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Radiographic measurements of hip dysplasia at skeletal maturity—new reference intervals based on 2,038 19-year-old Norwegians

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Abstract

Objective

Normative references for radiographic measurements commonly used in the diagnosis of developmental dysplasia of the hip at skeletal maturity are incomplete. The present study therefore aimed to establish new gender-specific standards for measurements reflecting the acetabular morphology, namely Sharp’s angle, the acetabular roof angle of Tönnis (AA) and the acetabular depth-width ratio (ADR), and measurements reflecting the position of the femoral head related to the acetabulum, namely the center-edge (CE) angle of Wiberg, the refined CE angle of Ogata, and the femoral head extrusion index (FHEI). The joint space width (JSW) is also reported.

Materials and methods

The population-based 1989 Bergen Birth Cohort (n = 3,935) was invited at age 19 years to a follow-up during 2007–09, of which 2,038 (52 %) attended. A standardized antero-posterior radiograph was assessed. The normative references are presented as mean ± standard deviation (SD) and 2.5–97.5 percentiles with 95 % confidence intervals.

Results

A total of 2,011 (841 males, 1,170 females, mean age 18.6 (SD 0.6)) radiographs were analyzed. Sharp’s angle was 38.8° ± 3.5° in males and 40.7° ± 3.5° in females, with 97.5 percentiles of 46° and 47°, respectively. The CE angle was 32.1° ± 6.1° in males and 31.0° ± 6.1° in females, with 2.5 percentiles of 21° and 20°, respectively. The FHEI was 86.0 % ± 6.3 % in males and 85.6 % ± 6.6 % in females, with 2.5 percentiles of 74° and 73°, respectively.

Conclusions

Updated gender-specific reference ranges for radiographic measurements commonly used for hip dysplasia at skeletal maturity are reported, similar to or slightly wider than those described in the literature. Statistically significant gender differences have been confirmed for most of the measurements.

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Acknowledgments

We thank radiographer Sigrun Tufta, Department of Radiology, Haukeland University Hospital, Bergen, for excellent work performing all the radiographic exams during the follow-up and orthopedic nurse Monica Olsen, Department of Orthopedics, for very important logistic work during the follow-up consultations. We also thank Anne Marte Haukom MD, Haukeland University Hospital, for performing some of the clinical examinations during the follow-up. We are grateful to statistical consultant Steinar Nilsen at the Norwegian Medical Birth Registry for all the help with linking of databases. We also thank Douglas Pedersen at the Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, USA, for the development of the digital measurement program, and Dr. Martin Biermann at the Department of Nuclear Medicine, Haukeland University Hospital, for irreplaceable technical assistance for the DICOM transfer of the study radiographs. We thank graphic illustrator Ellinor Moldeklev Hoff, Department of Photo and Drawing, University of Bergen, for the drawing of figures.

This study has received financial support from the Regional Health Board of Western Norway, University of Bergen, and Arthritis Research Campaign UK (grant number 18196). Two of the authors (LBL, IØE) have received PhD grants from the Regional Health Board of Western Norway, and one (TGL) from the Frank Mohn Foundation. The Centre of Epidemiology for Child Health at the University College London Institute of Child Health receives financial support from the Medical Research Council (grant reference G0400546).

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Bergen, Bergen, Norway

    Lene Bjerke Laborie, Ingvild Øvstebø Engesæter, Trude Gundersen Lehmann, Lars Birger Engesæter & Karen Rosendahl

  2. Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway

    Lene Bjerke Laborie, Ingvild Øvstebø Engesæter & Karen Rosendahl

  3. Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway

    Ingvild Øvstebø Engesæter, Trude Gundersen Lehmann & Lars Birger Engesæter

  4. MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH

    Francesco Sera & Carol Dezateux

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  1. Lene Bjerke Laborie
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Laborie, L.B., Engesæter, I.Ø., Lehmann, T.G. et al. Radiographic measurements of hip dysplasia at skeletal maturity—new reference intervals based on 2,038 19-year-old Norwegians. Skeletal Radiol 42, 925–935 (2013). https://doi.org/10.1007/s00256-013-1574-y

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