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. 2022 Feb;3(2):158-164.
doi: 10.1302/2633-1462.32.BJO-2021-0189.R1.

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

Pranai Buddhdev  1 , Frederico Vallim  2 , David Slattery  3 , Jitendra Balakumar  3
Affiliations

Acetabular retroversion is prevalent and proportional to the severity of slipped upper femoral epiphysis

Pranai Buddhdev et al. Bone Jt Open. 2022 Feb.

Abstract

Aims: Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Hips with dysplasia, osteoarthritis, and Perthes' disease, however, have higher rates, ranging from 18% to 48%. The aim of our study was to assess the prevalence of acetabular retroversion in patients presenting with SUFE using both validated radiological signs and tomographical measurements.

Methods: A retrospective review of all SUFE surgical cases presenting to the Royal Children's Hospital, Melbourne, Australia, from 2012 to 2019 were evaluated. Preoperative plain radiographs were assessed for slip angle, validated radiological signs of retroversion, and standardized postoperative CT scans were used to assess cranial and mid-acetabular version.

Results: In all, 116 SUFEs presented in 107 patients who underwent surgical intervention; 47 (52%) were male, with a mean age of 12.7 years (7.5 to 16.6). Complete radiological data was available for 91 patients (99 hips) with adequate axial CT imaging of both hips. Overall, 82 patients (82%) underwent pinning in situ (PIS), with subcapital realignment surgery (SRS) performed in 17 patients (18%) (slip angles > 75°). Contralateral prophylactic PIS was performed in 72 patients (87%). On the slip side, 62 patients (68%) had one or more radiological sign of retroversion. Tomographical acetabular retroversion was more pronounced cranially than caudally of the acetabulum on both the affected side and the contralateral side (p < 0.001) as expected in the normal population. Increasing severity of the slip was found to be directly proportional to the degree of reduction in cranial and central acetabular version (p < 0.05) in the SUFE hips.

Conclusion: Acetabular retroversion is more prevalent in patients with SUFE than previously reported, and have been shown be correlated to the severity of the slip presentation. The presence of radiological signs of acetabular retroversion could be used to justify prophylactic contralateral pinning. Cite this article: Bone Jt Open 2022;3(2):158-164.

Keywords: Acetabular retroversion; Adolescent hip; CT scans; Femoroacetabular impingement; Legg-calve-perthes disease; Plain radiographs; Retroversion of the acetabulum; Slipped upper femoral epiphysis; acetabulum; hips; osteoarthritis; paediatric orthopaedics; realignment surgery; upper femoral epiphysis.

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Conflict of interest statement

ICMJE COI statement: J. Balakumar reports royalties and consulting fees from Medacata, Johnson & Johnson, and Arthrex; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Mathys, and the Singapore Orthopaedic Association; support for attending meetings and/or travel from ISHA and the Singapore Orthopaedic Association; and being chairman of MEND Orthopaedic Nutrition Australia, all of which is unrelated to this work.

Figures

Fig. 1
Fig. 1
Measurements of the central acetabular version, as published by Dandachli et al.
Fig. 2
Fig. 2
Anteroposterior radiograph of patient with right slipped upper femoral epiphysis, demonstrating ischial spine sign on the solid line, posterior wall sign on the dashed line, and cross over sign on the dotted line.
Fig. 3
Fig. 3
Measurements of cranial acetabular version for slip side (n = 99) and contralateral (non-slip) side (n = 83) by presenting severity of slip. No statistically significant relationship was noted between slip and non-slip side (p = 0.262). *One-way analysis of variance demonstrated increasing retroversion (p = 0.008) on slip side with increasing severity.
Fig. 4
Fig. 4
Measurements of mid-acetabular version for slip side (n = 99) and contralateral (non-slip) side (n = 83) by presenting severity of slip. No statistically significant relationship was noted between slip and non-slip side (p = 0.284). *One-way analysis of variance demonstrated increasing retroversion (p = 0.004) on slip side with increasing severity.
See this image and copyright information in PMC

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