Clinical Orthopaedics and Related Research®

, Volume 470, Issue 12, pp 3297–3305 | Cite as

Pelvic Morphology Differs in Rotation and Obliquity Between Developmental Dysplasia of the Hip and Retroversion

  • Moritz Tannast
  • Peter Pfannebecker
  • Joseph M. Schwab
  • Christoph E. Albers
  • Klaus A. Siebenrock
  • Lorenz Büchler
Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Abstract

Background

Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality.

Questions/Purposes

We asked: How does DDH and retroversion differ with respect to rotation and coronal obliquity as measured by the pelvic width index, anterior inferior iliac spine (AIIS) sign, ilioischial angle, and obturator index? And what is the predictive value of each variable in detecting acetabular retroversion?

Methods

We reviewed AP pelvis radiographs for 51 dysplastic and 51 retroverted hips. Dysplasia was diagnosed based on a lateral center-edge angle of less than 20° and an acetabular index of greater than 14°. Retroversion was diagnosed based on a lateral center-edge angle of greater than 25° and concomitant presence of the crossover/ischial spine/posterior wall signs. We calculated sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for each variable used to diagnose acetabular retroversion.

Results

We found a lower pelvic width index, higher prevalence of the AIIS sign, higher ilioischial angle, and lower obturator index in acetabular retroversion. The entire innominate bone is internally rotated in DDH and externally rotated in retroversion. The areas under the ROC curve were 0.969 (pelvic width index), 0.776 (AIIS sign), 0.971 (ilioischial angle), and 0.925 (obturator index).

Conclusions

Pelvic morphology is associated with acetabular pathomorphology. Our measurements, except the AIIS sign, are indirect indicators of acetabular retroversion. The data suggest they can be used when the acetabular rim is not clearly visible and retroversion is not obvious.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Ait-Ameur A, Wakim A, Dubousset J, Kalifa G, Adamsbaum C. The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex? Pediatr Radiol. 2001;31:640–645.PubMedCrossRefGoogle Scholar
  2. 2.
    Albiñana J, Morcuende JA, Delgado E, Weinstein SL. Radiologic pelvic asymmetry in unilateral late-diagnosed developmental dysplasia of the hip. J Pediatr Orthop. 1995;15:753–762.PubMedCrossRefGoogle Scholar
  3. 3.
    Albiñana-Cilveti J, Delgado-Baeza E, Miralles-Flores C. Pelvic deformity in experimental dislocation of the growing hip. Int Orthop. 1992;16:317–321.PubMedCrossRefGoogle Scholar
  4. 4.
    Delgado-Baeza E, Albiñana-Cilveti J, Miralles-Flores C. Why does pelvic deformity occur in experimental dislocation of the growing hip? J Pediatr Orthop. 1992;12:376–383.PubMedCrossRefGoogle Scholar
  5. 5.
    Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia. J Orthop Trauma. 2000;14:483–489.PubMedCrossRefGoogle Scholar
  6. 6.
    Flückiger G, Eggli S, Kosina J, Ganz R. [Birth after peri-acetabular osteotomy] [in German]. Orthopade. 2000;29:63–67.PubMedGoogle Scholar
  7. 7.
    Fujii M, Nakashima Y, Sato T, Akiyama M, Iwamoto Y. Pelvic deformity influences acetabular version and coverage in hip dysplasia. Clin Orthop Relat Res. 2011;469:1735–1742.PubMedCrossRefGoogle Scholar
  8. 8.
    Gugenheim JJ, Gerson LP, Sadler C, Tullos HS. Pathologic morphology of the acetabulum in paralytic and congenital hip instability. J Pediatr Orthop. 1982;2:397–400.PubMedCrossRefGoogle Scholar
  9. 9.
    Hogervorst T, Bouma H, de Boer SF, de Vos J. Human hip impingement morphology: an evolutionary explanation. J Bone Joint Surg Br. 2011;93:769–776.PubMedCrossRefGoogle Scholar
  10. 10.
    Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign.” J Orthop Res. 2007;25:758–765.PubMedCrossRefGoogle Scholar
  11. 11.
    Jia J, Zhang L, Zhao Q, Li L, Liu X. Does medial rotational deformity of the whole pelvis universally exist in unilateral DDH? Arch Orthop Trauma Surg. 2011;131:1383–1388.PubMedCrossRefGoogle Scholar
  12. 12.
    Kakaty DK, Fischer AF, Hosalkar HS, Siebenrock KA, Tannast M. The ischial spine sign: does pelvic tilt and rotation matter? Clin Orthop Relat Res. 2010;468:769–774.PubMedCrossRefGoogle Scholar
  13. 13.
    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.PubMedCrossRefGoogle Scholar
  14. 14.
    Kojima S, Kobayashi S, Saito N, Nawata M, Horiuchi H, Takaoka K. Morphological characteristics of the bony birth canal in patients with developmental dysplasia of the hip (DDH): investigation by three-dimensional CT. J Orthop Sci. 2001;6:217–222.PubMedCrossRefGoogle Scholar
  15. 15.
    Kojima S, Kobayashi S, Saito N, Nawata M, Horiuchi H, Takaoka K. Three-dimensional computed tomography evaluation of bony birth canal morphologic deformity (small pelvic cavity) after dome pelvic osteotomy for developmental dysplasia of the hip. Am J Obstet Gynecol. 2002;187:1591–1595.PubMedCrossRefGoogle Scholar
  16. 16.
    Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res. 2003:245–253.Google Scholar
  17. 17.
    Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.PubMedGoogle Scholar
  18. 18.
    Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.PubMedCrossRefGoogle Scholar
  19. 19.
    Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278–286.PubMedGoogle Scholar
  20. 20.
    Suzuki S. Deformity of the pelvis in developmental dysplasia of the hip: three-dimensional evaluation by means of magnetic resonance image. J Pediatr Orthop. 1995;15:812–816.PubMedCrossRefGoogle Scholar
  21. 21.
    Tannast M, Albers CE, Steppacher SD, Siebenrock KA. Hip pain in the young adult. In: Bentley G, ed. European Instructional Lectures. Berlin, Germany: Springer; 2011:141–154.CrossRefGoogle Scholar
  22. 22.
    Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm—reliable and validated. J Orthop Res. 2008;26:1199–1205.PubMedCrossRefGoogle Scholar
  23. 23.
    Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.PubMedCrossRefGoogle Scholar
  24. 24.
    Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–190.PubMedCrossRefGoogle Scholar
  25. 25.
    Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.PubMedGoogle Scholar
  26. 26.
    Trousdale RT, Cabanela ME, Berry DJ, Wenger DE. Magnetic resonance imaging pelvimetry before and after a periacetabular osteotomy. J Bone Joint Surg Am. 2002;84:552–556.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Moritz Tannast
    • 1
  • Peter Pfannebecker
    • 1
  • Joseph M. Schwab
    • 1
  • Christoph E. Albers
    • 1
  • Klaus A. Siebenrock
    • 1
  • Lorenz Büchler
    • 1
  1. 1.Department of Orthopaedic Surgery, Murtenstrasse, InselspitalUniversity of BernBernSwitzerland

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