Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip

Abstract

Computed tomography measurements were made to quantify the relationship between the anteversion of the acetabulum and femoral neck in 27 early walking age patients (age range; 18-48 months) with developmental dysplasia of the hip. The centre-edge angle and acetabular index were measured in standard pelvis radiographs, and anteversion of acetabulum and femoral neck were measured by use of two-dimensional computed tomography in 25 complete dislocated, 19 subluxated and 10 unaffected hips (a total of 54 hips). The diagnosis of dysplasia, subluxation and complete dislocation of developmental hip dysplasia were determined radiographically using Ishida's criteria. There were statistically significant differences between the three groups for the centre-edge angle, the acetabular index, and acetabulum anteversion. There was no statistically significant difference between the three groups for femoral neck anteversion. The acetabular anteversion was found to be 13.4+/-2.8 degrees (mean+/-SD) in unaffected hips, 16.7+/-1.9 degrees in subluxated hips and 19.8+/-2.5 degrees in complete dislocated hips. There was statistically significant difference between the three groups, with a wide range of acetabular anteversion values noted in all groups (9-26 degrees ). The acetabular anteversion was increased on the dislocated side in each patient and we found no retroverted acetabulum. On the other hand there was no significant difference between the groups with regards to femoral neck anteversion. We conclude that confirming anteversion of the acetabulum and the femoral neck by two-dimensional computed tomography is needed in treatment planning of early walking age patients with developmental hip dysplasia.

Outcome of one-stage treatment of developmental dysplasia of hip in older children

“…We would like to know whether any radiographic analysis was done preoperatively to assess the femoral anteversion. In our experience, we found that femoral anteversion is rarely exaggerated in DDH of the early walking age group,2 and this is in coordinance with other radiographic studies 34. Secondly, the author's method of assessing the need for derotation seems a little unclear.…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…In a recent study open reduction without simultaneous femoral osteotomy strongly predicted the need for a secondary procedure, and the authors concluded there should be a low threshold to performing femoral osteotomy during a primary open reduction [136] . Although generally accepted that DDH is associated with increased femoral anteversion, some studies did not show a difference in anteversion compared with normal hips [137,138] while others did [139] . Therefore, the indications for femoral derotational osteotomy remain unclear.…”

A Practical Approach to Determining the Center of the Femoral Head in Subluxated and Dislocated Hips

“…A previous study suggests that although femoral version is increased in children with developmental dysplasia of the hip, there is not a significant difference between those with subluxated and dislocated hips. 13 A further weakness is the decision to use the center of the physis as a proxy for the center of the head in all hips in part II of the study. However, this method was equivalent to Mose circles in subluxated hips, very close to the center in dislocated hips and is significantly more practical for clinicians to apply.…”