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The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

  • Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool.

Questions/Purposes

We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model.

Methods

We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model.

Results

Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum.

Conclusions

Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Bern, Inselspital, Freiburgstrasse, 3010, Bern, Switzerland

    Klaus A. Siebenrock MD, Lea Kistler, Joseph M. Schwab MD, Lorenz Büchler MD & Moritz Tannast MD

Authors
  1. Klaus A. Siebenrock MD
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  2. Lea Kistler
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  3. Joseph M. Schwab MD
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  4. Lorenz Büchler MD
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  5. Moritz Tannast MD
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Corresponding author

Correspondence to Klaus A. Siebenrock MD.

Additional information

One of the authors (JMS) certifies that he, or a member of his immediate family, has received or may receive, during the study period, fellowship funding from the Maurice E. Müller Foundation of North America. Each author certifies that he or she, or a member of his or her immediate family, 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.

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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Siebenrock, K.A., Kistler, L., Schwab, J.M. et al. The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients. Clin Orthop Relat Res 470, 3355–3360 (2012). https://doi.org/10.1007/s11999-012-2477-2

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  • DOI: https://doi.org/10.1007/s11999-012-2477-2

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