Total acetabular retroversion following pelvic osteotomy: presentation, management, and outcome

Area of Science:

• Orthopedic Surgery
• Hip Reconstruction
• Radiology

Background:

• Acetabular retroversion following acetabular osteotomy can negatively impact hip function.
• Total acetabular retroversion, a rare condition, may be missed on standard pelvic radiographs.
• This malalignment can lead to pain, restricted motion, and progressive osteoarthritis.

Purpose of the Study:

• To evaluate the clinical and radiographic presentation of total acetabular retroversion.
• To assess the surgical management and outcomes of affected hips.
• To analyze complication rates associated with corrective procedures.

Main Methods:

• Retrospective review of 26 patients (26 hips) with total acetabular retroversion.
• Patients underwent assessment of range of motion, impingement tests, Drehmann's sign, Merle d’Aubigné-Postel score, and Tönnis osteoarthritis score.
• Surgical management included revision periacetabular osteotomy (PAO) or total hip arthroplasty (THA).

Main Results:

• Patients presented with restricted range of motion, positive anterior impingement and Drehmann's signs, and reduced functional scores due to pain.
• Corrective surgery (revision PAO or THA) led to improved Merle d’Aubigné-Postel scores.
• Revision PAO decreased positive impingement and Drehmann's signs, but showed a tendency for osteoarthritis progression. Complication rates were 37% for revision PAO and 29% for THA.

Conclusions:

• Iatrogenic total acetabular retroversion is a disabling complication following hip reorientation surgery.
• Revision PAO and THA can improve clinical outcomes in these challenging cases.
• Both corrective procedures are technically demanding and associated with significant complication risks.