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. 2008 Feb;466(2):417-23.
doi: 10.1007/s11999-007-0062-x. Epub 2008 Jan 10.

The asymmetric profile of the acetabulum

Eric Vandenbussche  1 , Mohammed Saffarini, Fabienne Taillieu, Céline Mutschler
Affiliations

The asymmetric profile of the acetabulum

Eric Vandenbussche et al. Clin Orthop Relat Res. 2008 Feb.

Abstract

Despite the curvaceous profile of the acetabulum, orthopaedic surgeons have continued to implant hemispheric cups since the introduction of total hip arthroplasty. The geometric discrepancies between the natural acetabulum and implant can result in painful iliopsoas impingement attributable to prosthetic overlap at the anterior acetabular ridge over which the iliopsoas tendon extends to leave the pelvis. We expanded on previous in vitro observations of acetabular morphology using a large in vivo sample and quantified the dimensions of the psoas valley. We studied computed tomographic scans of 200 healthy hips from 50 men and 50 women. The acetabular ridges were digitized on three-dimensional bone reconstructions and their coordinates were manipulated in spreadsheets to deduce acetabular diameter, anteversion, and inclination and to plot the rim profile. Our results confirm the acetabular rim is an asymmetric succession of three peaks and three troughs. The psoas valley has the following shape distribution: 79% curved, 11% angular, 10% irregular, and 0% straight. The mean depth of the psoas valley is 5 mm and the latitude of its trough is on average 6 mm below the acetabular equator. The use of side-specific cups that replicate the curvaceous acetabular profile could prevent prosthetic overlap and reduce the incidence of iliopsoas impingement.

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Figures

Fig. 1A–B
Fig. 1A–B
Anteroposterior photographs of cadaver acetabulum show (A) the curvaceous profile of the acetabular rim and (B) prosthetic overlap at the anterior valley leading to iliopsoas impingement.
Fig. 2
Fig. 2
The frontal pelvic plane and the pelvic coordinate system is defined by four anatomic landmarks on the pelvis, the left and right anterior superior iliac spines (L-ASIS and R-ASIS) and the left and right pubic tubercles (L-PT and R-PT).
Fig. 3A–B
Fig. 3A–B
The points digitized on the acetabular rim and on the articular surface illustrate the position of (A) the inferior margin of the acetabular notch, which was used as a reference point, and (B) the psoas valley, which is at the anterior rim of the acetabulum (Reprinted with permission from Vandenbussche E, Saffarini M, Delogé N, Moctezuma JL, Nogler M. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop. 2007;78:327–332).
Fig. 4A–B
Fig. 4A–B
Photographs of cadaver acetabulum show identified points of inflection. IMAN = inferior margin of the acetabular notch. (A) View taken perpendicular to acetabular equator and (B) view taken inferior to the acetabulum.
Fig. 5
Fig. 5
A two-dimensional acetabular profile indicates points of inflexion. The inferior margin of the acetabular notch (IMAN) is set to zero on the θ axis. Points A, B, and C correspond to the peaks and the trough of the posterosuperior depression. Points C, D, and E correspond to the peaks and the trough of the psoas valley.
See this image and copyright information in PMC

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