Variability of Acetabular Coverage Between Supine and Weightbearing Pelvic Radiographs

Pullen, W. Michael; Henebry, Andrew; Gaskill, Trevor R.

doi:10.1177/0363546514548854

Cited by 49 publications

(55 citation statements)

References 16 publications

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“…In our study, we demonstrate that the functional orientation of the acetabulum varies between supine and standing radiographs and should be considered when analyzing the radiographs of patients with symptomatic FAI. The SCD, which has become a commonly used surrogate measure of pelvic tilt, was noted to decrease by 7 mm when changing from the supine to standing position, which was slightly less than recently reported measurements by Pullen et al [25], which noted a mean decrease of 11 mm among males and 16 mm among females. Troelsen et al [26] also demonstrated similar changes in pelvic tilt when comparing supine with standing radiographs in a series of patients with acetabular dysplasia.…”

Section: Discussioncontrasting

confidence: 59%

“…Similar to the study by Troelsen et al [26], our study did not demonstrate any significant change in the LCEA. Other studies, however, have demonstrated significant decreases in the LCEA between 1.2°and 3.6° [8,25]. These studies, however, performed measurements of true weightbearing radiographs and perhaps weightbearing through the hip may allow for slight femoral head lateral translation, which would result in a decrease in the LCEA measurement.…”

Section: Discussionmentioning

confidence: 96%

“…AP pelvis radiographs are used routinely and are generally obtained with the patient positioned supine. Some have questioned the validity of supine pelvic radiographs in the patient with young hip disorders, because this pelvic position is not functional and does not include the dynamic influence of periarticular musculature and sagittal balance in the standing position [25]. The purpose of this study was to determine the effect of supine and standing pelvic orientation on acetabular version parameters on two-and 3-D imaging studies.…”

Section: Discussionmentioning

confidence: 99%

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Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Ross

Tannenbaum

Nepple

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Often, anteroposterior (AP) pelvic radiographs are performed with the patient positioned supine. However, this may not represent the functional position of the pelvis and the acetabulum, and so when assessing patients for conditions like femoroacetabular impingement (FAI), it is possible that standing radiographs better incorporate the dynamic influences of periarticular musculature and sagittal balance. However, this thesis remains largely untested. Questions/purposes The purpose of this study was to determine the effect of supine and standing pelvic orientation on (1) measurements of acetabular version and common radiographic signs of FAI as assessed on two-and three-dimensional (3-D) imaging; and (2) on terminal hip range of motion (ROM). Methods Preoperative pelvic CT scans of 50 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI between July 2013 and October 2014 were analyzed. The mean age of the study population was 29 ± 10 years (range, 15-50 years) and 70% were male. All patients had a standing AP pelvis radiograph, a reconstructed supine radiograph from the CT data, and a 3-D model created to allow manipulation of pelvic tilt and simulate ROM to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign were recorded on simulated plain radiographs. Measurements of ROM to bony impingement were made during (1) simulated hip flexion; (2) simulated internal rotation in 90°of flexion (IRF); and (3) simulated internal rotation in 90°of flexion and 15°adduction (FADIR), and the location of bony One or more of the authors has received funding outside of submitted work from Smith & Nephew (Andover, MA, USA) (JJN); Smith & Nephew and A3 Surgical (La Tronche, France) (CML); and Smith & Nephew, A3 Surgical, and Pivot (Sunnyvale, CA, USA) (BTK, AB). During the study period, an amount less than USD 10,000 was received. One or more of the authors has stock/stock options in A3 Surgical (CML, AB) and A3 Surgical and Pivot (BTK Clin Orthop Relat Res (2015) 473:1267-1273 DOI 10.1007/s11999-014-4104-x Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®contact between the proximal femur and acetabular rim was defined. These measurements were calculated for supine and standing pelvic orientations. A paired Student's t-test was used for comparison of continuous variables, whereas chi square testing was used for categorical variables. A p value of \ 0.05 was considered significant. Results When changing from supine to the standing radiographs, both mean cranial and central version increased by 2°± 4°(95% confidence interval [CI], 1°-3°) and 2°± 3°(95% CI, 1°-3°), respectively (both p \ 0.001). However, with the numbers available, there were no changes in the proportion of positive crossover, posterior wall, and prominent ischial spine signs. Standing pelvic position tilt resulted in an increased hip flexion of 3°( 95% CI, 2°-4°) as well as an i...

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Ross

Tannenbaum

Nepple

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…However, recent studies have shown that changes in pelvic tilt do not result in clinically significant changes in the LCEA and acetabular index. 32,38,40 In contrast, pelvic tilt does influence the presence or absence of the crossover sign. 38,40 As a result, the crossover sign was not evaluated, and our study is unable to comment on the prevalence of pincer FAI due to retroversion or focal acetabular overcoverage.…”

Section: Kapron Et Almentioning

confidence: 96%

The Prevalence of Radiographic Findings of Structural Hip Deformities in Female Collegiate Athletes

et al. 2015

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“…Importantly, the presence of cam morphology on lateral radiographs, as suggested by a positive α angle, does not necessitate a decrease in clearance between the femoral head and acetabular rim 30. An additional concern is the ability of positional changes (supine vs standing) to significantly alter radiographic measures 31. α Angle will only give an indication of the size of the bony morphology and, as previously discussed, the diagnosis of FAI should also include clinical findings.…”

Section: Current Fai Diagnosis—an Imperfect Foundation For Treatment mentioning

confidence: 99%

Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?

Reiman

Thorborg

2015

Br J Sports Med

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Femoroacetabuler impingement (FAI) is becoming increasingly recognised as a potential pathological entity for individuals with hip pain. Surgery described to correct FAI has risen exponentially in the past 10 years with the use of hip arthroscopy. Unfortunately, the strength of evidence supporting both the examination and treatment of FAI does not appear to accommodate this exponential growth. In fact, the direction currently taken for FAI is similar to previously described paths of other orthopaedic and sports medicine pathologies (eg, shoulder impingement, knee meniscus tear) for which we have learned valuable lessons. The time has come for improved terminology, study design, and focus on delineation of successful treatment variables in the interest of those individuals with clinical indications of FAI so that we can appropriately address their needs.

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Variability of Acetabular Coverage Between Supine and Weightbearing Pelvic Radiographs

Cited by 49 publications

References 16 publications

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

Functional Acetabular Orientation Varies Between Supine and Standing Radiographs: Implications for Treatment of Femoroacetabular Impingement

The Prevalence of Radiographic Findings of Structural Hip Deformities in Female Collegiate Athletes

Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?

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