The Journal of Hip Surgery 2018; 02(04): 156-166
DOI: 10.1055/s-0038-1676307
Special Section Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Management of Borderline Hip Dysplasia and Acetabular Retroversion

Michael Willey
1   Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Tai Holland
1   Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Holly Thomas-Aitken
1   Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Jessica E. Goetz
1   Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
› Author Affiliations
Further Information

Publication History

07 May 2018

11 October 2018

Publication Date:
10 January 2019 (online)

Abstract

Borderline hip dysplasia and acetabular retroversion are common radiographic findings in young individuals with and without hip pain. Orthopaedic surgeons should be knowledgeable about the radiographic findings, diagnosis, and appropriate nonsurgical and surgical treatment of these conditions. Borderline hip dysplasia is generally defined by a lateral center edge angle of Wiberg from 20 to 25° (some define as 18–25°) and is a cause of joint microinstability. The degree of soft tissue laxity can have significant implications for joint stability in patients with borderline hip dysplasia. The most common presenting symptoms are groin pain and lateral hip pain. Acetabular retroversion is defined by radiographic findings of crossover sign, ischial spine sign, and posterior wall sign. Individuals with symptomatic retroversion have a clinical presentation consistent with impingement, groin pain with flexion activities, and less commonly lateral hip pain. Physical therapy has been shown to improve symptoms in a subset of individuals with these conditions. There are multiple recent publications about arthroscopic treatment of patients with borderline hip dysplasia. These reports generally find that good short-term outcomes can be expected when using arthroscopic techniques that include labral preservation/repair and capsular plication. There are limited reports of periacetabular osteotomy as a treatment for borderline hip dysplasia. Publications focusing specifically on surgical treatment of acetabular retroversion are also infrequent. Periacetabular osteotomy has been shown to have superior long-term clinical outcomes to surgical hip dislocation with anterior rim trimming in patients with all three radiographic findings of retroversion. Arthroscopic treatment has been shown to have good short-term outcomes. Future work in the areas of borderline hip dysplasia and acetabular retroversion should focus on reporting long-term clinical follow-up of these surgical treatments and using computation techniques as a tool to determine appropriate surgical and nonsurgical treatment for each individual patient.

 
  • References

  • 1 Wiberg G. Relation between congenital subluxation of the hip and arthritis deformans. Acta Orthop Scand 1939; 10 (1–4): 351-371
  • 2 Zurmühle CA, Anwander H, Albers CE. , et al. Periacetabular osteotomy provides higher survivorship than rim trimming for acetabular retroversion. Clin Orthop Relat Res 2017; 475 (04) 1138-1150
  • 3 Wyatt M, Weidner J, Pfluger D, Beck M. The Femoro-Epiphyseal Acetabular Roof (FEAR) index: a new measurement associated with instability in borderline hip dysplasia?. Clin Orthop Relat Res 2017; 475 (03) 861-869
  • 4 Larson CM, Ross JR, Stone RM. , et al. Arthroscopic management of dysplastic hip deformities: predictors of success and failures with comparison to an arthroscopic FAI cohort. Am J Sports Med 2016; 44 (02) 447-453
  • 5 Chandrasekaran S, Darwish N, Martin TJ, Suarez-Ahedo C, Lodhia P, Domb BG. Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-year clinical outcomes in 55 cases. Arthroscopy 2017; 33 (07) 1332-1340
  • 6 Fukui K, Briggs KK, Trindade CA, Philippon MJ. Outcomes after labral repair in patients with femoroacetabular impingement and borderline dysplasia. Arthroscopy 2015; 31 (12) 2371-2379
  • 7 Ricciardi BF, Fields KG, Wentzel C, Nawabi DH, Kelly BT, Sink EL. Complications and short-term patient outcomes of periacetabular osteotomy for symptomatic mild hip dysplasia. Hip Int 2017; 27 (01) 42-48
  • 8 Kalisvaart MM, Safran MR. Microinstability of the hip-it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg 2015; 2 (02) 123-135
  • 9 McCarthy JC, Lee JA. Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 2002; (405) 122-128
  • 10 Domb BG, Chaharbakhshi EO, Perets I, Yuen LC, Walsh JP, Ashberg L. Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: minimum 5-year patient-reported outcomes. Am J Sports Med 2018; 46 (02) 305-313
  • 11 Hatakeyama A, Utsunomiya H, Nishikino S. , et al. Predictors of poor clinical outcome after arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of borderline hip dysplasia. Am J Sports Med 2018; 46 (01) 135-143
  • 12 Wells J, Schoenecker P, Duncan S, Goss CW, Thomason K, Clohisy JC. Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy: The Washington University experience. J Bone Joint Surg Am 2018; 100 (03) 218-225
  • 13 Lerch TD, Steppacher SD, Liechti EF, Tannast M, Siebenrock KA. One-third of hips after periacetabular osteotomy survive 30 years with good clinical results, no progression of arthritis, or conversion to THA. Clin Orthop Relat Res 2017; 475 (04) 1154-1168
  • 14 Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome: surgical technique. J Bone Joint Surg Am 2010; 92 (Suppl 1 Pt 2): 115-129
  • 15 Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy 2003; 19 (10) 1055-1060
  • 16 Parvizi J, Bican O, Bender B. , et al. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty 2009; 24 (6, Suppl): 110-113
  • 17 Hartigan DE, Perets I, Walsh JP, Close MR, Domb BG. Clinical outcomes of hip arthroscopy in radiographically diagnosed retroverted acetabula. Am J Sports Med 2016; 44 (10) 2531-2536
  • 18 Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am 2011; 93 (Suppl 2): 17-21
  • 19 Romanò CL, Frigo C, Randelli G, Pedotti A. Analysis of the gait of adults who had residua of congenital dysplasia of the hip. J Bone Joint Surg Am 1996; 78 (10) 1468-1479
  • 20 Nepple JJ, Riggs CN, Ross JR, Clohisy JC. Clinical presentation and disease characteristics of femoroacetabular impingement are sex-dependent. J Bone Joint Surg Am 2014; 96 (20) 1683-1689
  • 21 Maldonado DR, Krych AJ, Levy BA, Hartigan DE, Laseter JR, Domb BG. Does iliopsoas lengthening adversely affect clinical outcomes after hip arthroscopy? A multicenter comparative study. Am J Sports Med 2018; 46 (11) 2624-2631
  • 22 Yoon JY, Kwak HS, Yoon KS, Chang JS, Yoon PW. Arthroscopic treatment for external snapping hip. Hip Pelvis 2014; 26 (03) 173-177
  • 23 de Sa D, Alradwan H, Cargnelli S. , et al. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy 2014; 30 (08) 1026-1041
  • 24 Ross JR, Stone RM, Larson CM. Core muscle injury/sports hernia/athletic pubalgia, and femoroacetabular impingement. Sports Med Arthrosc Rev 2015; 23 (04) 213-220
  • 25 Kraeutler MJ, Chadayammuri V, Garabekyan T, Mei-Dan O. Femoral version abnormalities significantly outweigh effect of cam impingement on hip internal rotation. J Bone Joint Surg Am 2018; 100 (03) 205-210
  • 26 Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthop J Sports Med 2017; 5 (11) 2325967117740121
  • 27 Naal FD, Müller A, Varghese VD, Wellauer V, Impellizzeri FM, Leunig M. Outcome of hip impingement surgery: does generalized joint hypermobility matter?. Am J Sports Med 2017; 45 (06) 1309-1314
  • 28 Larson CM, Stone RM, Grossi EF, Giveans MR, Cornelsen GD. Ehlers-Danlos syndrome: arthroscopic management for extreme soft-tissue hip instability. Arthroscopy 2015; 31 (12) 2287-2294
  • 29 Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt?. Clin Orthop Relat Res 2015; 473 (04) 1255-1266
  • 30 Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res 2013; 471 (08) 2463-2470
  • 31 Tannast M, Hanke MS, Zheng G, Steppacher SD, Siebenrock KA. What are the radiographic reference values for acetabular under- and overcoverage?. Clin Orthop Relat Res 2015; 473 (04) 1234-1246
  • 32 Anderson LA, Anderson MB, Erickson JA, Chrastil J, Peters CL. Acetabular wall indices help to distinguish acetabular coverage in asymptomatic adults with varying morphologies. Clin Orthop Relat Res 2017; 475 (04) 1027-1033
  • 33 Wells J, Nepple JJ, Crook K. , et al. Femoral morphology in the dysplastic hip: Three-dimensional characterizations with CT. Clin Orthop Relat Res 2017; 475 (04) 1045-1054
  • 34 Anderson LA, Erickson JA, Swann RP. , et al. Femoral morphology in patients undergoing periacetabular osteotomy for classic or borderline acetabular dysplasia: are cam deformities common?. J Arthroplasty 2016; 31 (9, Suppl): 259-263
  • 35 Nepple JJ, Clohisy JC. The dysplastic and unstable hip: a responsible balance of arthroscopic and open approaches. Sports Med Arthrosc Rev 2015; 23 (04) 180-186
  • 36 Cvetanovich GL, Levy DM, Weber AE. , et al. Do patients with borderline dysplasia have inferior outcomes after hip arthroscopic surgery for femoroacetabular impingement compared with patients with normal acetabular coverage?. Am J Sports Med 2017; 45 (09) 2116-2124
  • 37 Nawabi DH, Degen RM, Fields KG. , et al. Outcomes after arthroscopic treatment of femoroacetabular impingement for patients with borderline hip dysplasia. Am J Sports Med 2016; 44 (04) 1017-1023
  • 38 Larson CM, Moreau-Gaudry A, Kelly BT. , et al. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res 2015; 473 (04) 1247-1254
  • 39 Lee AJ, Armour P, Thind D, Coates MH, Kang AC. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. Bone Joint J 2015; 97-B (05) 623-627
  • 40 Kobayashi N, Inaba Y, Kubota S. , et al. The distribution of impingement region in cam-type femoroacetabular impingement and borderline dysplasia of the hip with or without cam deformity: a computer simulation study. Arthroscopy 2017; 33 (02) 329-334
  • 41 Kubota S, Inaba Y, Kobayashi N, Choe H, Tezuka T, Saito T. Comparison of improved range of motion between cam-type femoroacetabular impingement and borderline developmental dysplasia of the hip -evaluation by virtual osteochondroplasty using computer simulation. BMC Musculoskelet Disord 2017; 18 (01) 417
  • 42 Knight SJ, Abraham CL, Peters CL, Weiss JA, Anderson AE. Changes in chondrolabral mechanics, coverage, and congruency following peri-acetabular osteotomy for treatment of acetabular retroversion: a patient-specific finite element study. J Orthop Res 2017; 35 (11) 2567-2576
  • 43 Haefeli PC, Steppacher SD, Babst D, Siebenrock KA, Tannast M. An increased iliocapsularis-to-rectus-femoris ratio is suggestive for instability in borderline hips. Clin Orthop Relat Res 2015; 473 (12) 3725-3734
  • 44 Nepple JJ, Wells J, Ross JR, Bedi A, Schoenecker PL, Clohisy JC. Three patterns of acetabular deficiency are common in young adult patients with acetabular dysplasia. Clin Orthop Relat Res 2017; 475 (04) 1037-1044
  • 45 Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. J Arthroplasty 2017; 32 (9S): S20-S27
  • 46 Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM R 2012; 4 (07) 479-487
  • 47 Lewis CL, Khuu A, Marinko LN. Postural correction reduces hip pain in adult with acetabular dysplasia: a case report. Man Ther 2015; 20 (03) 508-512
  • 48 Matsuda DK. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy 2009; 25 (04) 400-404
  • 49 Matsuda DK, Khatod M. Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia. Arthroscopy 2012; 28 (11) 1738-1743
  • 50 Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation?. Arthroscopy 2012; 28 (03) 440-445
  • 51 Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail?. Clin Orthop Relat Res 2013; 471 (08) 2523-2529
  • 52 Ross JR, Clohisy JC, Baca G, Sink E. ; ANCHOR Investigators. Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia. J Arthroplasty 2014; 29 (9, Suppl): 160-163
  • 53 Kalore NV, Jiranek WA. Save the torn labrum in hips with borderline acetabular coverage. Clin Orthop Relat Res 2012; 470 (12) 3406-3413
  • 54 Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med 2013; 41 (11) 2591-2598
  • 55 Chaharbakhshi EO, Perets I, Ashberg L, Mu B, Lenkeit C, Domb BG. Do ligamentum teres tears portend inferior outcomes in patients with borderline dysplasia undergoing hip arthroscopic surgery? A match-controlled study with a minimum 2-year follow-up. Am J Sports Med 2017; 45 (11) 2507-2516
  • 56 Uchida S, Utsunomiya H, Mori T. , et al. Clinical and radiographic predictors for worsened clinical outcomes after hip arthroscopic labral preservation and capsular closure in developmental dysplasia of the hip. Am J Sports Med 2016; 44 (01) 28-38
  • 57 Jayasekera N, Aprato A, Villar RN. Hip arthroscopy in the presence of acetabular dysplasia. Open Orthop J 2015; 9: 185-187
  • 58 Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 1988; ; ( (232) 26-36
  • 59 Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 2008; 466 (07) 1633-1644
  • 60 Clohisy JC, Ackerman J, Baca G. , et al. Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study. J Bone Joint Surg Am 2017; 99 (01) 33-41
  • 61 Siebenrock KA, Schaller C, Tannast M, Keel M, Büchler L. Anteverting periacetabular osteotomy for symptomatic acetabular retroversion: results at ten years. J Bone Joint Surg Am 2014; 96 (21) 1785-1792
  • 62 Peters CL, Anderson LA, Erickson JA, Anderson AE, Weiss JA. An algorithmic approach to surgical decision making in acetabular retroversion. Orthopedics 2011; 34 (01) 10
  • 63 Parry JA, Swann RP, Erickson JA, Peters CL, Trousdale RT, Sierra RJ. Midterm outcomes of reverse (anteverting) periacetabular osteotomy in patients with hip impingement secondary to acetabular retroversion. Am J Sports Med 2016; 44 (03) 672-676
  • 64 Ilizaliturri Jr VM, Joachin P, Acuna M. Description and mid-term results of the ‘over the top’ technique for the treatment of the pincer deformity in femoroacetabular impingement. J Hip Preserv Surg 2015; 2 (04) 369-373
  • 65 Byrd JW, Jones KS. Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy 2011; 27 (10) 1379-1388
  • 66 Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 2009; 91 (01) 16-23
  • 67 Bedi A, Dolan M, Hetsroni I. , et al. Surgical treatment of femoroacetabular impingement improves hip kinematics: a computer-assisted model. Am J Sports Med 2011; 39 (Suppl): 43S-49S
  • 68 Bedi A, Dolan M, Magennis E, Lipman J, Buly R, Kelly BT. Computer-assisted modeling of osseous impingement and resection in femoroacetabular impingement. Arthroscopy 2012; 28 (02) 204-210
  • 69 Liu L, Ecker T, Schumann S, Siebenrock K, Nolte L, Zheng G. Computer assisted planning and navigation of periacetabular osteotomy with range of motion optimization. Medical image computing and computer-assisted intervention: MICCAI International Conference on Medical Image Computing and Computer-Assisted Intervention. 2014 ;17(Pt 2):643–650
  • 70 Hadley NA, Brown TD, Weinstein SL. The effects of contact pressure elevations and aseptic necrosis on the long-term outcome of congenital hip dislocation. J Orthop Res 1990; 8 (04) 504-513
  • 71 Genda E, Konishi N, Hasegawa Y, Miura T. A computer simulation study of normal and abnormal hip joint contact pressure. Arch Orthop Trauma Surg 1995; 114 (04) 202-206
  • 72 Michaeli DA, Murphy SB, Hipp JA. Comparison of predicted and measured contact pressures in normal and dysplastic hips. Med Eng Phys 1997; 19 (02) 180-186
  • 73 Tsumura H, Miura H, Iwamoto Y. Three-dimensional pressure distribution of the human hip joint--comparison between normal hips and dysplastic hips. Fukuoka Igaku Zasshi 1998; 89 (04) 109-118
  • 74 Hipp JA, Sugano N, Millis MB, Murphy SB. Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res 1999; (364) 134-143
  • 75 Niknafs N, Murphy RJ, Armiger RS, Lepistö J, Armand M. Biomechanical factors in planning of periacetabular osteotomy. Front Bioeng Biotechnol 2013; 1: 20
  • 76 Rab GT. Lateral acetabular rotation improves anterior hip subluxation. Clin Orthop Relat Res 2007; 456 (456) 170-175
  • 77 Tsumura H, Kaku N, Ikeda S, Torisu T. A computer simulation of rotational acetabular osteotomy for dysplastic hip joint: does the optimal transposition of the acetabular fragment exist?. J Orthop Sci 2005; 10 (02) 145-151
  • 78 Armand M, Lepistö J, Tallroth K, Elias J, Chao E. Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years. Acta Orthop 2005; 76 (03) 303-313
  • 79 Armiger RS, Armand M, Tallroth K, Lepistö J, Mears SC. Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up. Acta Orthop 2009; 80 (02) 155-161
  • 80 Maxian TA, Brown TD, Weinstein SL. Chronic stress tolerance levels for human articular cartilage: two nonuniform contact models applied to long-term follow-up of CDH. J Biomech 1995; 28 (02) 159-166
  • 81 Chegini S, Beck M, Ferguson SJ. The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res 2009; 27 (02) 195-201
  • 82 Henak CR, Ellis BJ, Harris MD, Anderson AE, Peters CL, Weiss JA. Role of the acetabular labrum in load support across the hip joint. J Biomech 2011; 44 (12) 2201-2206
  • 83 Henak CR, Abraham CL, Anderson AE. , et al. Patient-specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia. Osteoarthritis Cartilage 2014; 22 (02) 210-217
  • 84 Russell ME, Shivanna KH, Grosland NM, Pedersen DR. Cartilage contact pressure elevations in dysplastic hips: a chronic overload model. J Orthop Surg Res 2006; 1: 6
  • 85 Ike H, Inaba Y, Kobayashi N. , et al. Effects of rotational acetabular osteotomy on the mechanical stress within the hip joint in patients with developmental dysplasia of the hip: a subject-specific finite element analysis. Bone Joint J 2015; 97-B (04) 492-497
  • 86 Liechti EF, Ferguson SJ, Tannast M. Protrusio acetabuli: joint loading with severe pincer impingement and its theoretical implications for surgical therapy. J Orthop Res 2015; 33 (01) 106-113
  • 87 Liu L, Ecker T, Xie L, Schumann S, Siebenrock K, Zheng G. Biomechanical validation of computer assisted planning of periacetabular osteotomy: A preliminary study based on finite element analysis. Med Eng Phys 2015; 37 (12) 1169-1173
  • 88 Liu L, Ecker TM, Schumann S, Siebenrock KA, Zheng G. Evaluation of constant thickness cartilage models vs. patient specific cartilage models for an optimized computer-assisted planning of periacetabular osteotomy. PLoS One 2016; 11 (01) e0146452
  • 89 Zhao X, Chosa E, Totoribe K, Deng G. Effect of periacetabular osteotomy for acetabular dysplasia clarified by three-dimensional finite element analysis. J Orthop Sci 2010; 15 (05) 632-640
  • 90 Zou Z, Chávez-Arreola A, Mandal P, Board TN, Alonso-Rasgado T. Optimization of the position of the acetabulum in a Ganz periacetabular osteotomy by finite element analysis. J Orthop Res 2013; 31 (03) 472-479
  • 91 Todd JN, Maak TG, Ateshian GA, Maas SA, Weiss JA. Hip chondrolabral mechanics during activities of daily living: role of the labrum and interstitial fluid pressurization. J Biomech 2018; 69: 113-120