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. 2009 Jun;33(3):625-31.
doi: 10.1007/s00264-007-0507-6. Epub 2007 Dec 21.

Postoperative acetabular retroversion causes posterior osteoarthritis of the hip

Takahiko Kiyama  1 , Masatoshi Naito, Kei Shiramizu, Tsuyoshi Shinoda
Affiliations

Postoperative acetabular retroversion causes posterior osteoarthritis of the hip

Takahiko Kiyama et al. Int Orthop. 2009 Jun.

Abstract
in English, French

We retrospectively reviewed 68 hips in 62 patients with acetabular dysplasia who underwent curved periacetabular osteotomy. Among the 68 hips, 33 had acetabular retroversion (retroversion group) and 35 had anteversion (control group) preoperatively. All hips were evaluated according to the Harris hip score. Radiographic evaluations of acetabular retroversion and posterior wall deficiency were based on the cross-over sign and posterior wall sign, respectively. The clinical scores of the two groups at the final follow-up were similar. In the retroversion group, 12 hips had anteverted acetabulum postoperatively. The posterior wall sign disappeared in these hips, but remained in 21 hips with retroverted acetabulum postoperatively. Among the 21 hips with retroverted acetabulum, posterior osteoarthritis of the hip developed postoperatively in five hips. When performing corrective osteotomy for a dysplastic hip with acetabular retroversion, it is important to correct the acetabular retroversion to prevent posterior osteoarthritis of the hip due to posterior wall deficiency.

Nous avons revu de façon rétrospective 68 hanches chez 62 patients présentant une dysplasie acétabulaire et ayant bénéficié d’une ostéotomie péri-acétabulaire. Parmi ces 68 hanches, 33 avaient en préopératoire une rétroversion acétabulaire (groupe rétroversion) et 35 une antéversion (groupe contrôle). Toutes les hanches ont été évaluées selon le score de Harris. L’évaluation radiographique de la rétroversion acétabulaire et du mur postérieur déficient ont été basées sur le signe du croisement et le signe du mur extérieur. Les scores cliniques des deux groupes au suivi final était semblable. Dans le groupe rétroversion, 12 hanches avaient antéversé leur acétabulum en post-opératoire le signe du mur postérieur disparaissant, mais celui-ci restant présent dans 21 hanches avec un acétabulum en rétroversion post-opératoire. Parmi les 21 hanches avec acétabulum rétroversé une coxarthrose postérieure s’est développée à 5 ans post-opératoire. Lorsque l’on réalise une correction par ostéotomie pour une hanche dysplasique avec un acétabulum rétroversé, il est important de corriger cette rétroversion de façon à prévenir une coxarthrose secondaire due à la déficience du mur postérieur.

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Figures

Fig. 1
Fig. 1
a Anteroposterior (AP) radiograph of a patient with acetabular dysplasia and acetabular anteversion. The anterior line always runs medial to the posterior line. b AP radiograph of a patient with acetabular dysplasia and acetabular retroversion. The superior aspect of the anterior line is lateral to the posterior line, and the anterior and posterior lines cross each other at the proximal part of the acetabulum. The posterior line is medial to the centre of the femoral head, representing positive posterior wall sign
Fig. 2
Fig. 2
a Preoperative AP radiograph of a 25-year-old woman showing acetabular dysplasia with acetabular retroversion and positive posterior wall sign. b AP radiograph taken 73 months postoperatively shows that the acetabular retroversion has been corrected. The posterior wall sign has disappeared in this hip. The patient had a Harris hip score of 99 points
Fig. 3
Fig. 3
a Preoperative AP radiograph of a 45-year-old man showing acetabular dysplasia with acetabular retroversion and positive posterior wall sign. b An AP radiograph taken 3 years postoperatively shows that the acetabular retroversion has not been corrected and the posterior wall sign is still present. c A preoperative false-profile view of the same hip shows no osteoarthritis of the posterior part. d A false-profile view taken 3 years postoperatively shows posterior wall deficiency and progressive osteoarthritis of the posterior part of the hip with cartilage space narrowing. The patient has a Harris hip score of 87 points
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