A Computed Tomography Study of Gender Differences in Acetabular Version and Morphology: Implications for Femoroacetabular Impingement

Tannenbaum, Eric; Zhang, Peng; Maratt, Joseph D.; Gombera, Mufaddal M.; Holcombe, Sven A.; Wang, Stewart C.; Bedi, Asheesh; Goulet, James A.

doi:10.1016/j.arthro.2015.02.007

Cited by 32 publications

(36 citation statements)

References 35 publications

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“…Patients with acetabular retroversion (based on version angles <0° at the 1 o’clock position as measured on CT axial slices) 17 were excluded from the study (n = 3). For patients with bilateral symptoms (n = 4), 1 hip was randomly selected.…”

Section: Methodsmentioning

confidence: 99%

Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage

Wylie

Kapron

Peters

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The lateral center-edge angle (LCEA) is an important measurement in understanding acetabular morphology and has had multiple interpretations. Misunderstanding of the LCEA and its relationship with acetabular 3-dimensional (3D) morphology may result in misdiagnosis and poor outcomes.Purpose:To determine the discrepancy between bone-edge and sourcil-edge LCEA measurements on anteroposterior (AP) radiographs and to determine the 3D anatomic location of the sourcil-edge and bone-edge LCEA measurements.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The LCEA was measured on radiographs to both the sourcil-edge and bone-edge on AP images of 60 symptomatic hips. On computed tomography (CT), coronal slices producing an LCEA matching the magnitude of each AP LCEA were identified. These coronal slices were mapped to a sagittal image of the acetabulum, which was divided into a standard clockface (3 = anterior, 12 = superior). We identified clockface locations corresponding to the AP sourcil-edge and bone-edge LCEA measurements. Paired t tests identified differences in magnitude and location of the bone and sourcil LCEAs. Limits of agreement were calculated for the differences between measures. Intraclass correlation coefficients (ICCs) assessed inter- and intraobserver repeatability.Results:On the AP radiographs, the bone-edge LCEA was a mean 4.7° (95% CI, −4.0° to 13.3°) greater than the sourcil-edge LCEA (P < .001). On CT, the sagittal clockface location of the sourcil-edge LCEA was more anterior compared with the sagittal clockface location of the maximum bone-edge LCEA (1:03 ± 0:42 vs 12:06 ± 0:30, respectively; P < .001). In hips with a difference >5° between sourcil-edge and bone-edge measurements, the coronal CT slice corresponding to the sourcil-edge LCEA was significantly more anterior (1:26 ± 0:35) than the CT slice corresponding to the bone-edge LCEA (11:46 ± 0:29; P < .001). This significant difference was similar in location but less pronounced in hips with a difference ≤5°: the sourcil-edge LCEA occurred at 12:50 ± 0:40, while the bone-edge LCEA occurred at 12:00 ± 0:11 (P < .001). Interobserver repeatability was excellent for all LCEA and clockface location measurements (all ICCs >0.82).Conclusion:The sourcil-edge LCEA represents anterosuperior acetabular coverage while the bone-edge LCEA represents superior/lateral coverage. This information can be used in preoperative evaluation of and perioperative planning for hip preservation procedures.

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Section: Methodsmentioning

confidence: 99%

Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage

Wylie

Kapron

Peters

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…We hypothesize that pelvic morphology and other dynamic factors, such as distinct sports activities, increased female flexibility, pelvic rotation, or forward tilt from weaker core muscles contribute to these overall differences [53][54][55].…”

Section: Discussionmentioning

confidence: 99%

Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjects

et al. 2016

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Objective Our objectives were to use 3D computed tomography (CT) to define head-neck morphologic gender-specific and normative parameters in asymptomatic individuals and use the omega angle (Ω°) to provide quantification data on the location and radial extension of a cam deformity. Methods We prospectively included 350 individuals and evaluated 188 asymptomatic hips that underwent semiautomated CT analysis. Different thresholds of alpha angle (α°) were considered in order to analyze cam morphology and determine Ω°. We calculated overall and gender-specific parameters for imaging signs of cam morphology (Ω°and circumferential α°). Results The 95 % reference interval limits were beyond abnormal thresholds found in the literature for cam morphology. Specifically, α°at 3/1 o´clock were 46.9°/60.8°overall, 51.8°/ 65.4°for men and 45.7°/55.3°for women. Cam prevalence, magnitude, location, and epicenter were significantly gender different. Increasing α°correlated with higher Ω°, meaning that higher angles correspond to larger cam deformities.Conclusion Hip morphometry measurements in this cohort of asymptomatic individuals extended beyond current thresholds used for the clinical diagnosis of cam deformity, and α°was found to vary both by gender and measurement location. These results suggest that α°measurement is insufficient for the diagnosis of cam deformity. Enhanced morphometric evaluation, including 3D imaging and Ω°, may enable a more accurate diagnosis. Key Points • 95% reference interval limits of cam morphotype were beyond currently defined thresholds.• Current morphometric definitions for cam-type morphotype should be applied with care.• Cam prevalence, magnitude, location, and epicenter are significantly gender different.• Cam and alpha angle thresholds should be defined according to sex/location. • Quantitative 3D morphometric assessment allows thorough and reproducible FAI diagnosis and monitoring.

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“…Zaprezentowane zróżni -co wanie w budowie i ustawieniu panewki żeńskiej (mniejszy rozmiar, większy kąt antewersji) w stosunku do męskiej powinno być brane pod uwagę w trakcie osadzania komponentu panewkowego endoprotezy, tym bardziej, że coraz częściej opisywany w literaturze jest fakt wykraczania pozycji anatomicznej panewki poza strefę bezpieczną Lewinka [6,8]. Powyż sze różnice należy rozważyć przedoperacyjnie rów nież w leczeniu innych patologii stawu biodrowego jak FAI czy stawy dysplastyczne, zwłaszcza w przypadku technik operacyjnych z zakresu osteotomii redyrekcyjnych panewki oraz techniki leczenia operacyjnego FAI z plastyką ściany panewki [31]. Pro ponowana analiza przedoperacyjna może znaczą -co wpłynąć na poprawę stosunków anatomicznych panujących w stawie biodrowym, a co za tym idzie na wynik funkcjonalny pacjenta.…”

Section: Discussionunclassified

“…The differences in the anatomy and orientation of the female (smaller volume and larger anteversion angle) and male acetabula revealed in this study should be taken into account during the pla cement of the acetabular component in hip re placement surgery, even more so as description of the anatomic position of the acetabulum exceeding the Lewinnek safe zone have been increasingly more frequent in the literature [6,8]. The differences should also be considered before surgery in patients with other hip conditions such as femoroacetabular impinge ment or arthrodysplasia, and especially acetabular redirection osteotomy and surgical therapy of FAI with reconstruction of the acetabular wall [31]. The suggested preoperative analysis may have a considerable impact on improvement of anatomic relations within the hip and therefore the patient's functional outcome.…”

Section: Wnioskimentioning

confidence: 99%

Sexual Dimorphism of Acetabular Anatomy Based on Three-dimensional Computed Tomography Images of Pelvises

Musielak

Rychlik

Jóźwiak

2016

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp. Prezentowane badanie ma na celu porównanie różnic płciowych w budowie i w przestrzennym ustawieniu panewek miednicy, w celu lepszego zrozumienia anatomii stawu biodrowego.Materiał i metody. Badanie wykonano w oparciu o trójwymiarowe rekonstrukcje tomografii komputerowych 50 panewek żeńskich oraz 50 panewek męskich. Na ich podstawie wykonano analizę przestrzenną panewek stawu biodrowego w stosunku do podstawy kości krzyżowej, jako płaszczyzny referencyjnej. W oparciu o analizę statystyczną, porównywano wartości kątowe parametrów opisujących rzeczywistą oś panewki (kąt inklinacji, kąt antewersji, kąt pochylenia) oraz objętość i powierzchnię wewnętrzną panewki stawu biodrowego.Wyniki. Zarówno kąt inklinacji, jak i kąt pochylenia panewki nie różniły się istotnie pomiędzy porównywanymi grupami i wyniosły odpowiednio: 68,61° i 26,53° w panewkach kobiecych oraz 70,56° i 30,19° w męskich (p>0,05). Kąt antewersji był istotnie większy w przypadku panewek żeńskich i wyniosł 38,27°, gdy w męskich -32,05° (p=0,0008), natomiast ich objętość i powierzchnia były istotnie mniejsze u kobiet (odpowiednio p=0,0007 i 0,0001).Wnioski. 1. Ustawienie panewki stawu biodrowego różni się w zależności od płci -panewki żeńskie zorientowane są bardziej ku przodowi niż męskie. 2. Objętość oraz powierzchnia wewnętrzna panewki także się różnią -są mniejsze u kobiet. 3. Niezależnie od wykorzystanej płaszczyzny odniesienia, dymorfizm płciowy panewki stawu biodrowego jest stały. 4. Znajomość powyższych różnic płciowych jest niezbędna dla planowania przedoperacyjnego w zabiegach ortopedycznych (jak w przypadku alloplastyki stawu biodrowego czy leczenia operacyjnego FAI).Słowa kluczowe panewka stawu biodrowego, orientacja przestrzenna panewki, rekonstrukcje trójwymiarowe, inżynieria odwrotna, różnice płciowe SUMMARY Background. The study aimed to compare sex differences in the morphology and spatial orientation of pelvic acetabula to advance the understanding of hip anatomy.Material and methods. The study was based on three-dimensional reconstructions of computed tomography images of 50 female and 50 male acetabula. The images were used for spatial analysis of hip acetabula relative to the base of the sacral bone as the plane of reference. Statistical analysis was performed to compare angles relevant to the actual axis of the acetabulum (inclination angle, anteversion angle, tilt angle) as well as the volume and inner surface area of the acetabulum.Results. Both the inclination and tilt angles of the acetabulum did not differ significantly between the groups, the respective values being: 68. 61° and 26.53° in females and 70.56° and 30.19° in males (p>0.05). The anteversion angle was significantly larger for female acetabula (38.27° compared to 32.05° in men, with p=0.0008), while the volume and the inner surface area were significantly smaller in women (p=0.0007 and 0.0001 respectively).Conclusions. 1. Acetabular orientation is sex-specific, with female acetabula being more forward-oriented than those of men. 2. The volume and inn...

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A Computed Tomography Study of Gender Differences in Acetabular Version and Morphology: Implications for Femoroacetabular Impingement

Cited by 32 publications

References 35 publications

Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage

Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage

Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjects

Sexual Dimorphism of Acetabular Anatomy Based on Three-dimensional Computed Tomography Images of Pelvises

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