Skip to main content
Log in

Defining a reference range of acetabular inclination and center-edge angle of the hip in asymptomatic individuals

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Acetabular morphology is an important predictor of the severity of osteoarthrosis and survival of hip prostheses but there is limited data on the normal range of acetabular measurements on plain radiographs. The aim of this project was to determine the statistically normal ranges of acetabular inclination (AI) and center-edge angle (CEA).

Method

One hundred coronal CT localizers (50 men and 50 women aged 20–30 years) were included in this study. All the patients underwent CT examination for thoracic or intra-abdominal indications. Patients with pelvic disease, fractures, history of serious trauma, or previous pelvic surgery were excluded. One pair of independent observers measured the AI and pelvic tilt (PT), and a further pair measured the center-edge angle (CEA), using electronic calipers on a high-resolution PACS workstation.

Results

AI and CEA measurements were obtained for 200 hips. There was very good intra-class correlation between the observers (r = 0.7–0.8). The mean AI was 38.8° (2SD 32.1–45.5°). That in men was 38.0° (2 SD 31.8–44.1°) and 39.6° (2 SD 32.7–46.8°) in women, which was statistically significantly different (p < 0.001). The mean CEA measurement for all patients was 36.3° (SD 13.8°), for men 37.7° (SD 10.8°) and for women 34.9° (SD 11.4°) with a statistically significant gender difference (p < 0.001). The mean pelvic tilt measurement (sacro-coccygeal-pubic symphysis) was 38.3 mm (2 SD 18.3–58.3 mm) with a significant gender difference (p < 0.001).

Conclusions

The results of this study define reference ranges of two common measures of acetabular morphology and confirm statistically significant differences between men and women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Murray DW. The definition and measurement of acetabular orientation. J Bone Jt Surg Br. 1993;75(2):228–32.

    Article  CAS  Google Scholar 

  2. Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:263–9.

    Google Scholar 

  3. Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Jt Surg Am. 1999;81(12):1747–70.

    Article  Google Scholar 

  4. Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis and Cartilage / OARS. 2003;11(7):508–18.

    Article  CAS  Google Scholar 

  5. Leunig M, Beck M, Dora C, Ganz R. Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade. 2006;35(1):77–84.

    Article  CAS  Google Scholar 

  6. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466(2):264–72.

    Article  Google Scholar 

  7. Steppacher SD, Tannast M, Werlen S, Siebenrock KA. Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res. 2008;466(4):782–90.

    Article  CAS  Google Scholar 

  8. Vossinakis IC, Georgiades G, Kafidas D, Hartofilakidis G. Unilateral hip osteoarthritis: can we predict the outcome of the other hip? Skeletal Radiol. 2008;37(10):911–6.

    Article  CAS  Google Scholar 

  9. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F. Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res. 2005;436:144–50.

    Article  Google Scholar 

  10. Haenle M, Heitner A, Mittelmeier W, Barbano R, Scholz R, Steinhauser E, et al. Assessment of cup position from plain radiographs: impact of pelvic tilting. Surg Radiol Anat. 2007;29(1):29–35.

    Article  CAS  Google Scholar 

  11. Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Jt Surg Br. 1961;43(2):268.

    Article  Google Scholar 

  12. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand. 1939;83:1–132.

    Google Scholar 

  13. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Jt Surg Am. 1978;60(2):217–20.

    Article  CAS  Google Scholar 

  14. Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–8.

    Article  Google Scholar 

  15. Nagao Y, Aohi H, Ishii SJ, Masuda T, Beppu M. Radiographic method to measure the inclination angle of the acetabulum. J Orthop Sci Jap Orthop Assoc. 2008;13(1):62–71.

    Google Scholar 

  16. Kalteis TA, Handel M, Herbst B, Grifka J, Renkawitz T. In vitro investigation of the influence of pelvic tilt on acetabular cup alignment. J Arthroplasty. 2009;24(1):152–7.

    Article  Google Scholar 

  17. Stulberg SD, Harris WH. 1974. Acetabular dysplasia and development of osteoarthritis of the hip. In The Hip: Proceeding of the Second Open Scientific Meeting of the Hip Society. St Louis, Mo: CV Mosby, pp. 83–93

  18. Armbuster TG, Guerra Jr J, Resnick D, Goergen TG, Feingold ML, Niwayama G, et al. The adult hip: an anatomic study. Part I: the bony landmarks. Radiology. 1978;128(1):1–10.

    Article  CAS  Google Scholar 

  19. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76(4):517–23.

    Article  Google Scholar 

  20. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays–a comparison of six parameters. Skeletal Radiol. 2006;35(3):149–55.

    Article  CAS  Google Scholar 

  21. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop. 1976;119:39–47.

    Google Scholar 

  22. McGraw K, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Meth. 1996;1(1):30–46.

    Article  Google Scholar 

  23. Altman DG, 1990. Practical Statistics for Medical Research 1st ed., Chapman and Hall/CRC

  24. Kojima A, Nakagawa T, Tohkura A. Simulation of acetabular coverage of femoral head using anteroposterior pelvic radiographs. Arch Orthop Trauma Surg. 1998;117(6–7):330–6.

    Article  CAS  Google Scholar 

  25. Sandring S, Healy J, Johnson D, Williams A, Ellis H (eds.) 2004. Pelvic girdle and lower limb. In Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 39th Ed. Churchill Livingstone, p 1430

  26. Pederson DR, Lamb CA, Dolan MA, Ralston BS, Weinstein SL, Morcuende JA. Radiographic measurements in developmental dysplasia of the hip: reliability and validity of a digitizing program. J Ped Orthop. 2004;24(2):156–60.

    Article  Google Scholar 

  27. Richards PJ, Pattison JM, Belcher J, DeCann RW, Anderson S, Wynn-Jones C. A new tilt on pelvic radiographs: a pilot study. Skeletal Radiol. 2009;38(2):113–22.

    Article  CAS  Google Scholar 

  28. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, et al. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–90.

    Article  CAS  Google Scholar 

  29. Anda S, Svenningsen S, Grontvedt T, Benum P. Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol. 1990;31(4):389–94.

    Article  CAS  Google Scholar 

  30. Sanders G, Starvakas P. A technique for measuring pelvic tilt. Phys Ther. 1981;61(1):49–50.

    Article  CAS  Google Scholar 

  31. Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H. Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res. 2003;411:140–51.

    Article  Google Scholar 

  32. Crawford MB, Toms AP, Shepstone L. Defining normal vertebral angulation at the thoracolumbar junction. AJR Am J Roentgenol. 2009;193(1):W33–7.

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lucy A. Fowkes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fowkes, L.A., Petridou, E., Zagorski, C. et al. Defining a reference range of acetabular inclination and center-edge angle of the hip in asymptomatic individuals. Skeletal Radiol 40, 1427–1434 (2011). https://doi.org/10.1007/s00256-011-1109-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-011-1109-3

Keywords

Navigation