Measurement of Acetabular Anteversion in Developmental Dysplasia of the Hip in Children by Two- and Three-dimensional Computed Tomography

Abstract

This study assessed the angle of acetabular anteversion (AA) in 66 children with developmental dysplasia of the hip (132 hips: 24 left, 25 right, 17 bilateral and 49 unaffected hips as controls). The AA was measured by two- and three-dimensional computed tomography (2D-CT and 3D-CT). Measurements were taken by three observers and repeated 2 weeks later by one of these observers. Intra- and inter-observer agreement was analysed using the intra-class correlation coefficient. For all hips, the mean AA (+/-SD) measured by 2D-CT versus 3D-CT was statistically significantly different (15.76 +/- 5.23 degrees versus 16.76 +/- 4.43 degrees , respectively). The mean (+/-SD) AA by 3D-CT in unaffected and affected hips was also statistically significantly different (13.92 +/- 3.95 degrees versus 18.44 +/- 3.82 degrees , respectively). A significant positive correlation between age at presentation and AA was found in affected, but not unaffected, hips. The 3D-CT showed better intra- and inter-observer agreement than 2D-CT for assessing AA hence is a more reliable measurement of AA. An increased AA is one component of anatomical abnormalities in developmental dysplasia of the hip and the abnormality appears to worsen with age.

Three dimensional-CT evaluation of femoral neck anteversion, acetabular anteversion and combined anteversion in unilateral DDH in an early walking age group

“…Although it is widely considered that two dimensional-CT scanning is an accurate method for the quantitative assessment on the anteversion of femoral neck and of acetabulum in children with DDH, its reliability and accuracy are limited by anatomical and positional variables [21,22]. Previously, we have reported that the three dimensional-CT showed better intra-and inter-observer agreement than two dimensional-CT for assessing acetabular anteversion in DDH [9]. Therefore, in the present study, we employed three dimensional-CT assessing the femoral neck anteversion, acetabular anteversion and combined anteversion in DDH.…”

“…Therefore, exactly evaluating the anteversion of acetabulum and femur could be quite crucial before surgical decision-making for children with DDH to avoid complications. Several investigators have reported that anteversion of the acetabulum is significantly increased on the side involved in DDH [7][8][9], whereas others have failed to confirm those findings [10][11][12][13]. In the past, the widely held belief was that there was increased femoral anteversion on the involved side in DDH; and so femoral derotational osteotomy was believed to be required.…”

Development of acetabular anteversion in children with normal hips and those with developmental dysplasia of the hip: a cross-sectional study using magnetic resonance imaging

“…At the same time, AA is also an important reference index for various pelvic rotational osteotomy or hip replacement procedures. Traditionally, AA is measured on 3D computed tomography (CT) (Li et al 2009), which represents the osseous acetabular anteversion (OAA). However, children's acetabulum is mostly composed of cartilage; the cartilaginous acetabular anteversion (CAA) determined by the cartilaginous anterior and posterior walls is the true AA, but cannot be measured by CT scan.…”

Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography

“…By using reconstruction techniques based on the special software, the orthopedic surgeon can inspect the anatomy from any desired angle and any section. Previously, we have reported that the three-dimensional computed tomography (3D-CT) showed better intra-and interobserver agreement than 2D-CT for assessing acetabular and femoral anteversion in DDH [16][17][18]. Therefore, the authors intend to employ 3D-CT and conventional plain Wlms evaluating the femoral head coverage in the present study.…”