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Acetabular retroversion

Seyed Ali Hashemi, Javad Dehghani, Amir Reza Vosoughi
OBJECTIVE: Diagnosis of acetabular retroversion based on crossover sign in the anteroposterior radiograph of the hip joint is well described. Accuracy of the crossover sign to identify global retroversion of the acetabulum in comparison to version of the acetabulum in reconstructed three-dimensional computed tomography (3D CT) scan of the hip was the aim of this study. MATERIALS AND METHODS: X-rays of 500 hips were assessed regarding presence of crossover sign and its location in the upper, middle, or lower third of the acetabulum...
October 18, 2016: Skeletal Radiology
Joel Wells, Jeffrey J Nepple, Karla Crook, James R Ross, Asheesh Bedi, Perry Schoenecker, John C Clohisy
BACKGROUND: Hip dysplasia represents a spectrum of complex deformities on both sides of the joint. Although many studies have described the acetabular side of the deformity, to our knowledge, little is known about the three-dimensional (3-D) head and neck offset differences of the femora of dysplastic hips. A thorough knowledge of proximal femoral anatomy is important to prevent potential impingement and improve results after acetabular reorientation. QUESTIONS/PURPOSES: (1) Are there common proximal femoral characteristics in patients with symptomatic hip dysplasia undergoing periacetabular osteotomy (PAO)? (2) Where is the location of maximal femoral head and neck offset deformity in hip dysplasia? (3) Do certain subgroups of dysplastic hips more commonly have cam-type femoral morphology? (4) Is there a relationship between hip ROM as well as impingement testing and 3-D head and neck offset deformity? METHODS: Using our hip preservation database, 153 hips (148 patients) underwent PAO from October 2013 to July 2015...
October 17, 2016: Clinical Orthopaedics and related Research
T Schwarz, M Weber, M Wörner, T Renkawitz, J Grifka, B Craiovan
PURPOSE: Accurate assessment of cup orientation on postoperative radiographs is essential for evaluating outcome after THA. However, accuracy is impeded by the deviation of the central X-ray beam in relation to the cup and the impossibility of measuring retroversion on standard pelvic radiographs. METHOD: In an experimental trial, we built an artificial cup holder enabling the setting of different angles of anatomical anteversion and inclination. Twelve different cup orientations were investigated by three examiners...
October 6, 2016: International Journal of Computer Assisted Radiology and Surgery
Takashi Yoshida, Wook-Cheol Kim, Atsushi Nishida, Yoshinobu Oka, Toshiharu Shirai, Kazuya Ikoma, Keiichiro Ueshima, Hiroyoshi Fujiwara, Toshikazu Kubo
OBJECTIVE: This study aimed to assess acetabular anteversion angle (AAA) from the early stage of Perthes disease to adolescence. METHODS: Twenty-five patients treated conservatively were examined. Changes in AAA from initial to final measurement were compared between the two groups (G-group: Stulberg classes I and II; P-group: classes III and IV). RESULTS: In the G-group, AAA decreased significantly in the affected hip compared with the unaffected hip, whereas AAA decreased in both hips in the P-group...
December 2016: Journal of Orthopaedics
James D Wylie, Jeremy A Ross, Jill A Erickson, Mike B Anderson, Christopher L Peters
BACKGROUND: Intraoperative fluoroscopy is commonly used to both guide the osteotomy and judge correction of the acetabular fragment in periacetabular osteotomy (PAO). Prior studies that have compared intraoperative fluoroscopic correction with postoperative radiographic correction were small studies that did not report intra- or interreader reliability. QUESTIONS/PURPOSES: (1) What is the correlation between intraoperative fluoroscopic correction in PAO compared with the correction seen on postoperative radiographs? (2) What is the reliability of radiographic measures of correction in PAO? METHODS: We performed a retrospective study of 121 patients (141 hips) who underwent PAO for symptomatic hip dysplasia at a tertiary referral center...
September 12, 2016: Clinical Orthopaedics and related Research
Lucas A Anderson, Mike B Anderson, Jill A Erickson, Jesse Chrastil, Christopher L Peters
BACKGROUND: The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy. QUESTIONS: (1) What are the ranges for AWI and PWI from measurements obtained on AP pelvic radiographs of asymptomatic senior athletes with well-functioning hips? (2) Is there a difference between the AWI and PWI in asymptomatic athletes with acetabular morphology consistent with acetabular dysplasia, overcoverage, and retroversion when compared with asymptomatic hips that do not meet the radiographic definitions for those morphologies (controls)? METHODS: Five hundred five athletes (998 asymptomatic native hips) were independently evaluated by two readers on AP pelvic radiographs for AWI and the PWI after excluding hips with prior surgery, inadequate radiographs, or poor function (modified Harris hip score < 80)...
September 6, 2016: Clinical Orthopaedics and related Research
R Wejnold Jørgensen, C Dippmann, L Dahl, J Stürup
BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition...
2016: Open Orthopaedics Journal
Helen Anwander, Kawan S Rakhra, Gerd Melkus, Paul E Beaulé
BACKGROUND: T1ρ MRI has been shown feasible to detect the biochemical status of hip cartilage, but various region-of-interest strategies have been used, compromising the reproducibility and comparability between different institutions and studies. QUESTIONS/PURPOSES: The purposes of this study were (1) to determine representative regions of interest (ROIs) for cartilage T1ρ mapping in hips with a cam deformity; and (2) to assess intra- and interobserver reliability for cartilage T1ρ mapping in hips with a cam deformity...
August 9, 2016: Clinical Orthopaedics and related Research
David E Hartigan, Itay Perets, John P Walsh, Mary R Close, Benjamin G Domb
BACKGROUND: Symptomatic global retroversion of the acetabulum, as diagnosed on plain radiographs of the pelvis, has traditionally been treated with reverse periacetabular osteotomy, which improves posterior undercoverage and eliminates the anterior pincer lesion. There is a paucity of literature on hip arthroscopy in this group, secondary to theoretical concern of iatrogenic dysplasia, subsequent instability, and arthritis. PURPOSE: To evaluate the outcomes of hip arthroscopy for patients with a radiographic diagnosis of acetabular retroversion, using patient-reported outcomes, visual analog scale (VAS), patient satisfaction, and pre- and postoperative Tönnis grades...
October 2016: American Journal of Sports Medicine
Dean K Matsuda, Hal D Martin, Javad Parvizi
Minimizing soft tissue dissection and improving visualization of vital structures during periacetabular osteotomy (PAO) is of paramount importance to improve patient outcome and minimize complications. The endoscopy-assisted PAO was introduced to accomplish this objective. It involves an initial hip arthroscopy, for treatment of central compartment pathology, followed by a mini-open Bernese periacetabular osteotomy under fluoroscopic and endoscopic guidance, and completed by final dynamic hip arthroscopy to assess acetabular reorientation and fixation and to perform femoroplasty in relation to the new acetabular rim position, if needed...
April 2016: Arthroscopy Techniques
Michael M Hadeed, Jourdan M Cancienne, F Winston Gwathmey
This article presents a brief review of pincer impingement pathomechanics and the current methods of diagnosis, followed by a discussion of many of the current controversies in addressing pincer morphology. These controversies include controversial surgical indications such as global acetabular retroversion and the role of prophylactic surgery, controversial surgical techniques to address the acetabular labrum, as well as the best methods for intraoperative evaluation of the arthroscopic acetabuloplasty.
July 2016: Clinics in Sports Medicine
J W Thomas Byrd, Kay S Jones, F Winston Gwathmey
BACKGROUND: Adolescent athletes with symptomatic femoroacetabular impingement (FAI) may respond well to arthroscopic intervention. PURPOSE: This study reports the outcomes of arthroscopic treatment for symptomatic FAI in adolescents. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included in this study were 104 consecutive athletes (116 hips) younger than 18 years who underwent arthroscopic correction of symptomatic FAI with a minimum 2-year follow-up...
August 2016: American Journal of Sports Medicine
T D Lerch, S D Steppacher, E F Liechti, K A Siebenrock, M Tannast
The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged...
August 2016: Der Orthopäde
William Z Morris, Ryan T Li, Raymond W Liu
PURPOSE: The triradiate cartilage transiently projects medially within the pelvic brim around the time of triradiate closure, mimicking the ischial spine sign. The purpose of this study was to characterize this newly identified radiographic sign using a longitudinal radiographic study. METHODS: We identified 72 subjects from a longitudinal radiographic study of healthy adolescents, each with at least four consecutive, annual anterior-posterior radiographs of the left hip, including physeal closure...
June 2016: Journal of Children's Orthopaedics
Richard Prazeres Canella, Guilherme Pradi Adam, Roberto André Ulhôa de Castillo, Daniel Codonho, Gerson Gandhi Ganev, Luiz Fernando de Vicenzi
OBJECTIVE: To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI), using computed tomography (CT). METHODS: We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third), femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient...
March 2016: Revista Brasileira de Ortopedia
Lucas A Anderson, Jill A Erickson, Russell P Swann, Ian P McAlister, Mike B Anderson, Rafael J Sierra, Christopher L Peters
BACKGROUND: The primary purpose of our study was to determine the prevalence of Cam deformity in patients with symptomatic acetabular dysplasia (SAD) who underwent periacetabular osteotomy (PAO). METHODS: We retrospectively reviewed 164 SAD PAO patients from 2 institutions. Preoperative anteroposterior and frog-lateral radiographs were analyzed for lateral center edge angle (LCEA), retroversion, alpha angles, and anterior femoral head-neck offset. Hips were classified as dysplastic (LCEA <20°, group A, n = 142) and borderline dysplastic (LCEA 20°-25°, group B, n = 22)...
September 2016: Journal of Arthroplasty
Charlotte Hartig-Andreasen, Anders Troelsen, Theis M Thillemann, John Gelineck, Kjeld Søballe
Despite the frequency of labral tears in symptomatic developmental dysplasia of the hip, no consensus exists regarding the treatment of coexisting dysplasia of the hip and tearing of the acetabular labrum. The purpose of this prospective, MR arthrography (MRA) based 2-year follow-up study was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year follow-up. MRA was performed in all patients prior to PAO...
December 2015: Journal of Hip Preservation Surgery
Jibanananda Satpathy, Arun Kannan, John R Owen, Jennifer S Wayne, Jason R Hull, William A Jiranek
The current literature on femoroacetabular impingement (FAI) is focused on acetabular orientation and femoral head asphericity, with little emphasis on the effect of version of the femoral neck. A biomechanical model was developed to determine the causative effect, if any, of femoral retroversion on hip contact stress and, if present, delineate the type of FAI with femoral neck retroversion. Five pairs of cadaveric hips (n = 10) were tested by loading the hip in 90° of flexion and measured the peak joint pressure and the location of the peak joint pressure...
October 2015: Journal of Hip Preservation Surgery
Felix Toft, Elmar Anliker, Martin Beck
Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment...
July 2015: Journal of Hip Preservation Surgery
Lorenz Büchler, Joseph M Schwab, Patrick W Whitlock, Martin Beck, Moritz Tannast
PURPOSE: To compare quantitative measurements of acetabular morphology obtained using intraoperative fluoroscopy, to standardized anteroposterior (AP) pelvis radiographs. METHODS: Ten dried human pelvis specimens (20 hips) were imaged using hip-centered fluoroscopy and standardized AP pelvis radiographs. Each hip was evaluated for acetabular version and coverage, including lateral center edge (LCE) angle, acetabular index (AI), total anterior and posterior coverage, and crossover sign...
March 15, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
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