Current concepts in the diagnosis and management of Os Acetabuli

Abstract

Purpose The aim of this review is to appraise the current evidence on the epidemiology, pathophysiology, diagnosis and management of os acetabuli. Methods A scoping review was conducted according to the Joanna Briggs Institute guidelines. A systematic search was performed on Medline (PubMed), Embase and Cochrane Library. Inclusion criteria comprised observational and interventional studies and review articles published in the English language that focused on patients with os acetabuli according to the PRISMA extension of scoping reviews checklist using the terms ‘Os Acetabuli’ or ‘os acetabula’ or ‘acetabular ossicles’. A narrative synthesis of results was undertaken, and the included articles were divided into (i) definition, (ii) aetiology, (iii) diagnosis and imaging and (iv) management of os acetabuli. Results 107 articles were screened, with 22 meeting the eligibility criteria. A total of 8836 patients were considered, of which 604 had os acetabuli. The mean age was 32.8 years. The prevalence of os acetabuli ranged from 3.4 to 7.7%, with a higher prevalence in males compared to females. True os acetabuli was defined as an unfused secondary ossification centre along the acetabular rim. The aetiology of os acetabuli is thought to be secondary to acetabular dysplasia and/or femoroacetabular impingement. Standard of care for management of symptomatic os acetabuli is considered to be arthroscopic excision unless the excision results in acetabular undercoverage and/or instability, in which case, fixation is recommended. Conclusions Successful management of os acetabuli depends on understanding the pathology and treating the underlying cause rather than treating the os acetabuli in isolation. Future work needs to focus on establishing clear diagnostic criteria, consensus on definition and an evidence-based treatment algorithm.

How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort

“…Not every patient with a borderline hip dysplasia may show clinical symptoms and it is unclear which hips and how quickly would develop an early osteoarthritis [ 6 , 7 ]. The management and diagnostic work-up of a hip with borderline dysplasia is complex, as it usually encompasses other concomitant pathologies of hip, such as: femoroacetabular impingement, labral tears, versional abnormalities and extra-articular impingement syndromes [ 8 – 11 ]. Arthroplasty is ultimately also impacted with difficulties in using traditional landmarks and techniques for osteoarthritis (OA) secondary to hip dysplasia [ 12 , 13 ].…”