Skip to main content
SpringerLink
Log in

Weightbearing Anteroposterior Pelvic Radiographs are Recommended in DDH Assessment

  • Symposium: Developmental Dysplasia of the Hip
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Neutral pelvic positioning during recording of anteroposterior pelvic radiographs has been recommended for precise interpretation of acetabular deformities. Because the effect of pelvic positioning is controversial in the literature, we asked whether the weightbearing position would alter radiographic interpretations. We obtained sets of supine and weightbearing anteroposterior pelvic radiographs of 31 patients with developmental dysplasia of the hip and measured pelvic tilt, acetabular version, center edge angle, acetabular index, joint space width and femoral head translation. For both genders the pelvis extended when patients were repositioned from supine to weightbearing but extension was more pronounced in women compared with men. The number of patients with apparent acetabular retroversion was reduced from 11 supine to four when weightbearing. The center edge angle, acetabular index, joint space width and femoral head translation were similar in both views. We recommend weightbearing anteroposterior pelvic radiographs be obtained to assess DDH given the differences in pelvic flexion-extension and interpretations of acetabular version.

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

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Altman RD, Bloch DA, Dougados M, Hochberg M, Lohmander S, Pavelka K, Spector T, Vignon E. Measurement of structural progression in osteoarthritis of the hip: the Barcelona consensus group. Osteoarthritis Cartilage. 2004;12:515–524.

    Article  PubMed  CAS  Google Scholar 

  2. Anda S, Svenningsen S, Grøntvedt T, Benum P. Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol. 1990;31:389–394.

    Article  PubMed  CAS  Google Scholar 

  3. Ball F, Kommenda K Sources of error in the roentgen evaluation of the hip in infancy. Ann Radiol. 1968;11:298–303.

    PubMed  CAS  Google Scholar 

  4. Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy. 2003;19:1055–1060.

    Article  PubMed  Google Scholar 

  5. Conrozier T, Lequesne MG, Tron AM, Mathieu P, Berdah L, Vignon E. The effects of position on the radiographic joint space in osteoarthritis of the hip. Osteoarthritis Cartilage. 1997;5:17–22.

    Article  PubMed  CAS  Google Scholar 

  6. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.

    Article  PubMed  CAS  Google Scholar 

  7. Jacobsen S. Adult hip dysplasia and osteoarthritis. Studies in radiology and clinical epidemiology. Acta Orthop. 2006;77(Suppl 324):1–37.

    Google Scholar 

  8. Jacobsen S, Sonne-Holm S, Lund B, Søballe K, Kiær T, Rovsing H, Monrad H. Pelvic orientation and assessment of hip dysplasia in adults. Acta Orthop. 2004;75:721–729.

    Article  Google Scholar 

  9. Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anterior pelvic radiographs to assess acetabular retroversion: high validity of the ‘cross-over-sign. J Orthop Res. 2007;25:758–765.

    Article  PubMed  Google Scholar 

  10. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.

    PubMed  CAS  Google Scholar 

  11. Konishi N, Mieno N, Mieno T. Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique. J Bone Joint Surg Am. 1993;75:1318–1333.

    PubMed  CAS  Google Scholar 

  12. Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80.

    Article  PubMed  Google Scholar 

  13. Leunig M, Siebenrock KA, Ganz R. Rationale of the periacetabular osteotomy and background work. Instr Course Lect. 2001;50:229–238.

    PubMed  CAS  Google Scholar 

  14. Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48–53.

    Article  PubMed  Google Scholar 

  15. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.

    Article  PubMed  Google Scholar 

  16. 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;411:140–151.

    Article  PubMed  Google Scholar 

  17. Pitto RP, Klaue K, Ganz R, Ceppatelli S Acetabular rim pathology secondary to congenital hip dysplasia in the adult. A radiographic study. Chir Organi Mov. 1995;80:361–368.

    PubMed  CAS  Google Scholar 

  18. Portinaro NM, Murray DW, Bhullar TP, Benson MK. Errors in measurement of acetabular index. J Pediatr Orthop. 1995;15:780–784.

    PubMed  CAS  Google Scholar 

  19. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  PubMed  CAS  Google Scholar 

  20. Siebenrock K, Kalbermatten D, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.

    Article  PubMed  Google Scholar 

  21. Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.

    Article  PubMed  Google Scholar 

  22. Tannast M, Murphy S, Langlotz F, Anderson S, Siebenrock K. Estimation of pelvic tilt on anteroposterior x-rays—a comparison of six parameters. Skeletal Radiol. 2006;35:149–155.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  25. Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Berlin, Heidelberg, New York: Springer; 1987.

  26. Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–150.

    Article  PubMed  Google Scholar 

  27. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand. 1939;83(Suppl 58):1–132.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Research Unit, University Hospital of Aarhus, Tage-Hansens Gade 2, Building 7B, DK-8000, Aarhus C, Denmark

    Anders Troelsen MD & Kjeld Søballe MD, DMSc

  2. Department of Orthopaedic Surgery, University Hospital of Hvidovre, Kettegård Alle 30, DK-2650, Hvidovre, Copenhagen, Denmark

    Steffen Jacobsen MD, DMSc

  3. Department of Radiology, University Hospital of Aarhus, Tage-Hansens Gade 2, Building 2B, DK-8000, Aarhus C, Denmark

    Lone Rømer MD

Authors
  1. Anders Troelsen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen Jacobsen MD, DMSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lone Rømer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kjeld Søballe MD, DMSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anders Troelsen MD.

Additional information

Each author certifies that he or she has no 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.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Troelsen, A., Jacobsen, S., Rømer, L. et al. Weightbearing Anteroposterior Pelvic Radiographs are Recommended in DDH Assessment. Clin Orthop Relat Res 466, 813–819 (2008). https://doi.org/10.1007/s11999-008-0156-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0156-0

Keywords

Search

Navigation