this patient population may require advanced imaging with a CT scan. Cite this article: Bone Joint J 2021;103-B(7 Supple B):59–65.

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ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

Coluna/Columna ◽

10.1590/s1808-185120151403145172 ◽

2015 ◽

Vol 14 (3) ◽

pp. 205-209

Author(s):

Jefferson Coelho de Léo ◽

Álvaro Coelho de Léo ◽

Igor Machado Cardoso ◽

Charbel Jacob Júnior ◽

José Lucas Batista Júnior

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Lordosis ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Lumbar Disc ◽

Sacral Slope ◽

Spinopelvic Parameters ◽

Lateral Recess ◽

Central Disc

Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5%) had low lumbar lordosis; in this group 24 (82.8%) had central disc herniation, 4 (13.8%) had lateral recess disc herniation and 1 (3.4%) had extraforaminal disc herniation (p<0.05). Of the 61 patients, 18 (29.5%) had low sacral slope; of this group 15 (83.3%) had central disc herniation and 3 (16.7%) had disc herniation in lateral recess (p<0.05).Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

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Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

Bone & Joint Open ◽

10.1302/2633-1462.210.bjo-2021-0069.r1 ◽

2021 ◽

Vol 2 (10) ◽

pp. 813-824

Author(s):

Till Dominic Lerch ◽

Adam Boschung ◽

Florian Schmaranzer ◽

Inga A. S. Todorski ◽

Jan Vanlommel ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Sagittal Balance ◽

Hip Dysplasia ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

External Rotation ◽

Acetabular Retroversion ◽

Control Group ◽

Acetabular Version ◽

Iliac Wing

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.

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IMPACT OF THE MIS-TLIF TECHNIQUE ON THE SPINOPELVIC PARAMETERS OF PATIENTS WITH LUMBAR ARTHRODESIS

Coluna/Columna ◽

10.1590/s1808-185120191801188450 ◽

2019 ◽

Vol 18 (1) ◽

pp. 47-50

Author(s):

Cristiano Magalhães Menezes ◽

Leonardo Fernandes Aguiar ◽

André de Oliveira Arruda ◽

Rodrigo Vieira Cardoso ◽

Germano Senna Oliveira do Valle ◽

...

Keyword(s):

Lumbar Lordosis ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Mean Value ◽

Radiographic Evaluation ◽

Spinopelvic Parameters ◽

Level Of Evidence ◽

Lumbar Arthrodesis ◽

Retrospective Comparative Study ◽

Segmental Lordosis

ABSTRACT Objective: To evaluate the influence of the MIS-TLIF technique on the spinopelvic parameters of patients submitted to lumbar arthrodesis up to three levels for the treatment of vertebral degenerative conditions without deformity. Methods: Retrospective radiographic evaluation of 52 patients submitted to the surgical treatment of lumbar arthrodesis using the MIS-TLIF technique in up to three levels. The spinopelvic parameters – pelvic incidence (PI), pelvic tilt(PT), lumbar lordosis (LL), segmental lordosis (Lseg), and the difference between lumbar lordosis and pelvic incidence (LL-PI mismatch) were analyzed in orthostatic lateral radiographs in the pre- and postoperative periods, with a minimum follow-up of 1 year. The patients were divided into three groups: PI <45°, PI between 45° and 55° and PI >55°. Results: Sixty-nine operated levels were evaluated in 15 patients with PI <45°, 19 with PI between 45° and 55° and 18 with PI >55°. The mean value of the pelvic incidence was 52.3° (± 11.5), lumbar lordosis 46.1° (pre)/45.6° (post); segmental lordosis 20.3° (pre)/20.6° (post); pelvic tilt 18.5° (pre)/18.2° (post); “mismatch” (PI-LL) 7° (pre)/ 6.6° (post), with no statistical difference among all parameters (p>0.05). Conclusions: The MIS-TLIF technique had no influence on postoperative spinopelvic parameters of patients undergoing lumbar arthrodesis surgery. Level of evidence: III. Retrospective comparative study.

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Correlation of tilt of the anterior pelvic plane angle with anatomical pelvic tilt and morphological configuration of the acetabulum in patients with developmental dysplasia of the hip: a cross-sectional study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1382-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Norio Imai ◽

Hayato Suzuki ◽

Asami Nozaki ◽

Yuki Hirano ◽

Naoto Endo

Keyword(s):

Pelvic Tilt ◽

Pelvic Incidence ◽

Developmental Dysplasia ◽

Morphological Parameters ◽

Plane Angle ◽

Acetabular Anteversion ◽

Anterior Pelvic Plane ◽

Functional Parameters ◽

Pelvic Parameters ◽

Dysplasia Of The Hip

Abstract Background It was previously reported that pelvises with developmental dysplasia of the hip are tilted anteriorly, which increases bony coverage of the femoral head. This study aimed to investigate the correlation between anatomical parameters of the pelvis such as pelvic incidence and anatomical pelvic tilt and functional parameters of the spine and pelvis such as tilt of the anterior pelvic plane. Methods We examined 84 female patients with bilateral developmental dysplasia of the hip who had undergone curved periacetabular osteotomy at author’s institution. Radiographs of the thoracic to lumbar spines and the pelvis were obtained in the standing position to measure spino-pelvic parameters before surgery. Morphological parameters of the acetabulum such as the anterior center-edge (CE) angle, posterior CE angle, lateral CE angle, and acetabular anteversion were measured using a preoperative three-dimensional pelvic model reconstructed from computed tomography images. Pearson’s correlation analysis was conducted to evaluate the relationship of these parameters. Results With regard to correlations between pelvic incidence (PI) and other parameters, the sacral slope (SS) value (r = 0.666) was the highest among functional parameters and the anatomical-SS value (r = 0.789) was the highest among morphological parameters. There were moderate correlations of the anterior pelvic plane angle (APPA) with pelvic tilt (PT) (r = − 0.594) and anatomical-PT (r = 0.646). With regard to correlations between spino-pelvic parameters and bony morphological parameters of the acetabulum, there was a moderate correlation between anatomical-PT and acetabular anteversion (AA) (r = 0.424). There were moderate correlations of APPA with the anterior CE angle (r = − 0.478), posterior CE angle (r = 0.432), and AA (r = 0.565). APPA had a stronger correlation with anatomical-PT (r = 0.646) than with AA. Conclusions The tilt of the pelvis may be more dependent on anatomical-PT, a morphological parameter of the pelvis, than the lateral CE angle, anterior CE angle, posterior CE angle, and acetabular anteversion on bony coverage of the acetabulum. This study is the first to investigate the correlation between functional parameters of the pelvis and spine and morphological parameters of the pelvis and acetabulum besides PI.

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RADIOGRAPHIC ANALYSIS OF THE RESULTS OF ANTERIOR INTERNODY ARTHRODESIS ON THE SAGITTAL LUMBOPELVIC PARAMETERS

Coluna/Columna ◽

10.1590/s1808-185120201902224026 ◽

2020 ◽

Vol 19 (2) ◽

pp. 104-107

Author(s):

FELIPE DE NEGREIROS NANNI ◽

EMILIANO NEVES VIALLE ◽

MARVIN DURANTE BRUNET

Keyword(s):

Lumbar Lordosis ◽

Interbody Fusion ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Degenerative Spondylolisthesis ◽

Anterior Lumbar Interbody Fusion ◽

Sacral Slope ◽

Lumbar Interbody Fusion ◽

Pelvic Parameters ◽

Segmental Lordosis

ABSTRACT Objective The objective of this study is to analyze the radiographs of patients who underwent anterior lumbar interbody fusion (ALIF), to compare the values of the lumbopelvic measurements, and to quantify improvements in these parameters achieved through this technique. Methods The radiographs of 42 patients, all submitted to ALIF with a 12° interbody device, were evaluated from a database at a single center. The pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, segmental lordosis, and regional lordosis angles of each patient were measured in pre- and postoperative radiographs. Results We observed a discreet change in the pelvic parameters and a marked increase in regional lordosis with a mean increase of 5.8° (p>0.001). Segmental lordosis also showed a mean increase of 2.43°. The gain in segmental lordosis was even higher in patients with degenerative spondylolisthesis and when the operated level was L5-S1. Conclusions The ALIF technique in the lumbar spine is capable of significantly increase the lordosis of a segment, whether at one or two levels. Greater improvement in the lumbopelvic parameters was observed it the procedures performed in level L5-S1 and in cases that presented spondylolisthesis.

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Factors Predicting the Surgical Risk of Osteoporotic Vertebral Compression Fractures

Journal of Clinical Medicine ◽

10.3390/jcm8040501 ◽

2019 ◽

Vol 8 (4) ◽

pp. 501

Author(s):

Fu-Cheng Kao ◽

Yu-Jui Huang ◽

Ping-Yeh Chiu ◽

Ming-Kai Hsieh ◽

Tsung-Ting Tsai

Keyword(s):

Conservative Treatment ◽

Pelvic Tilt ◽

Pelvic Incidence ◽

Surgical Intervention ◽

Clinical Symptoms ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Spinopelvic Parameters ◽

Compression Fractures

The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < −2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.

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Anatomical Variation of the Psoas Valley: A Scoping Review

10.21203/rs.3.rs-16684/v1 ◽

2020 ◽

Author(s):

Yuichi Kuroda ◽

Ankit Rai ◽

Masayoshi Saito ◽

Vikas Khanduja

Keyword(s):

Scoping Review ◽

Case Reports ◽

Anatomical Variation ◽

Case Series ◽

Anatomical Variations ◽

Anterior Wall ◽

Computer Search ◽

Retrospective Case ◽

Cross Sectional ◽

Acetabular Rim

Abstract Background: The aim of this scoping review was to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications. Methods: A systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded. Results: Of the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analysed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately the 3 o'clock on the acetabular rim which may have implications with labral pathology. Conclusion: This review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.

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