Correlation between radiographic measures of acetabular morphology with 3D femoral head coverage in patients with acetabular retroversion

Background: Diagnosis and surgical treatment of hips with different types of pincer femoroacetabular impingement (FAI), such as protrusio acetabuli and acetabular retroversion, remain controversial because actual 3-dimensional (3D) acetabular coverage and location of impingement cannot be studied via standard 2-dimensional imaging. It remains unclear whether pincer hips exhibit intra- or extra-articular FAI. Purpose: (1) To determine the 3D femoral head coverage in these subgroups of pincer FAI, (2) determine the impingement-free range of motion (ROM) through use of osseous models based on 3D-computed tomography (CT) scans, and (3) determine the osseous intra-and extra-articular 3D impingement zones by use of 3D impingement simulation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This is a retrospective, comparative, controlled study involving 70 hips in 50 patients. There were 24 patients (44 hips) with symptomatic pincer-type or mixed-type FAI and 26 patients (26 hips) with normal hips. Surface models based on 3D-CT scans were reconstructed and compared for hips with acetabular retroversion (30 hips), hips with protrusio acetabuli (14 hips), and normal asymptomatic hips (26 hips). Impingement-free ROM and location of impingement were determined for all hips through use of validated 3D collision detection software based on CT-based 3D models. No abnormal morphologic features of the anterior iliac inferior spine were detected. Results: (1) Mean total femoral head coverage was significantly ( P < .001) increased in hips with protrusio acetabuli (92% ± 7%) and acetabular retroversion (71% ± 5%) compared with normal hips (66% ± 6%). (2) Mean flexion was significantly ( P < .001) decreased in hips with protrusio acetabuli (104°± 9°) and acetabular retroversion (116°± 6°) compared with normal hips (125°± 13°). Mean internal rotation in 90° of flexion was significantly ( P < .001) decreased in hips with protrusio acetabuli (16°± 12°) compared with normal hips (35°± 13°). (3) The prevalence of extra-articular subspine impingement was significantly ( P < .001) higher in hips with acetabular retroversion (87%) compared with hips with protrusio acetabuli (14%) and normal hips (0%) and was combined with intra-articular impingement. The location of anterior impingement differed significantly ( P < .001) between hips with protrusio acetabuli and normal hips. Conclusion: Using CT-based 3D hip models, we found that hips with pincer-type and mixed-type FAI have significantly larger femoral head coverage and different osseous ROM and location of impingement compared with normal hips. Additionally, intra- and extra-articular subspine impingement was detected predominantly in hips with acetabular retroversion. Acetabular rim trimming during hip arthroscopy or open surgical hip dislocation should be performed with caution for these hips. Patient-specific analysis of location of impingement using 3D-CT could theoretically improve diagnosis and planning of surgical treatment.

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The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

Hip International ◽

10.1177/11207000211013029 ◽

2021 ◽

pp. 112070002110130

Author(s):

Leigh-Anne Tu ◽

Douglas S Weinberg ◽

Raymond W Liu

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Hip Osteoarthritis ◽

Volume Ratio ◽

Femoral Head Coverage ◽

Neck Shaft Angle ◽

Hip Arthritis ◽

Femoral Version ◽

Shaft Angle ◽

The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

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LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00213 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0021

Author(s):

Clarabelle DeVries ◽

Jeffrey J Nepple ◽

Lucas Fowler ◽

Sean Akers ◽

Gail Pashos ◽

...

Keyword(s):

Femoral Head ◽

Normative Data ◽

Low Dose ◽

Periacetabular Osteotomy ◽

Femoral Head Coverage ◽

Edge Angle ◽

Center Edge ◽

Two Sectors ◽

Posterior Sector ◽

Center Edge Angle

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

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Comparison of four parameters to assess acetabular dysplasia and acetabular dysplasia rates in primary hip osteoarthritis patients: A study in Turkish population

Journal of Orthopaedic Surgery ◽

10.1177/2309499018768032 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901876803 ◽

Cited By ~ 1

Author(s):

Oktay Adanir ◽

Gazi Zorer

Keyword(s):

Femoral Head ◽

Acetabular Dysplasia ◽

Hip Prosthesis ◽

Hip Osteoarthritis ◽

High Rate ◽

Femoral Head Coverage ◽

Coverage Ratio ◽

Total Hip ◽

Center Edge ◽

Age At Surgery

Introduction: Hip osteoarthritis is an important orthopedic problem frequently observed in the elderly. Acetabular dysplasia (AD) is one of the pathologies that cause coxarthrosis. Nearly 20–45% of primary or idiopathic hip osteoarthritis is linked to AD. In our country, there are few studies on this topic. We measured the center–edge (CE) angle, Sharp’s angle, acetabular depth, and femoral head coverage ratio on pelvis anteroposterior radiographs of patients with primary coxarthrosis and calculated the dysplasia rates. Patients and method: Age at surgery and sex of the patients; and CE angle, Sharp’s angle, acetabular depth, and femoral head coverage ratio for both operated and opposite hips were evaluated in 223 total hip prosthesis–performed patients with coxarthrosis. Also the distribution of mean age at surgery, sex of patients, dysplasia rates of operated hips, and bilateral dysplasia rates were calculated. Results: The right to left ratio of operated hips was 104/119. Female to male ratio was 163/60 (2.7/1), for those with CE angle below 20° it was 123/30 (4.1/1), and it was 40/30 (1.3/1) with CE angle above 20°. Mean age of patients at surgery was 56.9 (±11.4) years. CE angle less than 20° was found in 68.6% of patients, acetabulum depth less than 9 mm was found in 75.3%, Sharp’s angle was more than 45° in 65.9%, and femoral head coverage ratio was less than 70% in 70.3% of patients. Conclusions: We identified a high rate of AD in primary coxarthrosis patients undergoing total hip arthroplasty in the study population.

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Correlation between ultrasonic and radiographic imaging of developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.180165 ◽

2019 ◽

Vol 13 (2) ◽

pp. 155-160 ◽

Cited By ~ 2

Author(s):

A. J. Spaans ◽

F. J. A. Beek ◽

C. S. P. M. Uiterwaal ◽

J. E. H. Pruijs ◽

R. J. Sakkers

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Acetabular Index ◽

Ultrasound Images ◽

Radiographic Imaging ◽

Femoral Head Coverage ◽

Level Of Evidence ◽

Developmental Hip Dysplasia ◽

Α Angle

Purpose The correlation between the degree of developmental hip dysplasia (DDH) measured on ultrasound images compared with that measured on radiographs is not clear. Most studies have compared ultrasonography (US) and radiographic images made at different times of follow-up. In this study the correlation between US images and radiographs of the hip made on the same day was evaluated. Methods US images and radiographs of both hips of 74 infants, who were treated for stable DDH, were reviewed in a retrospective study. Only infants who had an US examination and a radiograph on the same day were included. Results The correlation between α-angle of Graf and femoral head coverage on US was strong (p ≤ 0.0001). Weak correlations were found between the acetabular index of Tönnis on radiographs and α-angle of Graf on US (p = 0.049) and between acetabular index of Tönnis on radiographs and femoral head coverage of Morin on US (p = 0.100). Conclusion This study reports on the correlation between US and radiographic imaging outcomes, both made on the same day in patients for treatment and follow-up of DDH. Level of Evidence IV

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Canine hip dysplasia radiographic screening. Prevalence of rotation of the pelvis along its length axis in 7,012 conventional hip extended radiographs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1160/vcot-07-01-0007 ◽

2007 ◽

Vol 20 (04) ◽

pp. 296-298 ◽

Cited By ~ 6

Author(s):

T. Cachon ◽

D. Fau ◽

C. Carozzo ◽

E. Viguier ◽

F. Collard ◽

...

Keyword(s):

Femoral Head ◽

Hip Dysplasia ◽

Femoral Head Coverage ◽

Left Hand ◽

Radiographic Screening ◽

Pelvis Rotation ◽

The Right ◽

Canine Hip Dysplasia

SummaryThe prevalence of rotation of the pelvis along its length axis was noted, as was the number of rotations towards the right or left hand side of the dog, on 7,012 conventional hip extended radiographs, which were sent for official screening. 29.8% of the radiographs showed a rotation the pelvis. The rotation was statistically more frequent towards the left hand side of the dog. The number of rejected radiographs for too important pelvis rotation was only 5.2%. The consequences of the pelvis rotation on the Norberg-Olsson angle, on the dorsal femoral head coverage, and in the aspect of cranial acetabular edge have to be taken into account when scoring the dog for hip dysplasia.

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The acetabulum in healed Legg–Calvé–Perthes disease is cranially retroverted and associated with global reduction of femoral head coverage: a matched-cohort study

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa003 ◽

2020 ◽

Vol 7 (1) ◽

pp. 49-56

Author(s):

Daniel A Maranho ◽

Mariana Ferrer ◽

Leslie A Kalish ◽

Whitney Hovater ◽

Eduardo N Novais

Keyword(s):

Femoral Head ◽

Ct Scan ◽

Skeletal Maturity ◽

Perthes Disease ◽

Width Ratio ◽

Acetabular Version ◽

Center Edge ◽

Acetabular Morphology ◽

Hip Disease ◽

Ct Evaluation

Abstract To evaluate the acetabular morphology in healed Legg–Calvé–Perthes disease after skeletal maturity using computed tomography (CT) scan and to compare with matched controls. We identified 33 (37 hips) patients with healed Legg–Calvé–Perthes disease and closed triradiate cartilage who underwent pelvic CT scan. Each patient was matched based on sex, age and side to a subject with no history of hip disease who had undergone pelvic CT evaluation because of abdominal pain. Both cohorts had 23 (70%) males and mean age of 16.4–16.5 ± 3.6 years. Two independent readers assessed lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version 10 mm below the dome (cranial) and at the acetabular center and anterior (AASA) and posterior acetabular sector angles (PASA). All measurements had good to excellent interobserver agreement (intraclass coefficients ≥ 0.87). The hips in the Legg–Calvé–Perthes disease cohort had a smaller mean ± standard deviation (SD) superior, anterior and posterior acetabular coverage as assessed by LCEA (13.2° ± 10.7° versus 28.2° ± 3.4°; P < 0.0001), IA (11.6° ± 6.7° versus 3.5° ± 2.8°; P < 0.0001), AASA (52.4° ± 9.5° versus 59.3° ± 5.0°; P = 0.001) and PASA (79.3° ± 5.9° versus 92.3° ± 5.5°; P < 0.0001) compared with controls. The acetabulum was shallower (ADR 287 ± 45 versus 323 ± 28; P = 0.0002) and the acetabular version was decreased cranially (0.4°±9.2° versus 8.2°±6.8°; P = 0.0002) and at the acetabular center (13.7°±5.1° versus 17.2° ±3.8°; P = 0.004) in Legg–Calvé–Perthes disease hips. After skeletal maturity, hips with healed Legg–Calvé–Perthes disease have shallower and more cranially retroverted acetabula, with globally reduced coverage of the femoral head compared with age-, sex- and side-matched control hips.

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Canine Femoral Neck Lengthening Combined with DARthroplasty to Manage Severe Canine Juvenile Hip Dysplasia: A Case Report

VCOT Open ◽

10.1055/s-0039-1694036 ◽

2019 ◽

Vol 02 (02) ◽

pp. e25-e29

Author(s):

Massimo Petazzoni ◽

Melania Dallago

Keyword(s):

Case Report ◽

Femoral Head ◽

Femoral Neck ◽

Hip Dysplasia ◽

Case Description ◽

Femoral Head Coverage ◽

Design Case ◽

Hip Luxation ◽

Acetabular Rim

Objective This study is a case description of femoral neck lengthening and dorsal acetabular rim (DAR) arthroplasty to treat severe hip luxation in a 5-month-old male Cocker Spaniel (14.3 kg) and to compare the clinical outcome with that of contralateral femoral neck excision. Study design Case report. Results Femoral head coverage improved after surgery (preoperative lateralization of the centre of the femoral head with regard to the dorsolateral acetabular rim: 10 mm; postoperative lateralization of the centre of the femoral head: –1.3 mm). The postoperative Barden's test was negative. The dog was bearing weight 2 weeks postoperatively. Radiographic signs of bone healing were present at the 6-week follow-up examination. No complications were detected. Conclusions Femoral neck lengthening and DAR augmentation were performed in a growing dog affected by severe hip luxation and DAR insufficiency.

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