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Acetabular overcoverage in the horizontal plane: an underdiagnosed trigger of early hip arthritis. A CT scan study in young adults

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Acetabular overcoverage promotes hip osteoarthritis causing a pincer-type femoroacetabular impingement. Acetabular coverage in the horizontal plane is usually poorly defined in imaging studies and may be misdiagnosed. The goal of this study was to analyze the role of acetabular overcoverage measured in the frontal plane and in the horizontal plane by CT scan and to determine its relationship with other anatomic features in the onset of hip arthritis in young adults.

Materials and methods

We compared prospectively CT scans from two groups of adults of 55 years or younger: the patient group (n = 30) consisted of subjects with diagnosis of early hip arthritis (Tönnis Grade I or II) and the control group (n = 31) consisted of subjects with healthy hips. Two independent observers analyzed centre edge angle (CEA), acetabular anteversion angle (AAA), anterior sector acetabular angle (AASA), posterior sector acetabular angle (PASA), horizontal acetabular sector angle (HASA), femoral anteversion angle (FAVA), alpha angle (AA), and Mckibbin Instability Index (MI).

Results

Angles measuring the acetabular coverage on the horizontal plane (AASA, PASA and, HASA) were significantly higher in the patient group (p < 0.001, p = 0.03 and p < 0.001, respectively). Pearson’s correlation coefficient showed a positive correlation between CEA and HASA in patients (r = 0.628) and in controls (r = 0.660). However, a high CEA (> 35º) was strongly associated with a high HASA (> 160º) in patients (p = 0.024) but not in controls (p = 0.21), suggesting that pincer should be simultaneously present in the horizontal and frontal plane to trigger hip degeneration. No significant association was detected between a high alpha angle (> 60º) and a high CEA (> 35º suggesting that a mixed pincer-cam aetiology was not prevalent in our series. Multivariate regression analysis showed the most significant predictors of degenerative joint disease were HASA (p = 0.008), AA (p = 0.048) and ASAA (p = 0.004).

Conclusions

Acetabular overcoverage in the horizontal plane plays an important role in the onset of early hip arthritis. Considering that this condition is usually underdiagnosed, we suggest the anterior sector acetabular angle, the posterior sector acetabular angle, and the horizontal acetabular sector angles be routinely included in decision-making algorithms in hip conservative surgery to better define hips-at-risk of developing early hip osteoarthritis.

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Author information

Authors and Affiliations

  1. Hip Unit, Department of Orthopaedics Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Màrius Valera & Rogelio Sancho

  2. Department of Orthopaedics Surgery, Hospital Residència Sant Camil - Seu, Consorci Sanitari del Garraf, Sant Pere de Ribes, Spain

    Natalia Ibáñez

  3. Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Jaume Llauger

  4. Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Ignasi Gich

Authors
  1. Màrius Valera
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  2. Natalia Ibáñez
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  3. Rogelio Sancho
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  4. Jaume Llauger
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  5. Ignasi Gich
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Correspondence to Màrius Valera.

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The authors declare that they have no conflict of interest.

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Ethical approval

The study was approved by the clinical research ethics committee at our institution (CODE: EBE-2011-74).

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Informed consent was obtained from all individual participants included in the study.

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Valera, M., Ibáñez, N., Sancho, R. et al. Acetabular overcoverage in the horizontal plane: an underdiagnosed trigger of early hip arthritis. A CT scan study in young adults. Arch Orthop Trauma Surg 138, 73–82 (2018). https://doi.org/10.1007/s00402-017-2811-y

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  • DOI: https://doi.org/10.1007/s00402-017-2811-y

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