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Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study
Jeroen C F Verhaegen1,2,3, Zach DeVries1, Kawan Rakhra4
1Department of Orthopaedic Surgery, the Ottawa Hospital, Ottawa, ON, Canada.
Clinical Orthopaedics and Related Research
|July 27, 2023
Summary
Acetabular anteversion and posterior wall index are key indicators differentiating symptomatic from asymptomatic hips. Lower anteversion and posterior coverage suggest a higher likelihood of hip symptoms, guiding management decisions.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomechanical Engineering
Background:
- Acetabular morphology significantly influences hip biomechanics and the development of hip symptoms.
- Accurate identification of acetabular characteristics is crucial for understanding hip pathology, especially when considering spinopelvic factors.
- Previous studies often lacked control for physical status, potentially skewing morphological threshold definitions.
Purpose of the Study:
- To define acetabular morphological characteristics in asymptomatic individuals aged 45-60.
- To compare these characteristics with those of symptomatic hip patients undergoing hip preservation surgery (arthroscopy or PAO).
- To identify radiographic and CT parameters that effectively differentiate symptomatic from asymptomatic hips, establishing thresholds for clinical guidance.
Main Methods:
- A comparative study analyzed CT scans of asymptomatic individuals (n=40) and patients undergoing hip preservation surgery (n=107).
- Detailed assessments included acetabular (depth, cartilage coverage, anteversion, inclination) and spinopelvic (pelvic tilt, incidence) parameters.
- Receiver operating characteristic (ROC) analysis was employed to determine the diagnostic accuracy of morphological parameters and their thresholds.
Main Results:
- Asymptomatic hips exhibited greater acetabular depth (22 ± 2 mm), higher anatomic (24° ± 7°) and functional (22° ± 6°) anteversion, and larger subtended angles compared to symptomatic hips.
- Symptomatic hips showed reduced acetabular depth (20 ± 4 mm) and lower pelvic tilt (8° ± 8°).
- The posterior wall index (<0.9, AUC 0.84) demonstrated the highest discriminatory ability, followed by functional anteversion (<19°, AUC 0.79) and acetabular depth (<22 mm, AUC 0.74).
Conclusions:
- Specific acetabular anteversion (24° anatomical, 22° functional) and pelvic tilt (10°) are associated with optimal hip function and reduced impingement.
- Lower anteversion and reduced posterior coverage (indicated by posterior wall index and subtended angles) are linked to symptomatic hips.
- These identified parameters and thresholds can potentially aid in patient selection for hip preservation procedures, warranting further investigation.
