Effect of acetabular tilt angle on acetabular version in adults with developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YAN Liang , WANG Peng , TANG Chunping , CHENG Hongbing

Department of Orthopaedics, Nantong Rich Hospital, The Fourth Clinical College, Yangzhou University, Nantong Jiangsu, 226010, P.R.China;

Corresponding author：

YAN Liang, Email: 17155685@qq.com

Keywords：

Developmental dysplasia of the hip; acetabular tilt angle; acetabular version; periacetabular osteotomies

DOI：

10.7507/1002-1892.201610040

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Objective To investigate the difference in acetabular tilt angle (ATA) between adults with deve-lopmental dysplasia of the hip (DDH) and normal adults and the effect of ATA on acetabular version. Methods Between February 2009 and October 2015, 31 adult female patients with DDH (39 hips) (DDH group) and 31 female patients with osteoarthritis of the knee (31 hips) who had no history of hip disease (control group) were included in this study. The average age was 39 years (range, 18-59 years) in the DDH group, and was 69 years (range, 52-79 years) in control group. The morphometric parameters of the acetabulum including ATA, acetabular anteversion angle (AAA), acetabular inclination angle (AIA), acetabular cranial anteversion angle (ACAA), and acetabular sector angle (ASA) were mea- sured by CT reconstruction; The ASA was used as an index for acetabular coverage of the femoral head. The correlation between ATA and other parameters was analyzed using Pearson correlation analysis. Results The values of ATA, AAA, and AIA of the DDH group were significantly larger than those of the control group (P<0.05). The ASA in all directions was significantly decreased in the DDH group when compared with the values in the control group (P<0.05). There was no significant difference in ACAA between two groups (t=1.918, P=0.523). The ATA was positively correlated with AAA and ACAA in the DDH group (r=0.439, P=0.001; r=0.436, P=0.002), but there was no correlation between ATA and AIA (r=0.123, P=0.308). In the control group, the ATA was not correlated with AAA, ACAA, and AIA (r=–0.004, P=0.724; r=–0.079, P=0.626; r=–0.058, P=0.724). Regarding acetabular coverage of the femoral head, the ATA and AAA were correlated negatively with anterior ASA (P<0.05) and positively with posterior ASA (P<0.05), but had no correlation with superior ASA (P>0.05) in the DDH group; AIA was correlated negatively with anterior ASA and superior ASA (P<0.05) and had no correlation with posterior ASA (r=–0.092, P=0.440). In the control group, there was no correlation between ATA and ASA in any direction (P>0.05). In the DDH group, defects of the acetabular anterior wall, lateral wall, and posterior wall were observed in 18 hips (46.2%), 15 hips (38.5%), and 6 hips (15.3%), respectively. ATA value of the posterior wall defect [(15.70±10.00)°] was significantly smaller than those of the acetabular anterior wall and lateral wall defects [(22.91±5.06)° and (21.59±3.81) °] (P<0.05), but no signficant difference was found between anterior wall and lateral wall defects (P>0.05). Conclusion ATA will influence acetabular version in DDH. The anterior rotation of the acetabular fragment during periacetabular osteotomies is an anatomically reasonable maneuver for hips with anterolateral acetabular defect, while the maneuver should be avoided in hips with posterior acetabular defect.

Citation： YAN Liang, WANG Peng, TANG Chunping, CHENG Hongbing. Effect of acetabular tilt angle on acetabular version in adults with developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 647-652. doi: 10.7507/1002-1892.201610040 Copy

1.	Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res, 1986, (213): 20-33.
2.	Dandachli W, Kannan V, Richards R, et al. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg (Br), 2008, 90(11): 1428-1434.
3.	Jacobsen S, Romer L, Soballe K. The other hip in unilateral hip dysplasia. Clin Orthop Relat Res, 2006, 446: 239-246.
4.	Murphy SB, Kijewski PK, Millis MB, et al. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res, 1990, (261): 214-223.
5.	严亮, 夏军, 黄钢勇, 等. 成人髋关节发育不良患者股骨近端的解剖形态学特征. 中华骨科杂志, 2013, 33(9): 941-947.
6.	Chegini S, Beck M, Ferguson SJ. The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res, 2009, 27(2): 195-201.
7.	Hipp JA, Sugano N, Millis MB, et al. Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res, 1999, (364): 134-143.
8.	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(3): 423-429.
9.	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(7): 985-989.
10.	Noguchi Y, Miura H, Takasugi S, et al. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior weight-bearing area: an arthroscopic observation. Arthroscopy, 1999, 15(5): 496-506.
11.	Wedge JH, Wasylenko MJ. The natural history of congenital dislocation of the hip: a critical review. Clin Orthop Relat Res, 1978, (137): 154-162.
12.	Fujii M, Nakashima Y, Sato T, et al. Pelvic deformity influences acetabular version and coverage in hip dysplasia. Clin Orthop Relat Res, 2011, (469): 1735-1742.
13.	Fujii M, Nakashima Y, Yamamoto T, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2010, 92(4): 895-903.
14.	Ganz R, Leunig M. Morphological variations of residual hip dysplasia in the adult. Hip Int, 2007, 17 Suppl 5: S22-28.
15.	Ito H, Matsuno T, Hirayama T, et al. Three-dimensional computed tomography analysis of non osteoarthritic adult acetabular dysplasia. Skeletal Radiol, 2009, 38(2): 131-139.
16.	Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res, 2003, (416): 245-253.
17.	Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res, 2004, (418): 48-53.
18.	Johnston CE 2nd, Wenger DR, Roberts JM, et al. Acetabular coverage: three-dimensional anatomy and radiographic evaluation. J Pediatr Orthop, 1986, 6(5): 548-558.
19.	Klaue K, Wallin A, Ganz R. CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res, 1988, (232): 15-25.
20.	Peters CL, Erickson JA, Anderson L, et al. Hip-preserving surgery: understanding complex pathomorphology. J Bone Joint Surg (Am), 2009, 91 Suppl 6: 42-58.
21.	Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg (Am), 2006, 88(9): 1920-1926.
22.	Kiyama T, Naito M, Shiramizu K, et al. Postoperative acetabular retroversion causes posterior osteoarthritis of the hip. Int Orthop, 2009, 33(3): 625-631.
23.	Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res, 1999, (363): 93-99.
24.	Steppacher SD, Tannast M, Ganz R, et al. Mean 20-year follow up of Bernese periacetabular osteotomy. Clin Orthop Relat Res, 2008, 466(7): 1633-1644.
25.	Köhnlein W, Ganz R, Impellizzeri FM, et al. Acetabular morphology: implications for joint-preserving surgery. Clin Orthop Relat Res, 2009, 467(3): 682-691.
26.	Cobb J, Logishetty K, Davda K, et al. Cams and pincer impingement are distinct, not mixed the acetabular pathomorphologyof femoroacetabular impingement. Clin Orthop Relat Res, 2010, 468(8): 2143-2151.
27.	Vandenbussche E, Saffarini M, Delogé N, et al. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop, 2007, 78(3): 327-332.
28.	Vandenbussche E, Saffarini M, Taillieu F, et al. The asymmetric profile of the acetabulum. Clin Orthop Relat Res, 2008, 466(2): 417-423.
29.	Tönnis D. Clinical and radiographic schemes for evaluating the rapeutic results//Tönnis D, eds. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin: Springer, 1987: 165-171.
30.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
31.	Jamali AA, Mladenov K, Meyer DC, et al. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the " cross-over-sign”. J Orthop Res, 2007, 25(6): 758-765.
32.	Anda S, Svenningsen S, Dale LG, et al. The acetabular sector angle of the adult hip determined by computed tomography. Acta Radiol Diagn (Stockh), 1986, 27(4): 443-447.
33.	Anda S, Terjesen T, Kvistad KA, et al. Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr, 1991, 15(1): 115-120.
34.	Azuma H, Taneda H, Igarashi H, et al. Preoperative and postoperative assessment of rotational acetabular osteotomy for dysplastic hips in children by three-dimensional surface reconstruction computed tomography imaging. J Pediatr Orthop, 1990, 10(1): 33-38.
35.	Johnston CE 2nd, Wenger DR, Roberts JM, et al. Acetabular coverage: three-dimensional anatomy and radiographic evaluation. J Pediatr Orthop, 1986, 6(5): 548-558.

1. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res, 1986, (213): 20-33.
2. Dandachli W, Kannan V, Richards R, et al. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg (Br), 2008, 90(11): 1428-1434.
3. Jacobsen S, Romer L, Soballe K. The other hip in unilateral hip dysplasia. Clin Orthop Relat Res, 2006, 446: 239-246.
4. Murphy SB, Kijewski PK, Millis MB, et al. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res, 1990, (261): 214-223.
5. 严亮, 夏军, 黄钢勇, 等. 成人髋关节发育不良患者股骨近端的解剖形态学特征. 中华骨科杂志, 2013, 33(9): 941-947.
6. Chegini S, Beck M, Ferguson SJ. The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res, 2009, 27(2): 195-201.
7. Hipp JA, Sugano N, Millis MB, et al. Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res, 1999, (364): 134-143.
8. 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(3): 423-429.
9. 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(7): 985-989.
10. Noguchi Y, Miura H, Takasugi S, et al. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior weight-bearing area: an arthroscopic observation. Arthroscopy, 1999, 15(5): 496-506.
11. Wedge JH, Wasylenko MJ. The natural history of congenital dislocation of the hip: a critical review. Clin Orthop Relat Res, 1978, (137): 154-162.
12. Fujii M, Nakashima Y, Sato T, et al. Pelvic deformity influences acetabular version and coverage in hip dysplasia. Clin Orthop Relat Res, 2011, (469): 1735-1742.
13. Fujii M, Nakashima Y, Yamamoto T, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2010, 92(4): 895-903.
14. Ganz R, Leunig M. Morphological variations of residual hip dysplasia in the adult. Hip Int, 2007, 17 Suppl 5: S22-28.
15. Ito H, Matsuno T, Hirayama T, et al. Three-dimensional computed tomography analysis of non osteoarthritic adult acetabular dysplasia. Skeletal Radiol, 2009, 38(2): 131-139.
16. Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res, 2003, (416): 245-253.
17. Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res, 2004, (418): 48-53.
18. Johnston CE 2nd, Wenger DR, Roberts JM, et al. Acetabular coverage: three-dimensional anatomy and radiographic evaluation. J Pediatr Orthop, 1986, 6(5): 548-558.
19. Klaue K, Wallin A, Ganz R. CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res, 1988, (232): 15-25.
20. Peters CL, Erickson JA, Anderson L, et al. Hip-preserving surgery: understanding complex pathomorphology. J Bone Joint Surg (Am), 2009, 91 Suppl 6: 42-58.
21. Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg (Am), 2006, 88(9): 1920-1926.
22. Kiyama T, Naito M, Shiramizu K, et al. Postoperative acetabular retroversion causes posterior osteoarthritis of the hip. Int Orthop, 2009, 33(3): 625-631.
23. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res, 1999, (363): 93-99.
24. Steppacher SD, Tannast M, Ganz R, et al. Mean 20-year follow up of Bernese periacetabular osteotomy. Clin Orthop Relat Res, 2008, 466(7): 1633-1644.
25. Köhnlein W, Ganz R, Impellizzeri FM, et al. Acetabular morphology: implications for joint-preserving surgery. Clin Orthop Relat Res, 2009, 467(3): 682-691.
26. Cobb J, Logishetty K, Davda K, et al. Cams and pincer impingement are distinct, not mixed the acetabular pathomorphologyof femoroacetabular impingement. Clin Orthop Relat Res, 2010, 468(8): 2143-2151.
27. Vandenbussche E, Saffarini M, Delogé N, et al. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop, 2007, 78(3): 327-332.
28. Vandenbussche E, Saffarini M, Taillieu F, et al. The asymmetric profile of the acetabulum. Clin Orthop Relat Res, 2008, 466(2): 417-423.
29. Tönnis D. Clinical and radiographic schemes for evaluating the rapeutic results//Tönnis D, eds. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin: Springer, 1987: 165-171.
30. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
31. Jamali AA, Mladenov K, Meyer DC, et al. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the " cross-over-sign”. J Orthop Res, 2007, 25(6): 758-765.
32. Anda S, Svenningsen S, Dale LG, et al. The acetabular sector angle of the adult hip determined by computed tomography. Acta Radiol Diagn (Stockh), 1986, 27(4): 443-447.
33. Anda S, Terjesen T, Kvistad KA, et al. Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr, 1991, 15(1): 115-120.
34. Azuma H, Taneda H, Igarashi H, et al. Preoperative and postoperative assessment of rotational acetabular osteotomy for dysplastic hips in children by three-dimensional surface reconstruction computed tomography imaging. J Pediatr Orthop, 1990, 10(1): 33-38.
35. Johnston CE 2nd, Wenger DR, Roberts JM, et al. Acetabular coverage: three-dimensional anatomy and radiographic evaluation. J Pediatr Orthop, 1986, 6(5): 548-558.

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