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An algorithmic approach to surgical decision making in acetabular retroversion
Christopher L Peters1, Lucas A Anderson, Jill A Erickson
1Department of Orthopedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108, USA. chris.peters@hsc.utah.edu
Orthopedics
|January 8, 2011
Summary
Surgical treatment for femoroacetabular impingement due to acetabular retroversion depends on hip coverage. Acetabular reorientation or osteochondroplasty effectively improves outcomes and hip function.
Area of Science:
- Orthopedic surgery
- Hip joint biomechanics
- Radiographic imaging
Background:
- Symptomatic femoroacetabular impingement (FAI) in young adults often results from acetabular retroversion.
- Acetabular retroversion can present with varying degrees of acetabular coverage, influencing treatment strategies.
- Optimal surgical management for FAI with acetabular retroversion is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of a treatment algorithm for femoroacetabular impingement (FAI) caused by acetabular retroversion.
- To compare outcomes of periacetabular osteotomy versus surgical hip dislocation with osteochondroplasty for acetabular retroversion.
- To determine the impact of acetabular coverage and cartilage status on treatment selection and success.
Main Methods:
- Prospective data collection from 60 hips with symptomatic FAI and acetabular retroversion (2001-2006).
- Radiographic assessment including crossover sign, lateral center edge angle, and posterior wall sign.
- Treatment algorithm based on acetabular coverage and cartilage condition, directing either periacetabular osteotomy or surgical dislocation with osteochondroplasty.
Main Results:
- Both periacetabular osteotomy (30 hips) and surgical dislocation with osteochondroplasty (30 hips) demonstrated significant improvements in Harris Hip Score.
- Overall survivorship was 96% at 4 years, with average follow-up of 46 months.
- Correction of radiographic signs (crossover, posterior wall) exceeded 90% in hips where they were initially present.
Conclusions:
- Acetabular retroversion with deficient lateral/posterior coverage and intact cartilage is effectively treated with acetabular reorientation.
- Retroverted hips with anterior overcoverage but adequate posterior coverage benefit from osteochondroplasty of the acetabulum and femur.
- A tailored surgical approach based on radiographic parameters improves outcomes for FAI with acetabular retroversion.
