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- Title
Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?
- Authors
DeVries, Zachary; Speirs, Andrew D.; Salih, Saif; Beaulé, Paul E.; Witt, Johan; Grammatopoulos, George
- Abstract
Background: In addition to the relative size of the acetabular rim and how the pelvis is positioned in space, the plane in which the acetabular version is calculated also affects its measurement. Purpose: To determine the relative contribution of pelvic and acetabular characteristics on morphological version (measured relative to the anterior pelvic plane angle [APPA]) and functional version (measured relative to the horizontal table). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 acetabular dysplasia patients and 109 asymptomatic controls. Using image analysis software, morphological parameters of the pelvis and acetabulum were determined from 2-dimensional computed topography: pelvic incidence, pelvic tilt angle, sacral slope, APPA, morphological and functional acetabular versions, and subtended angles (measure of acetabular rim prominence relative to the femoral head center) around the acetabular clockface in 30° increments. Correlation and multivariable regression analyses were performed with morphological and functional version as dependent variables and spinopelvic and acetabular parameters as independent variables. Results: Morphological version was moderately associated with differences between anterior and posterior subtended angles (R = 0.68 [ P <.001] and R = 0.57 [ P <.001] for differences at 165° and 15° and 135° and 45°, respectively). Functional version was moderately associated with pelvic tilt angle (R = 0.56; P <.001) and the difference in subtended angles between anterior and posterior rims (R = 0.61 [ P <.001] and R = 0.50 [ P <.001] for differences at 165° and 15° and 135° and 45°, respectively). Multivariate analysis revealed a good model for predicting morphological version (R 2 = 0.44; P <.01) and functional version (R 2 = 0.58; P <.01). Subtended angle difference between 165° and 15° (B = 0.36 [95% CI, 0.24-0.49]; P <.001) was most strongly related to morphological version, and pelvic tilt angle (B = 0.57 [95% CI, 0.46-0.68]; P <.001) was most strongly related to functional version. Conclusion: Functional acetabular version was influenced most strongly by pelvic tilt angle rather than the relative prominence of the acetabular rims. Before determining surgical management for version abnormalities, it would be prudent to assess pelvic mobility and characteristics in different functional positions. In patients with minimal pelvic tilt change dynamically, corrective osteotomy would be the treatment of choice to improve functional version.
- Subjects
CANADA; PELVIC physiology; PELVIC anatomy; DIGITAL image processing; CROSS-sectional method; MULTIVARIATE analysis; MULTIPLE regression analysis; ACETABULUM (Anatomy); DESCRIPTIVE statistics; COMPUTED tomography; SPINE
- Publication
Orthopaedic Journal of Sports Medicine, 2021, Vol 9, Issue 10, p1
- ISSN
2325-9671
- Publication type
Article
- DOI
10.1177/23259671211030495