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Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage.

Christopher M Larson1, Alexandre Moreau-Gaudry, Bryan T Kelly

  • 1Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN, 55435, USA, chrislarson@tcomn.com.

Clinical Orthopaedics and Related Research
|November 20, 2014
PubMed
Summary
This summary is machine-generated.

This study developed a CT-based method to measure acetabular coverage, finding that signs like cranial retroversion (crossover sign) are common in asymptomatic individuals and may not always indicate pathology.

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Area of Science:

  • Radiology
  • Orthopedic Surgery
  • Medical Imaging Analysis

Background:

  • Plain radiography has limitations in accurately assessing acetabular coverage and pathomorphology.
  • CT scans offer more precise measurements for acetabular overcoverage and undercoverage.
  • A standardized method and normative data for CT-based acetabular coverage assessment are currently lacking.

Purpose of the Study:

  • To establish a method for quantifying acetabular coverage of the femoral head.
  • To define normative CT-based acetabular coverage data in an asymptomatic population.
  • To investigate acetabular version variability in asymptomatic hips with normal lateral coverage (LCEA 20°-40°).

Main Methods:

  • Evaluated 409 hips from 222 asymptomatic patients using CT scans.
  • Excluded hips with overt dysplasia (LCEA < 20°) or profunda (LCEA > 40°).
  • Corrected CT scan alignment and determined regional and global percent acetabular coverage; correlated lateral coverage with LCEA and assessed prevalence of crossover and posterior wall signs.

Main Results:

  • Mean regional coverage: 40% anterior, 61% superior, 48% posterior; mean global coverage: 40%.
  • Mean lateral coverage corresponded to an LCEA of 31°.
  • Cranial retroversion (crossover sign) found in 15% and posterior wall sign in 30% of hips; both signs were more prevalent in males.

Conclusions:

  • The study presents a reproducible method and normative data for CT-based acetabular coverage evaluation.
  • Cranial acetabular retroversion and positive posterior wall signs are frequent in asymptomatic individuals.
  • These findings suggest that crossover and posterior wall signs may represent normal variants in a significant number of cases, rather than pathology.