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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 4/2015

01-04-2015 | Symposium: 2014 Bernese Hip Symposium

How Do Acetabular Version and Femoral Head Coverage Change With Skeletal Maturity?

Authors: Andreas M. Hingsammer, MD, Sarah Bixby, MD, David Zurakowski, PhD, Yi-Meng Yen, MD, PhD, Young-Jo Kim, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2015

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Abstract

Background

Normal changes in acetabular version over the course of skeletal development have not been well characterized. Knowledge of normal version development is important because acetabular retroversion has been implicated in several pathologic hip processes.

Questions/purposes

The purpose of this study was to characterize the orientation of the acetabulum by measuring (1) acetabular version and (2) acetabular sector angles in pediatric patients during development. We also sought to determine whether these parameters vary by sex in the developing child.

Methods

We evaluated CT images of 200 hips in 100 asymptomatic pediatric patients (45 boys, 55 girls; mean age, 13.5 years; range, 9–18 years) stratified by the status of the triradiate physis and sex. We determined the acetabular anteversion angle at various levels in the axial plane as well as acetabular sector angles at five radial planes around the acetabulum.

Results

For both genders, anteversion angle was greater for the closed physis group throughout all levels (p < 0.001) and both open and closed physis groups were more anteverted as the cut moved caudally away from the acetabular roof (p < 0.001). At the center of the femoral head, the mean anteversion angle (± SD) in girls was 15° ± 3° in the open group and 19° ± 5° in the closed group (p < 0.001). In boys, the mean anteversion angle increased from 14° ± 4° in the open group to 19° ± 4° in the closed group (p = 0.003). In the superior, posterosuperior, and posterior planes, the acetabular sector angles were greater in the closed compared with the open physis group for both boys and girls with the largest increase occurring in the male posterosuperior plane (approximately 20°) (all p < 0.05).

Conclusions

This study demonstrates that acetabular anteversion and acetabular sector angles in both male and female subjects increase with skeletal maturity as a result of growth of the posterior wall. This suggests that radiographic appearance of acetabular retroversion may not be attributable to overgrowth of the anterior wall but rather insufficient growth of the posterior wall, which has clinical treatment implications for pincer-type impingement.

Level of Evidence

Level IV diagnostic study.
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Metadata
Title
How Do Acetabular Version and Femoral Head Coverage Change With Skeletal Maturity?
Authors
Andreas M. Hingsammer, MD
Sarah Bixby, MD
David Zurakowski, PhD
Yi-Meng Yen, MD, PhD
Young-Jo Kim, MD, PhD
Publication date
01-04-2015
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 4/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-4014-y

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