The Shenton Line in the Diagnosis of Acetabular Dysplasia in the Skeletally Mature Patient

Rhee, Peter C.; Woodcock, Jessica A.; Clohisy, John C.; Millis, Michael B.; Sucato, Daniel J.; Beaulé, Paul E.; Trousdale, Robert T.; Sierra, Rafael J.

doi:10.2106/jbjs.j.01717

Cited by 35 publications

(30 citation statements)

References 14 publications

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“…[15][16][17][18][19][20] At some critical point, greater than normal amounts of load/shear will result in significant cartilage damage. Second, orthopaedic surgeons believe that the concept relating acetabular dysplasia to osteoarthritis is valid.…”

Section: Discussionmentioning

confidence: 99%

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What is the Evidence to Support Acetabular Dysplasia as a Cause of Osteoarthritis?

Cooperman

2013

Journal of Pediatric Orthopaedics

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The term "acetabular dysplasia" suggests a smaller than normal acetabulum or one that is abnormally vertical. Acetabular dysplasia has been linked to the development of hip osteoarthritis over the last 90 years in 3 ways. First, it has been linked through the concept that biomechanical forces can cause osteoarthritis. A smaller than normal acetabulum will result in a smaller than normal contact surface between the femoral head and the acetabulum. This will generate increased pressure per unit of area, which will precipitate articular cartilage failure when the pressure reaches a critical point. Osteoarthritis will ensue in response to this cartilage failure. A more vertical than normal acetabulum will be associated with increased shear. When that shear reaches a critical level, articular cartilage will fail, leading that to osteoarthritis. This critical level, for a small or a steep acetabulum, may differ between individuals, based on their biology and their life styles. Second, it has been linked by multiple empirical studies. One of these is Wiberg's 1939 thesis entitled "Studies on Dysplastic Acetabula and Congenital Subluxation of the Hip Joint with Special reference to the Complication of Osteoarthritis." It is among the most quoted and most powerful works in the Orthopaedic literature connecting a disease entity with an antecedent. Third, the linkage is reenforced by an absence of glaring exceptions to the hypothesis that acetabular dysplasia causes osteoarthritis. Orthopaedic surgeons just do not report on dysplastic hips in the arthritis-free elderly. The inability of the Orthopaedic community to identify even 1 elderly, arthritis-free individual with significant hip dysplasia should not carry weight in establishing the concept that acetabular dysplasia causes osteoarthritis. However, the longer this case report goes unpublished, the more certain orthopaedic surgeons will be that the 2 are linked.

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Section: Discussionmentioning

confidence: 99%

“…[19][20][21] There is simply no case report or study reporting on a card-carrying Medicare patient who is arthritis-free with a subluxated hip, (Fig. If we saw a few, our confidence might be shaken.…”

Section: Discussionmentioning

confidence: 99%

What is the Evidence to Support Acetabular Dysplasia as a Cause of Osteoarthritis?

Cooperman

2013

Journal of Pediatric Orthopaedics

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“…Several reference lines and angles are useful in evaluating anteroposterior radiographs of the pelvis. Shenton's line[12] is a curved line that begins at the lesser trochanter, continues along the femoral neck, and connects to a line along the inner margin of the pubis. In the dislocated hip, Shenton's line has a step-off because the femoral neck lies cephalad to the line from the pubis.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults

Tian

Zhao

Wang

et al. 2017

Chinese Medical Journal

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Background:The prevalence of developmental dysplasia of the hip (DDH) is unknown in China. We aimed to determine the prevalence of DDH in Chinese adults.Methods:In this study, we performed a cross-sectional survey of a nationally representative sample of Chinese adults. All participants underwent questionnaire investigation, physical examination, and X-ray examination. Factors associated with DDH were analyzed with logistic regression.Results:We invited 29,180 individuals aged 18 years and over to participate, randomly selected from 18 primary sampling units (street districts in urban areas and townships in rural areas). The survey and examination were completed in 25,767 people (10,296 men and 15,471 women). DDH was diagnosed in 391 people, yielding an overall DDH prevalence of 1.52%. Based on this information, we estimate the number of individuals with DDH in China to be approximately 16.05 million. DDH prevalence increased with age (odds ratio = 1.53 [1.03–2.27], P = 0.036), was significantly higher among women than men (2.07% vs. 0.75%, P < 0.001), and was higher among rural residents than urban residents (1.75% vs. 1.29%, P < 0.001). Economic development was independently associated with the presence of DDH. There was no evidence of an association between body mass index alone, education, or current smoking or drinking and risk of DDH (P > 0.05).Conclusions:DDH has become an important public health problem. Special attention should be paid to residents with DDH. Screening for DDH should be performed in China.

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“…In surgical planning, joint congruity and subluxation are two additional important radiographic factors. The Shenton line (an arc drawn from the medial aspect of the femoral neck through the superior margin of the obturator foramen) is a reliable and accurate radiographic marker to detect superior femoral head subluxation 46 . For joint congruity, Yasunaga et al 47 developed a classification system with four grades: excellent, indicating the subchondral plates of the acetabulum and the femoral head are parallel and the joint space is uniformly maintained; good, the subchondral plates of the acetabulum and the femoral head are not parallel, but the joint space is maintained; fair, partial narrowing of the joint space; and poor, partial loss of the joint space.…”

Section: Imagingmentioning

confidence: 99%

Hip Dysplasia in the Young Adult

Gala

Clohisy²,

Beaulé

2016

The Journal of Bone and Joint Surgery

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215

163

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The Shenton Line in the Diagnosis of Acetabular Dysplasia in the Skeletally Mature Patient

Abstract: The Shenton line is a reliable and accurate radiographic marker to detect superior femoral head subluxation indicative of acetabular dysplasia.

Cited by 35 publications

References 14 publications

What is the Evidence to Support Acetabular Dysplasia as a Cause of Osteoarthritis?

What is the Evidence to Support Acetabular Dysplasia as a Cause of Osteoarthritis?

Prevalence of Developmental Dysplasia of the Hip in Chinese Adults

Hip Dysplasia in the Young Adult

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