Center edge angle measurement for hip preservation surgery: technique and caveats

Anterior and lateral center edge angles have traditionally been used to determine acetabular coverage, and thereby strongly influence the decision to perform acetabular reorientation versus osteochondroplasty in patients with dysplasia and/or femoroacetabular impingement. We propose templating the center of the contained articular femoral head in aspherical hips to provide reliable assessment of acetabular coverage. Digital radiographs of 30 patients with various combinations of femoral and acetabular morphologies were evaluated using 2 methods to identify the anterior center edge angle and lateral center edge angle. The control method used an estimated femoral head center for angle apex. The study technique determined the center of the femoral head by templating the congruent aspect of the femoral head contained by the acetabulum while ignoring the increasing lateral and anterior radius associated with cam deformities. Four readers measured lateral center edge angles on anteroposterior radiographs and anterior center edge angles on false-profile radiographs. Two reads were performed by each reader using both the estimated and the templated methods for a total of 4 reads. Interobserver reliability using the proposed method compared to the standard was much improved for anterior center edge angles (intraclass correlation coefficient of 0.76 vs 0.55) as well as with lateral center edge angles (ICC of 0.80 vs 0.42). Decreased correlation was most commonly associated with abnormal sourcil morphology, posterior wall deficiency combined with calcified labra, and os acetabuli. Including the anterolateral cam deformity in identifying the center of the femoral head for measuring center edge angles leads to an underestimation of acetabular coverage, which may negatively affect hip preservation surgical decision making.