Skeletally Mature Acetabular Dysplasia: Anatomy, Pathomorphology, Pathomechanics, Clinical Presentation, and Imaging Studies

  • Jesse Chrastil
  • Christopher Pelt
  • Jill Erickson
  • Christopher Peters
Reference work entry


Acetabular dysplasia is a developmental disorder that affects approximately 4 % of the population and can lead to hip pain in the young adult. Over the last decade, the field of hip preservation has evolved with an increased understanding of the underlying pathomorphology and biomechanics of dysplasia. Significant advancements have also been made in the surgical treatment. The treating physician should be well versed in the clinical exam findings and pertinent history to accurately make a diagnosis. There is often significant delay in patient presentation to final diagnosis. Plain radiographs provide significant information and can confirm the diagnosis of dysplasia. Advanced imaging may provide additional information about intra-articular processes and can be useful for preoperative planning. Goals of the surgical treatment of acetabular dysplasia include improving acetabular coverage, medializing the center of rotation, decreasing the joint reactive forces at the hip, and improving overall joint congruity. Left untreated, acetabular dysplasia and associated deformities may be precursors for hip joint arthrosis, early hip pain, and the need for hip arthroplasty in the young active patient.


Femoral Head Acetabular Dysplasia Acetabular Index Acetabular Retroversion Joint Reactive Force 
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  1. 1.
    Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010;92(5):1162–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Wiberg GGF, Helen D. Studies on dysplastic acetabula and congenital subluxation of the Hip joint, with special reference to the complication of osteo-arthritis. (translated from the Swedish by Helen Frey). Stockholm: P. A. Norstedt & Sönep; 1939. p. 135.Google Scholar
  3. 3.
    Gade HG. A contribution to the surgical treatment of osteoarthritis of the Hip-joint: a clinical study. Oslo: Grøndahl & søns boktr; 1947.Google Scholar
  4. 4.
    Le Coeur P. Correction des défauts d’orientation de l’articulation coxofémorale par ostéotomie de l’isthme iliaque. Rev Chir Orthop. 1965;51:211–2.Google Scholar
  5. 5.
    Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am. 1973;55(2):343–50.PubMedGoogle Scholar
  6. 6.
    Tönnis D, Behrens K, Tscharani F. A modified technique of the triple pelvic osteotomy: early results. J Pediatr Orthop. 1981;1(3):241–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Carlioz H, Khouri N, Hulin P. Triple juxtacotyloid osteotomy. Rev Chir Orthop Reparatrice Appar Mot. 1982;68(7):497–501 (PubMed – NCBI. … et réparatrice de l'appareil moteur. 1982.).PubMedGoogle Scholar
  8. 8.
    Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias technique and preliminary results. Clin Orthop Relat Res. 1988;232:26–36.PubMedGoogle Scholar
  9. 9.
    Aminian A, Mahar A, Yassir W, Newton P, Wenger D. Freedom of acetabular fragment rotation following three surgical techniques for correction of congenital deformities of the Hip. J Pediatr Orthop. 2005;25(1):10.PubMedGoogle Scholar
  10. 10.
    Matheney T, Kim Y-J, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Am. 2009;91(9):2113–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466(7):1633–44.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia : section I symposium. Clin Orthop Relat Res. 2004;418:48–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Nehme A, Trousdale R, Tannous Z, Maalouf G, Puget J, Telmont N. Developmental dysplasia of the hip: is acetabular retroversion a crucial factor? Orthop Traumatol Surg Res. 2009;95(7):511–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Fujii M, Nakashima Y, Yamamoto T, Mawatari T, Motomura G, Matsushita A, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg Am. 2010;92(4):895–903.PubMedCrossRefGoogle Scholar
  15. 15.
    Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:93.PubMedCrossRefGoogle Scholar
  16. 16.
    Ginnetti JG, Pelt CE, Erickson JA, Van Dine C, Peters CL. Prevalence and treatment of intraarticular pathology recognized at the time of periacetabular osteotomy for the dysplastic hip. Clin Orthop Relat Res. 2013;471(2):498–503.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA. Role of the acetabular labrum in load support across the hip joint. J Biomech. 2011;44(12):2201–6.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg. 1986;68(3):400–3.Google Scholar
  19. 19.
    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(3):423–9.PubMedGoogle Scholar
  20. 20.
    Guevara CJ, Pietrobon R, Carothers JT. Comprehensive morphologic evaluation of the hip in patients with symptomatic labral tear. Clin Orthop Relat Res. 2006;453:277–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Wu X, Li S-H, Lou L-M, Cai Z-D. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop. 2012;36(9):1795–801.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Paavilainen T, Hoikka V, Solonen KA. Cementless total replacement for severely dysplastic or dislocated hips. J Bone Joint Surg Br. 1990;72(2):205–11.PubMedGoogle Scholar
  23. 23.
    Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005;87(2):254–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Harris MD, Anderson AE, Henak CR, Ellis BJ, Peters CL, Weiss JA. Finite element prediction of cartilage contact stresses in normal human hips. J Orthop Res. 2012;30(7):1133–9.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Peters CL, Erickson J. The etiology and treatment of Hip pain in the young adult. J Bone Joint Surg Am. 2006;88(suppl_4):20–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Parvizi J, Bican O, Bender B, Mortazavi SMJ, Purtill JJ, Erickson J, et al. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty. 2009;24(6 Suppl):110–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Feldman GJ, Peters CL, Erickson JA, Hozack BA, Jaraha R, Parvizi J. Variable expression and incomplete penetrance of developmental dysplasia of the hip: clinical challenge in a 71-member multigeneration family. J Arthroplast. 2012;27(4):527–32.CrossRefGoogle Scholar
  28. 28.
    Nunley RM. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am. 2011;93 Suppl 2:17.PubMedCrossRefGoogle Scholar
  29. 29.
    Peters CL. Hip-preserving surgery: understanding complex pathomorphology. J Bone Joint Surg Am. 2009;91 Suppl 6:42.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Byrd JT. Physical examination. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd ed. New York: Springer; 2005. p. 36–50.CrossRefGoogle Scholar
  31. 31.
    Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med. 2004;32(7):1668–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Anderson LA, Gililland J, Pelt C, Linford S, Stoddard GJ, Peters CL. Center edge angle measurement for hip preservation surgery: technique and caveats. Orthopedics. 2011;34(2):86.PubMedGoogle Scholar
  33. 33.
    Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, et al. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res. 2007;25(6):758–65.PubMedCrossRefGoogle Scholar
  34. 34.
    Eijer H, Leunig M, Mahomed MN, Ganz R. Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int. 2001;11(1):37–41.Google Scholar
  35. 35.
    Lequesne M, Djian A. New radiographic angles for the study of the hip. The“false profile” of the pelvis. Vie médicale (Paris, France: 1920). 1961;42:1629.Google Scholar
  36. 36.
    Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res. 2007;462:115–21.PubMedCrossRefGoogle Scholar
  37. 37.
    Dunn DM. Anteversion of the neck of the femur; a method of measurement. J Bone Joint Surg Br. 1952;34-B(2):181–6.PubMedGoogle Scholar
  38. 38.
    Clohisy JC. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90 Suppl 4:47.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis. Clin Orthop Relat Res. 2008;466(3):677–83.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Tönnis D. Clinical and radiographic schemes for evaluating therapeutic results. In: Congenital dysplasia and dislocation of the hip in children and adults. New York: Springer; 1987. p. 165–71.CrossRefGoogle Scholar
  41. 41.
    Sharp IK. Acetabular dysplasia the acetabular angle. J Bone Joint Surg Br. 1961;43(2):268–72.Google Scholar
  42. 42.
    Laage H, Barnett JC, Brady JM, Dulligan PJ, Fett HC, Gallagher TF, et al. Horizontal lateral roentgenography of the hip in children; a preliminary report. J Bone Joint Surg Am. 1953;35-A(2):387–98.PubMedGoogle Scholar
  43. 43.
    Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61(1):15–23.PubMedGoogle Scholar
  44. 44.
    Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N. Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am. 1996;78(5):683–92.Google Scholar
  45. 45.
    Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex Hip deformities. Clin Orthop Relat Res. 2010;468(12):3168–80.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jesse Chrastil
    • 1
  • Christopher Pelt
    • 1
  • Jill Erickson
    • 1
  • Christopher Peters
    • 1
  1. 1.University of Utah Health Care Orthopaedic CenterSalt Lake CityUSA

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