Femoral Morphology in Patients Undergoing Periacetabular Osteotomy for Classic or Borderline Acetabular Dysplasia: Are Cam Deformities Common?

Anderson, Lucas A.; Erickson, Jill; Swann, Russell P.; McAlister, Ian P.; Anderson, Mike B.; Sierra, Rafael J.; Peters, Christopher L.

doi:10.1016/j.arth.2016.01.066

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…Radiographic evaluation demonstrates that dysplastic hips can have signs of coexisting radiographic impingement [1,10,17,33]. Studies that investigate comprehensive head and neck offset or identify the exact location of maximal deformity using 3-D remodeling are limited [20,28].…”

Section: Discussionmentioning

confidence: 99%

“…Anderson and colleagues [1] assessed a group of 164 symptomatic dysplastic hips before undergoing PAO. They found a prevalence of cam deformities of 10% and they concluded that cam impingement is overdiagnosed in developmental dysplasia of the hip and this could possibly lead to unnecessary femoral osteochondroplasty procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Dysplastic femora have been shown to have shorter necks, smaller and straighter canals, with increased anteversion and aspheric femoral heads with characteristics and variables dependent on the severity of dysplasia [2,10,12,30,35,38]. A few studies have assessed femoral anatomy with regard to head and neck offset in mild to moderate dysplasia using radiographic imaging [1,10,17,33]. In the course of treating patients with hip dysplasia, we have noted the frequent coexistence of femoral deformity and its association with the need for a concurrent head and neck osteochondroplasty at the time of acetabular correction.…”

Section: Introductionmentioning

confidence: 99%

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Femoral Morphology in the Dysplastic Hip: Three-dimensional Characterizations With CT

Wells

Nepple

Crook

et al. 2017

Clinical Orthopaedics &Amp; Related Research

124

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Femoral Morphology in the Dysplastic Hip: Three-dimensional Characterizations With CT

Wells

Nepple

Crook

et al. 2017

Clinical Orthopaedics &Amp; Related Research

124

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“…Our results indicate that congruity of the borderline dysplastic hip is impaired but its incongruity is not as severe as the dysplastic hips. As for the borderline dysplasia, it is recognized that instability or concomitant cam deformity may cause labrum tears and cartilage degeneration [11][12][13][14]34,35]. Regarding the concomitant cam deformity, there are several reports that evaluated the 3D morphology in the borderline dysplastic hips [34][35][36][37][38].…”

Section: Plos Onementioning

confidence: 99%

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

et al. 2020

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Whether borderline hip dysplasia is pathologic remains unclear. In order to evaluate the three-dimensional joint congruity, this study sought to answer the question: are borderline dysplastic hip curvature mismatch and eccentricity between the acetabulum and the femoral head different from dysplastic or control hips three-dimensionally? The 113 hips, categorized as: dysplastic (LCEA � 20˚), 47 hips; borderline (20˚� LCEA < 25˚), 32 hips; and control (25˚� LCEA < 35˚), 34 hips; were evaluated. Three-dimensional (3D) femoral and coxal bone models were reconstructed from CT images. Using a custom-written Visual C++ routine, the femoral head and acetabular radii of curvature, and the femoral head and the acetabular curvature center were calculated. Then the ratio of the acetabular radius to the femoral head radius (3D curvature mismatch ratio), and the distance between the acetabular curvature center and the femoral head center (3D center discrepancy distance) were calculated. These indices were compared statistically among the three groups using Tukey's post hoc test. The mean 3D curvature mismatch ratio in the borderline (1.13 ± 0.05) was smaller than in the dysplasia (1.23 ± 0.08, p < 0.001), and larger than in the control (1.07 ± 0.02, p < 0.001). The mean 3D center discrepancy distance in the borderline (3.2 ± 1.4 mm) was smaller than in the dysplasia (4.8 ± 2.3, p < 0.001) and larger than in the control (1.6 ± 0.7, p < 0.001). These results demonstrated that three-dimensional congruity of the borderline dysplastic hip is impaired, but its incongruity is not as severe as in dysplastic hips. The 3D curvature mismatch ratio and the 3D center discrepancy distance can be valuable signs of joint congruity in patients with borderline dysplasia. However, future studies are necessary to clarify any associations between curvature mismatch and pathogenesis of osteoarthritis in borderline dysplasia.

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“…32 Evaluation of the proximal femur on radiographs is also important because offset deformity of the femoral headneck junction is common in both borderline hip dysplasia and acetabular retroversion. 2,33,34 A 45°Dunn lateral view provides a view of the anterolateral femoral head-neck junction, allowing proper measurement of the α angle. A frog leg lateral view of the hip provides an assessment of the anterior femoral head-neck junction.…”

Section: Physical Examinationmentioning

confidence: 99%

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

et al. 2018

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Borderline hip dysplasia and acetabular retroversion are common radiographic findings in young individuals with and without hip pain. Orthopaedic surgeons should be knowledgeable about the radiographic findings, diagnosis, and appropriate nonsurgical and surgical treatment of these conditions. Borderline hip dysplasia is generally defined by a lateral center edge angle of Wiberg from 20 to 25° (some define as 18–25°) and is a cause of joint microinstability. The degree of soft tissue laxity can have significant implications for joint stability in patients with borderline hip dysplasia. The most common presenting symptoms are groin pain and lateral hip pain. Acetabular retroversion is defined by radiographic findings of crossover sign, ischial spine sign, and posterior wall sign. Individuals with symptomatic retroversion have a clinical presentation consistent with impingement, groin pain with flexion activities, and less commonly lateral hip pain. Physical therapy has been shown to improve symptoms in a subset of individuals with these conditions. There are multiple recent publications about arthroscopic treatment of patients with borderline hip dysplasia. These reports generally find that good short-term outcomes can be expected when using arthroscopic techniques that include labral preservation/repair and capsular plication. There are limited reports of periacetabular osteotomy as a treatment for borderline hip dysplasia. Publications focusing specifically on surgical treatment of acetabular retroversion are also infrequent. Periacetabular osteotomy has been shown to have superior long-term clinical outcomes to surgical hip dislocation with anterior rim trimming in patients with all three radiographic findings of retroversion. Arthroscopic treatment has been shown to have good short-term outcomes. Future work in the areas of borderline hip dysplasia and acetabular retroversion should focus on reporting long-term clinical follow-up of these surgical treatments and using computation techniques as a tool to determine appropriate surgical and nonsurgical treatment for each individual patient.

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Femoral Morphology in Patients Undergoing Periacetabular Osteotomy for Classic or Borderline Acetabular Dysplasia: Are Cam Deformities Common?

Cited by 19 publications

References 22 publications

Femoral Morphology in the Dysplastic Hip: Three-dimensional Characterizations With CT

Femoral Morphology in the Dysplastic Hip: Three-dimensional Characterizations With CT

Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

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