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Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

  • Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Recent biplanar radiographic studies have demonstrated acetabular retroversion and increased superolateral femoral head coverage in hips with slipped capital femoral epiphysis (SCFE), seemingly divergent from earlier CT-based studies suggesting normal acetabular version.

Question/purposes

We therefore asked: Are there differences in (1) acetabular version at the superior ¼ of the acetabular dome (AVsup), (2) acetabular version at the center of the femoral head (AVcen), and (3) superolateral femoral head coverage (lateral center-edge angle [LCEA]) among affected SCFE hips, unaffected hips, and normal controls?

Methods

We identified 32 patients with SCFE who underwent CT between 2007 and 2012. Twenty-three met our inclusion criteria. Seventy-six age- and sex-matched normal patients comprised the control group. Pelvic rotation, tilt, and inclination were corrected on each CT. AVsup, AVcen, and LCEA were measured.

Results

The mean AVsup of the affected hips (−1.71°) demonstrated retroversion compared to the unaffected hips and the control group; the mean AVsup of the unaffected hips was similar to that of the normal controls. Mean AVcen was similar among the three groups. The LCEA was higher in affected and unaffected SCFE hips than in the control group (34.3° versus 34.5° versus 28.9°, respectively), but we found no difference between affected and unaffected hips.

Conclusions

Our data suggest an association of superior acetabular retroversion and increased superolateral femoral head coverage in SCFE. Whether this represents a primary abnormal morphology or a secondary pathologic response remains unclear. Further studies investigating the role of acetabular morphology in SCFE and its implications for development of symptomatic femoroacetabular impingement are warranted.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Rady Children’s Hospital and Health Center, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Shafagh Monazzam MD, Venkatadass Krishnamoorthy MD, Bernd Bittersohl MD, James D. Bomar MPH & Harish S. Hosalkar MD

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  1. Shafagh Monazzam MD
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  2. Venkatadass Krishnamoorthy MD
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  3. Bernd Bittersohl MD
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  4. James D. Bomar MPH
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  5. Harish S. Hosalkar MD
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Corresponding author

Correspondence to Harish S. Hosalkar MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Monazzam, S., Krishnamoorthy, V., Bittersohl, B. et al. Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?. Clin Orthop Relat Res 471, 2145–2150 (2013). https://doi.org/10.1007/s11999-012-2697-5

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  • DOI: https://doi.org/10.1007/s11999-012-2697-5

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