Development of acetabular retroversion in LCPD hips-an observational radiographic study from early stage to healing.
Acetabular retroversion
Femoroacetabular impingement
LCPD
Legg–Calvé–Perthes Disease
Morbus perthes
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
21
04
2022
accepted:
03
09
2022
medline:
28
6
2023
pubmed:
24
10
2022
entrez:
23
10
2022
Statut:
ppublish
Résumé
Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters. In a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion. Both parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip. This is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version. Level III, retrospective observational study.
Sections du résumé
BACKGROUND
BACKGROUND
Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters.
METHODS
METHODS
In a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion.
RESULTS
RESULTS
Both parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip.
CONCLUSIONS
CONCLUSIONS
This is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version.
LEVEL OF EVIDENCE
METHODS
Level III, retrospective observational study.
Identifiants
pubmed: 36274080
doi: 10.1007/s00402-022-04612-0
pii: 10.1007/s00402-022-04612-0
pmc: PMC10293407
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3945-3956Informations de copyright
© 2022. The Author(s).
Références
Albinana J, Morcuende JA, Delgado E, Weinstein SL (1995) Radiologic pelvic asymmetry in unilateral late-diagnosed developmental dysplasia of the hip. J Pediatr Orthop 15(6):753–762
doi: 10.1097/01241398-199511000-00007
pubmed: 8543604
Barker DJ, Hall AJ (1986) The epidemiology of Perthes’ disease. Clin Orthopaed Relat Res 209:89–94
doi: 10.1097/00003086-198608000-00012
Berg RP, Galantay R, Eijer H (2010) Retroversion of the contralateral adult acetabulum after previous Perthes’ disease. Acta Orthop Belg 76(1):42–47
pubmed: 20306963
Eijer H (2007) Towards a better understanding of the aetiology of Legg-Calve-Perthes’ disease: acetabular retroversion may cause abnormal loading of dorsal femoral head-neck junction with restricted blood supply to the femoral epiphysis. Med Hypotheses 68(5):995–997
doi: 10.1016/j.mehy.2006.10.011
pubmed: 17118567
Ezoe M, Naito M, Inoue T (2006) The prevalence of acetabular retroversion among various disorders of the hip. J Bone Jt Surg 88(2):372–379
doi: 10.2106/JBJS.D.02385
Fujii M, Nakashima Y, Sato T, Akiyama M, Iwamoto Y (2011) Pelvic deformity influences acetabular version and coverage in hip dysplasia. Clin Orthop Relat Res 469(6):1735–1742
doi: 10.1007/s11999-010-1746-1
pubmed: 21203874
pmcid: 3094603
Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH (1992) The lateral pillar classification of Legg-Calve-Perthes disease. J Pediatr Orthop 12(2):143–150
doi: 10.1097/01241398-199203000-00001
pubmed: 1552014
Jamali AA, Mladenov K, Meyer DC et al (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign.” J Orthopaed Res Off Publ Orthopaed Res Soc 25(6):758–765
doi: 10.1002/jor.20380
Jones DH (2010) Shenton’s line. J Bone Jt Surg Br 92(9):1312–1315
doi: 10.1302/0301-620X.92B9.25094
Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M (2008) Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res 466(3):677–683
doi: 10.1007/s11999-007-0058-6
pubmed: 18264856
pmcid: 2505226
Kawahara S, Nakashima Y, Oketani H et al (2012) High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calve-Perthes disease. J Orthopaed Sci Off J Jap Orthopaed Assoc 17(3):226–232
doi: 10.1007/s00776-012-0213-0
Larson AN, Stans AA, Sierra RJ (2011) Ischial spine sign reveals acetabular retroversion in Legg-Calve-Perthes disease. Clin Orthop Relat Res 469(7):2012–2018
doi: 10.1007/s11999-011-1793-2
pubmed: 21279483
Liao S, Zhao M, Wang T et al (2021) Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease. Sci Rep 11(1):16506
doi: 10.1038/s41598-021-95806-w
pubmed: 34389771
pmcid: 8363621
Murphy SB, Ganz R, Muller ME (1995) The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Jt Surg 77(7):985–989
doi: 10.2106/00004623-199507000-00002
Parvaresh KC, Pennock AT, Bomar JD, Wenger DR, Upasani VV (2018) Analysis of acetabular ossification from the triradiate cartilage and secondary centers. J Pediatr Orthop 38(3):e145–e150
doi: 10.1097/BPO.0000000000001120
pubmed: 29309383
Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Jt Surg Br 81(2):281–288
doi: 10.1302/0301-620X.81B2.0810281
Sankar WN, Flynn JM (2008) The development of acetabular retroversion in children with Legg-Calve-Perthes disease. J Pediatr Orthop 28(4):440–443
doi: 10.1097/BPO.0b013e318168d97e
pubmed: 18520281
Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg-Calve-Perthes disease. J Bone Jt Surg 63(7):1095–1108
doi: 10.2106/00004623-198163070-00006
Suzuki S (1995) Deformity of the pelvis in developmental dysplasia of the hip: three-dimensional evaluation by means of magnetic resonance image. J Pediatr Orthop 15(6):812–816
doi: 10.1097/01241398-199511000-00016
pubmed: 8543613
Tannast M, Hanke M, Ecker TM, Murphy SB, Albers CE, Puls M (2012) LCPD: reduced range of motion resulting from extra- and intraarticular impingement. Clin Orthop Relat Res 470(9):2431–2440
doi: 10.1007/s11999-012-2344-1
pubmed: 22492172
pmcid: 3830083
Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA (2015) What are the radiographic reference values for acetabular under- and overcoverage? Clin Orthop Relat Res 473(4):1234–1246
doi: 10.1007/s11999-014-4038-3
pubmed: 25384429
Tannast M, Pfannebecker P, Schwab JM, Albers CE, Siebenrock KA, Buchler L (2012) Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion. Clin Orthop Relat Res 470(12):3297–3305
doi: 10.1007/s11999-012-2473-6
pubmed: 22798136
pmcid: 3492631
Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol 188(6):1540–1552
doi: 10.2214/AJR.06.0921
pubmed: 17515374
Waldenstrom H (1984) The classic. The first stages of coxa plana by Henning Waldenstrom. Clin Orthopaed Relat Res 191:4–7
doi: 10.1097/00003086-198412000-00002
Werner CM, Ramseier LE, Ruckstuhl T et al (2012) Normal values of Wiberg’s lateral center-edge angle and Lequesne’s acetabular index–a coxometric update. Skeletal Radiol 41(10):1273–1278
doi: 10.1007/s00256-012-1420-7
pubmed: 22584462
Yoshida T, Kim WC, Nishida A et al (2016) Acetabular anteversion angle from early stage of Perthes disease to adolescence. J Orthop 13(4):410–413
doi: 10.1016/j.jor.2016.08.001
pubmed: 27621557
pmcid: 5009232