J Pediatr Genet 2023; 12(01): 048-052
DOI: 10.1055/s-0041-1732476
Original Article

Acetabular Protrusion in a Cohort of Patients with Osteogenesis Imperfecta Evaluated in a Pediatric Hospital

1   Department of Growth and Development, Paediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
,
Francisco Monterroza-Quintana
1   Department of Growth and Development, Paediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
,
Claudio Primomo
1   Department of Growth and Development, Paediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
,
2   Department of Orthopedics and Traumatology, Paediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
,
2   Department of Orthopedics and Traumatology, Paediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
› Author Affiliations

Abstract

Acetabular protrusion (AP) is present in 33 to 55% of patients with osteogenesis imperfecta (OI). Even though the finding is relatively common, it is poorly described in pediatric patients. The objective of this study was to describe the incidence and associations of AP in pediatric OI patients. We retrospectively and cross-sectionally evaluated clinical histories and radiographic findings of OI patients aged 2 to 19.5 years, recording sex, age, severity, anthropometric measurements, ambulation status, femoral fractures history, and occurrence of orthopaedic surgeries and nephropathy. AP was considered present when the center-edge (CE) angle was more than 35 degrees and the acetabular line crossed the Kohler's line by more than 1 and 3 mm in boys and girls, respectively, and 3 and 6 mm in adult males and females, respectively. The association with risk factors and complications was analyzed through univariate and multivariate logistic regression. A total of 71 children were evaluated. The median age was 8.6 years, and 54.9% of them had moderate to severe forms of OI. In 71.8% of the children, an abnormal CE angle was found, being frequent in mild, moderate, and severe cases. AP was present in 22.5% of all patients and in 41% of children with moderate to severe OI, and was significantly associated with older ages (p = 0.0062) and nonwalking status (p = 0.0093). We found a high prevalence of AP in children with moderate to severe forms of OI, which was present even at younger ages. In addition, we found a significant increase in the number of children with abnormal CE angles even in those with mild forms of OI. The presence of AP was associated with the severity of the OI and age, and in a negative association with the ambulatory status.



Publication History

Received: 26 November 2020

Accepted: 17 June 2021

Article published online:
22 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pomeranz MM. Intrapelvic protrusion of the acetabulum (Otto pelvis). 1932. Clin Orthop Relat Res 2007; 465 (465) 6-15
  • 2 Overgaard K. Otto's disease and other forms of protrusio acetabuli. Acta Radiol 1935; 16 (03) 390-410
  • 3 Bregou Bourgeois A, Aubry-Rozier B, Bonafé L, Laurent-Applegate L, Pioletti DP, Zambelli PY. Osteogenesis imperfecta: from diagnosis and multidisciplinary treatment to future perspectives. Swiss Med Wkly 2016; 146: w14322
  • 4 McBride MT, Muldoon MP, Santore RF, Trousdale RT, Wenger DR. Protrusio acetabuli: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (02) 79-88
  • 5 Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand 1939; 83 (Suppl. 58) 53-68
  • 6 Friedenberg ZB. Protrusio acetabuli. Am J Surg 1953; 85 (06) 764-770
  • 7 Mac Donald D. Primary protrusio acetabuli. J Bone Joint Surg. 1971; 53-B (01) 30-36
  • 8 Armbuster TG, Guerra Jr J, Resnick D. et al. The adult hip: an anatomic study. Part I: the bony landmarks. Radiology 1978; 128 (01) 1-10
  • 9 Severin E. Arthrograms of hip joints in children. Surg Gynecol Obstet 1941; 72: 601-604
  • 10 Hooper JC, Jones EW. Primary protrusion of the acetabulum. J Bone Joint Surg Br 1971; 53 (01) 23-29
  • 11 Alexander C. The aetiology of primary protrusio acetabuli. Br J Radiol 1965; 38: 567-580
  • 12 Violas P, Fassier F, Hamdy R, Duhaime M, Glorieux FH. Acetabular protrusion in osteogenesis imperfecta. J Pediatr Orthop 2002; 22 (05) 622-625
  • 13 Trehan SK, Morakis E, Raggio CL, Twomey KD, Green DW. Acetabular protrusio and proximal femur fractures in patients with osteogenesis imperfecta. J Pediatr Orthop 2015; 35 (06) 645-649
  • 14 Ahn J, Carter E, Raggio CL, Green DW. Acetabular protrusio in patients with osteogenesis imperfecta: risk factors and progression. J Pediatr Orthop 2019; 39 (10) e750-e754
  • 15 Van Dijk FS, Sillence DO. Osteogenesis imperfecta: clinical diagnosis, nomenclature and severity assessment. Am J Med Genet A 2014; 164A (06) 1470-1481
  • 16 Gusis SE, Babini JC, Garay SM, García Morteo O, Maldonado Cocco JA. Evaluation of the measurement methods for protrusio acetabuli in normal children. Skeletal Radiol 1990; 19 (04) 279-282
  • 17 Upasani VV, Bomar JD, Parikh G, Hosalkar H. Reliability of plain radiographic parameters for developmental dysplasia of the hip in children. J Child Orthop 2012; 6 (03) 173-176
  • 18 Engelbert RH, Uiterwaal CS, Gerver WJ, van der Net JJ, Pruijs HE, Helders PJ. Osteogenesis imperfecta in childhood: impairment and disability. A prospective study with 4-year follow-up. Arch Phys Med Rehabil 2004; 85 (05) 772-778
  • 19 Shapiro F. Consequences of an osteogenesis imperfecta diagnosis for survival and ambulation. J Pediatr Orthop 1985; 5 (04) 456-462
  • 20 Fano V, Rodríguez Celin M, Del Pino M. et al. Osteogénesis imperfecta. Evaluación clínica, funcional y multidisciplinaria de 65 pacientes. An Pediatr (Barc) 2010; 72 (05) 324-330
  • 21 Rodríguez Celin M, Fano V. Osteogenesis imperfecta: level of independence and of social, recreational and sports participation among adolescents and youth. Arch Argent Pediatr 2016; 114 (03) 248-251