DOI: https://doi.org/10.22141/1608-1706.4.20.2019.178745

Patterns of acetabular sectoral deficiency in hip dysplasia

A.E. Loskutov, E.A. Kovbasa, A.E. Oleynik, V.G. Strijeniy, A.V. Gubarik

Abstract


Background. Variability and combination of acetabular morphological abnormalities make a wide spectrum of deformity patterns that requires reliable visualization. Acetabular deficiency localization and severity, as well as frontal inclination angle are pivotal for implantation technique, however inaccessible through a routine radiography. The purpose was to assess acetabular sectoral deficiency in hip dysplasia and to define its correlation with head cranial migration and acetabular sphericity indices. Materials and methods. There was performed a complex comparative MSCT-morphometric investigation of 66 patients with hip dysplasia (Crowe I — 20 (30.3 %), Crowe II — 29 hips (43.9 %), Crowe III — 17 hips (25.8 %)). There were assessed anterior (AASA), posterior (PASA) and horizontal (HASA) sector angles; Wiberg and Sharp angles; acetabular frontal inclination; their correlation with indices of femoral head cranial migration and acetabular sphericity. Results. Normal values of acetabular coverage were defined as AASA — 63.5° [57; 68], PASA — 105° [97; 115], HASA — 166° [163; 178], Wiberg angle — 40° [39; 43], Sharp angle — 37° [35; 38]; acetabular frontal inclination — 22 ° [17; 26]. There were revealed strong correlation between HASA and femoral head cranial migration (r = –0.65; p < 0.00001) and acetabular sphericity index (r = 0.89; p < 0.00001) that confirms progressive deepening of acetabular deficiency according to dysplasia severity. The similar tendency is defined for anterior ASA: Crowe I — 45° [40; 50], Crowe II — 35° [28; 38], Crowe III — 25.5° [27; 31] (p < 0.001). Posterior wall deficiency is accompanied neither with anterior (r = 0.17) nor superior (r = 0.43) one. No statistically significant difference (p > 0.05) was defined between acetabular inclination angles either during between-group or intra-group comparison. The acetabular inclination was defined as the relation of anterior and posterior sector angles (1/2 х (PASA-ASA)). Conclusions. The acetabular sectoral deficiency remains to be multidirectional and is realized in multiple deformity patterns. MSCT-morphomerty during preplanning is of important value due to verification and quantification of the acetabular sectoral deficiency that is an issue for implantation technique chose.

Keywords


total hip replacement; hip dysplasia; acetabulum; sectoral deficiency; pattern

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