The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 93, Issue Supplement 2

Scientific Articles | May 04, 2011

Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients

Ryan M. Nunley, MD¹; Heidi Prather, DO¹; Devyani Hunt, MD¹; Perry L. Schoenecker, MD¹; John C. Clohisy, MD¹

¹ Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.C. Clohisy: clohisyj@wudosis.wustl.edu

View Disclosures and Other Information

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits or a commitment or agreement to provide such benefits from commercial entities (Wright Medical and Zimmer, Inc. [in excess of $10,000] and Smith & Nephew and Salient Surgical [less than $10,000]).

Investigation performed at the Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri

J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):17-21. doi: 10.2106/JBJS.J.01735

5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Article

Comments (0)

text A A A

Abstract

Background:

Acetabular dysplasia is recognized as a cause of early degenerative hip osteoarthritis. The purpose of this study was to prospectively determine the early clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients.

Methods:

Fifty-seven consecutive skeletally mature patients with a total of sixty-five symptomatic hips were diagnosed with symptomatic acetabular dysplasia on the basis of the history, physical examination, and radiographs. These fifty-seven patients were enrolled in this study and were followed prospectively for a minimum of twenty-four months postoperatively.

Results:

The study group included forty-one female patients (72%) and sixteen male patients (28%) with a mean age of twenty-four years. All were treated with a periacetabular osteotomy and were followed for a minimum of twenty-four months. The initial presentation was insidious in 97% of the hips, and the majority (77%) of the hips were associated with moderate-to-severe pain on a daily basis. Pain was most commonly localized to the groin (72%) and/or the lateral aspect of the hip (66%). Activity-related hip pain was common (88%), and activity restriction frequently diminished hip pain (in 75% of the cases). On examination, thirty-one hips (48%) were associated with a limp; twenty-five (38%), with a positive Trendelenburg sign; and sixty-three (97%), with a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of hip dysplasia was 61.5 months. The mean number of health-care providers seen prior to the definitive diagnosis was 3.3. The mean Harris hip score improved from 66.4 points preoperatively to 91.7 points at a mean of 29.2 months after the periacetabular osteotomy.

Conclusions:

The diagnosis of symptomatic acetabular dysplasia is commonly delayed, and procedures other than a pelvic reconstructive osteotomy are frequently recommended. The diagnosis of developmental dysplasia of the hip should be suspected and investigated when a skeletally mature, young, active patient has a predominant complaint of insidious activity-related groin pain and/or lateral hip pain.

Level of Evidence:

Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article

Introduction

Introduction | Materials and Methods | Results | Discussion | References

Acetabular dysplasia is a common deformity that results in an increase in joint reactive forces, acetabular rim overload, and eventually articular cartilage degeneration^1-7. Many patients with symptomatic and functionally limiting hip dysplasia experience symptoms prior to the development of advanced secondary osteoarthritis. In these patients, acetabular reorientation can optimize femoral head coverage, decrease articular cartilage loading, delay or prevent the development of secondary osteoarthritis, and enhance patient function and activity^8-16. To optimize the clinical results of hip joint preservation procedures, the hip should be treated in the prearthritic or early arthritic phase of the disease^17,18; thus, early diagnosis is important.

For health-care providers to make a timely diagnosis of symptomatic acetabular dysplasia, they must have a familiarity with the clinical presentation, common findings on physical examination, and radiographic abnormalities. There is a paucity of detailed information regarding the specific signs and symptoms of early symptomatic hip dysplasia. The purpose of this study was to prospectively determine the early clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. Symptoms, clinical signs, timeliness of diagnosis, and treatment recommendations were analyzed in patients with symptomatic acetabular dysplasia treated with a periacetabular osteotomy.

Materials and Methods

Introduction | Materials and Methods | Results | Discussion | References

All participants provided informed consent prior to participation in this study, which was approved by our institutional review board. Patients were recruited from the clinic of the senior authors (J.C.C. and P.L.S.). Fifty-seven consecutive skeletally mature patients with a total of sixty-five symptomatic hips were diagnosed with symptomatic acetabular dysplasia on the basis of the history, physical examination, and radiographs. These fifty-seven patients were enrolled in this study and were followed prospectively for a minimum of twenty-four months postoperatively. Preoperative data were available for all patients, and only one patient was lost to follow-up less than two years postoperatively. The mean patient age was twenty-four years (range, 13.4 to 44.3 years). Forty-one patients (72%), with forty-seven involved hips, were female, and sixteen (28%), with eighteen involved hips, were male. All hips were treated with a periacetabular osteotomy^8-10. Eight patients had a staged bilateral procedure. Only symptomatic patients whose physical examination and radiographic findings were consistent with acetabular dysplasia and who had had prior unsuccessful nonoperative treatment were included in this study.

Clinical Evaluation

All fifty-seven patients completed a comprehensive set of questionnaires to detail their history and describe their symptom complex. This study design was similar to that of two previous reports from our group^19,20. Demographic data, including sex, height, weight, and age at the time of surgery, were recorded for each patient. Patients were asked to characterize their pain with regard to its severity, location, character, duration, mechanical symptoms, aggravating factors, and modes of relief. They were asked about their activity level, which they self-reported as sedentary, active, recreational athletics, or high-level athletics. The onset of symptoms (traumatic, acute, or insidious) was also assessed. The impact of the symptoms on daily activities was solicited through questions regarding limping; the use of assistive devices; and the ability to walk various distances, to ascend and descend stairs, to don shoes and socks, to sit for extended periods of time, and to utilize public transportation²¹. The patients were asked to report prior diagnoses as well as the number and type of health-care providers (physicians, chiropractors, physical therapists, and nurse practitioners) whom they had seen for their hip problem. The length of time from the onset of symptoms to the definitive diagnosis of acetabular dysplasia was also recorded.

The physical examination findings recorded for this study included the presence or absence of a limp and Trendelenburg sign and the results of a hip impingement test²². The hip impingement test was considered positive when passive hip flexion (90°), adduction (10°), and internal rotation (10° to 15°) reproduced the patient's symptom of groin and/or lateral hip pain²². The Harris hip score was administered preoperatively and at each follow-up visit to assess hip pain and function²³. Patients were evaluated at follow-up visits at six weeks, three months, twelve months, and annually thereafter. The clinical response to surgery as measured with the Harris hip score was utilized to confirm that the symptoms at the time of presentation were reduced by surgical correction.

Radiographic Evaluation

The patients were evaluated with supine anteroposterior pelvic, cross-table lateral, false-profile²⁴, and functional flexion-abduction radiographs²⁵. Preoperative degenerative changes in the hip were classified into four grades, according to the criteria outlined by Tönnis and Heinecke²⁶. The radiographic measurements used to evaluate the hip included the acetabular inclination^3,24,26-28, the lateral center-edge angle of Wiberg²⁸, the anterior center-edge angle of Lequesne and de Sèze²⁴ as measured on a false-profile radiograph^3,26,27, and the hip-joint-center position^29,30. Radiographic findings associated with anterior femoroacetabular impingement were also evaluated. The anteroposterior pelvic radiograph was used to determine acetabular version^26,31-35. The cross-table lateral radiograph was used to determine femoral head-neck offset according to the method described by Eijer et al.³⁶.

Preoperatively, no patient had radiographic evidence of moderate degenerative joint disease (Tönnis grade 2 or higher) and all had adequate hip joint congruency as assessed with a functional anteroposterior flexion-abduction radiograph. Radiographically, acetabular dysplasia was defined as a lateral center-edge angle of Wiberg of <25°, an anterior center-edge angle of Lequesne and de Sèze of <20°, and an acetabular roof obliquity of >10°³.

Statistical Evaluation

Chi-square analysis was used to test the proportionality of symptoms. Random probability determines that each category for a symptom would contain roughly the same number of patients. The significance level was set at p = 0.05. Comparisons of preoperative and postoperative Harris hip scores were done with the Wilcoxon signed-rank test. A paired t test was used to compare the preoperative and postoperative radiographic parameters of the acetabular position, with significance set at p < 0.05.

Results

Introduction | Materials and Methods | Results | Discussion | References

Clinical Results

The preoperative presenting symptoms are presented in Table I. The onset of symptoms was insidious in sixty-three (97%) of the sixty-five hips, acute in one hip, and secondary to a traumatic episode in one hip. The severity of the symptoms was rated by the patient as moderate for thirty-three hips (51%, p < 0.001) and severe for seventeen hips (26%, p < 0.001). Pain was localized to the groin in forty-seven cases (72%) and to the lateral aspect of the hip in forty-three (66%). Pain was less commonly noted in the anterior aspect of the thigh (29%) or the buttock (18%). No patient had isolated buttock pain, and the presence of buttock pain was always associated with groin pain. Pain in more than one anatomic site was reported in forty-one cases (63%). The quality of the pain was characterized as sharp in forty-nine hips (77%) and as dull in fifty hips (78%). Activity-related pain was noted in fifty-six hips (88%, p < 0.001), and night pain was noted in thirty-eight (59%, p = 0.12). Increased symptoms were associated with walking in fifty-two cases (81%, p < 0.001), running in fifty-one (80%, p < 0.001), standing in forty-five (70%, p < 0.001), impact activities in thirty-five (55%, p = 0.61), pivoting on the affected side in twenty-nine (45%, p = 0.44), and prolonged sitting in twenty-eight (44%, p = 0.20). At least one mechanical symptom (catching, clicking, popping, or locking) was reported in fifty-one hips (80%). Functional limitations are presented in Table II. Limping was the most commonly reported functional loss and was noted by the patient in association with 48% of the hips. A limited walking distance was associated with 35% of the hips. On physical examination, thirty-one hips (85%) were associated with a limp when the patient was walking a short distance. Twenty-five hips (38%) were associated with a positive Trendelenburg sign and sixty-three (97%) with a positive impingement test.

View Larger

TABLE I Summary of Symptoms Associated with Developmental Dysplasia of the Hip in Present Series

Symptoms	No. of Hips Affected	% of Hips Affected	P Value
Onset of symptoms (n = 65)
Insidious	63	96.9	<0.001
Acute	1	1.5	<0.001
Traumatic	1	1.5	<0.001
Severity of symptoms (n = 65)
None	0	0	<0.001
Slight	6	9.2	<0.001
Mild	9	13.8	<0.001
Moderate	33	50.8	<0.001
Severe	17	26.2	<0.001
Location of pain (n = 65)
Groin	47	72.3	<0.001
Anterior aspect of thigh	19	29.2	<0.05
Lateral aspect of hip	43	66.2	<0.05
Posterior (buttock)	12	18.5	<0.001
Quality of pain (n = 64)
Sharp	49	76.6	<0.001
Dull (aching)	50	78.1	<0.001
Constant	27	42.2	0.19
Intermittent	34	53.1	0.44
Activity related	56	87.5	<0.001
Night pain	38	59.4	0.12
Mechanical symptoms (n = 64)
Snapping/popping	43	67.2	<0.001
Locking	15	23.4	0.07
Subluxation	14	21.9	<0.05
None	14	21.9
Aggravation (n = 64)
Walking	52	81.3	<0.001
Running	51	79.7	<0.001
Standing	45	70.3	<0.001
Impact	35	54.7	0.61
Pivoting	29	45.3	0.44
Sitting	28	43.8	0.20
Standing from sitting (n = 43)	20	31.3	0.65
Relief mode (n = 64)
Rest	48	75	<0.001
NSAIDs	36	56.3	0.15
Narcotics	5	7.8	<0.001
Positioning	27	42.2	0.52
Other	7	10.9

Add to My JBJS

TABLE I Summary of Symptoms Associated with Developmental Dysplasia of the Hip in Present Series

Symptoms	No. of Hips Affected	% of Hips Affected	P Value
Onset of symptoms (n = 65)
Insidious	63	96.9	<0.001
Acute	1	1.5	<0.001
Traumatic	1	1.5	<0.001
Severity of symptoms (n = 65)
None	0	0	<0.001
Slight	6	9.2	<0.001
Mild	9	13.8	<0.001
Moderate	33	50.8	<0.001
Severe	17	26.2	<0.001
Location of pain (n = 65)
Groin	47	72.3	<0.001
Anterior aspect of thigh	19	29.2	<0.05
Lateral aspect of hip	43	66.2	<0.05
Posterior (buttock)	12	18.5	<0.001
Quality of pain (n = 64)
Sharp	49	76.6	<0.001
Dull (aching)	50	78.1	<0.001
Constant	27	42.2	0.19
Intermittent	34	53.1	0.44
Activity related	56	87.5	<0.001
Night pain	38	59.4	0.12
Mechanical symptoms (n = 64)
Snapping/popping	43	67.2	<0.001
Locking	15	23.4	0.07
Subluxation	14	21.9	<0.05
None	14	21.9
Aggravation (n = 64)
Walking	52	81.3	<0.001
Running	51	79.7	<0.001
Standing	45	70.3	<0.001
Impact	35	54.7	0.61
Pivoting	29	45.3	0.44
Sitting	28	43.8	0.20
Standing from sitting (n = 43)	20	31.3	0.65
Relief mode (n = 64)
Rest	48	75	<0.001
NSAIDs	36	56.3	0.15
Narcotics	5	7.8	<0.001
Positioning	27	42.2	0.52
Other	7	10.9

View Larger

TABLE II Functional Limitations Associated with Acetabular Dysplasia in Present Series

	No. of Hips Affected	% of Hips Affected
Limp (n = 65)
None	10	15.4
Slight	35	53.8
Moderate	16	24.6
Severe	4	6.2
Support (n = 65)
None	63	96.9
Cane (long distances)	1	1.5
Walker or 2 crutches	1	1.5
Distance (n = 65)
Unlimited	42	64.6
6 blocks	7	10.8
2-3 blocks	12	18.5
Able indoors only	4	6.2
Stairs (n = 65)
Normal	30	46.2
With banister	29	44.6
Any method	6	9.2
Public transportation (n = 65)
Yes	58	89.2
No	7	10.8
Donning shoes (n = 65)
Easy	49	75.4
Difficult	13	20.0
Unable	3	4.6
Sitting (n = 65)
60 minutes/any chair	53	81.5
30 minutes/high chair	12	18.5

Add to My JBJS

TABLE II Functional Limitations Associated with Acetabular Dysplasia in Present Series

	No. of Hips Affected	% of Hips Affected
Limp (n = 65)
None	10	15.4
Slight	35	53.8
Moderate	16	24.6
Severe	4	6.2
Support (n = 65)
None	63	96.9
Cane (long distances)	1	1.5
Walker or 2 crutches	1	1.5
Distance (n = 65)
Unlimited	42	64.6
6 blocks	7	10.8
2-3 blocks	12	18.5
Able indoors only	4	6.2
Stairs (n = 65)
Normal	30	46.2
With banister	29	44.6
Any method	6	9.2
Public transportation (n = 65)
Yes	58	89.2
No	7	10.8
Donning shoes (n = 65)
Easy	49	75.4
Difficult	13	20.0
Unable	3	4.6
Sitting (n = 65)
60 minutes/any chair	53	81.5
30 minutes/high chair	12	18.5

It was not uncommon for the patients to experience delays in diagnosis, inaccurate diagnoses, and ineffective treatments. The mean time from the onset of symptoms until the definitive diagnosis of acetabular dysplasia was 61.5 months (range, five months to twenty-nine years). The mean delay in diagnosis after the patient initially sought medical care was 41.6 months (range, zero to 204 months). Other providers seen for the condition included primary care physicians (fifty-four), orthopaedic surgeons (109), chiropractors (fourteen), and others (five). The patients were evaluated by an average of 3.3 health-care providers (range, zero to eleven) prior to the establishment of the definitive diagnosis. Most commonly, patients were diagnosed with some type of soft-tissue injury (eleven hips, 17%) or osteoarthritis (seven hips, 11%), although radiographs did not demonstrate notable degenerative changes in any hips. A variety of other diagnoses were given for fourteen hips. The most common treatment option recommended by other health-care providers was nonsteroidal anti-inflammatory drugs (NSAIDs) (thirty-seven hips, 57%; p < 0.15), and narcotics were recommended to five patients (8%, p < 0.001). Physical therapy was recommended for twenty-eight hips (43%, p = 0.05). Twelve patients (twelve hips) had previous surgical treatment.

The mean Harris hip scores improved from 66.4 points (range, 44 to 100 points) preoperatively to 91.7 points (range, 39 to 100 points; p < 0.001) at the time of the most recent follow-up (at a mean of 29.2 months). One patient (one hip) was lost to follow-up. One patient (one hip) required revision to a total hip arthroplasty, and one required revision surgery because of symptomatic femoroacetabular impingement. Of the remaining sixty-two hips, fifty-nine (95%) had improvement in function and/or diminished symptoms compared with preoperatively (p < 0.001). One patient reported no change postoperatively, and one patient was lost to follow-up.

Radiographic Results

Radiographic analysis demonstrated consistent deformity correction with substantial improvement in femoral head coverage and acetabular inclination postoperatively (Table III). The hip joint center was medialized by a mean of 6.3 mm. The Tönnis osteoarthritis grade was unchanged in fifty-nine hips and had increased by one grade in five. Only one hip had Tönnis grade-2 degenerative changes and no hip had advanced degenerative changes at the time of the most recent follow-up. There were no nonunions of the major acetabular osteotomy cuts (ischial, iliac, or posterior column). One patient developed an asymptomatic nonunion of the osteotomy cut in the superior pubic ramus but did not require additional surgical intervention.

View Larger

TABLE III Radiographic Measurements Before and After Periacetabular Osteotomy

	Mean (Range)
Measurements	Preop.	Postop.	Change	P Value
Lateral center-edge angle (deg)	-1.2 (-30 to 19)	27.4 (10 to 47)	28.7 (5 to 54.0)	<0.0001
Anterior center-edge angle (deg)	-1.65 (-37 to 29)	30.6 (0 to 59)	32.3 (-2 to 71)	<0.0001
Acetabular inclination (deg)	26.2 (12 to 41)	8.02 (-12 to 22)	-18.2 (-39 to 7)	<0.0001
Hip joint medialization (mm)	16.6 (5 to 33)	10.4 (0 to 27)	-6.3 (-23 to 7)	<0.0001

Add to My JBJS

TABLE III Radiographic Measurements Before and After Periacetabular Osteotomy

	Mean (Range)
Measurements	Preop.	Postop.	Change	P Value
Lateral center-edge angle (deg)	-1.2 (-30 to 19)	27.4 (10 to 47)	28.7 (5 to 54.0)	<0.0001
Anterior center-edge angle (deg)	-1.65 (-37 to 29)	30.6 (0 to 59)	32.3 (-2 to 71)	<0.0001
Acetabular inclination (deg)	26.2 (12 to 41)	8.02 (-12 to 22)	-18.2 (-39 to 7)	<0.0001
Hip joint medialization (mm)	16.6 (5 to 33)	10.4 (0 to 27)	-6.3 (-23 to 7)	<0.0001

Discussion

Introduction | Materials and Methods | Results | Discussion | References

The clinical presentation of symptomatic acetabular dysplasia is variable in adults. Definitive diagnosis of this condition is commonly delayed as the specific clinical symptoms and physical findings may be subtle. Radiographic analysis can also be challenging, especially in patients with borderline or mild acetabular deformity. We performed the present prospective study to describe the clinical syndrome associated with symptomatic acetabular dysplasia.

In 1991, Klaue et al. described the acetabular rim syndrome in the dysplastic hip³⁷. Their study demonstrated that the dysplastic acetabulum is associated with abnormal stresses along the rim, which lead to rupture of the limbus, pain, and impaired function. While Klaue et al. discussed the overloading of the soft-tissue structures as the final common pathway in the generation of pain in the dysplastic hip, they did not fully describe the symptom complex associated with acetabular dysplasia. The results of our study enabled us to provide a description of the presenting symptoms, physical examination findings, and radiographic findings associated with acetabular dysplasia as well as the improved clinical function following surgical treatment. The onset of hip pain was primarily insidious (in 97% of the cases) and most commonly involved the groin and/or lateral aspect of the hip. We documented that fifty (77%) of the hips were associated with moderate or severe pain on a daily basis. The disproportionately high number of patients who walked with a limp (85% of the hips) emphasizes the magnitude of the functional impairment that these patients experienced. Additionally, the mean delay in establishing the correct diagnosis and the finding that patients had been evaluated by multiple health-care providers before obtaining the correct diagnosis indicate the need for improved medical recognition of this disorder.

This study has a number of limitations. First, the data were based on the patients’ recollection of the onset of symptoms and time-courses and are thus subjective. It is conceivable that patients with long-standing disease may not accurately recall the duration or cause of their symptoms. Second, there was no age-matched control set of data from patients with hip pain who did not have acetabular dysplasia. Therefore, it is difficult to describe one symptom as being pathognomonic for this syndrome. Third, we cannot exclude the possibility that these same symptoms and signs represented coexisting extra-articular conditions such as hip flexor tendinitis, bursitis, capsular injury, or muscular abnormality. However, the significant improvement in hip scores and the 95% rate of subjective patient-reported improvement (fifty-nine of sixty-two hips) after periacetabular osteotomy strongly support the assumption that the preoperative clinical symptoms were directly related to acetabular dysplasia.

There remains a need for improved awareness of hip dysplasia by clinicians, especially in the setting of radiographically mild disease or subtle clinical symptoms. Skeletally mature patients with acetabular dysplasia remain at risk for a delayed diagnosis and a lack of timely intervention. In young patients, complaints of insidious-onset, activity-related groin pain and/or lateral hip pain should be carefully investigated so that an accurate diagnosis is obtained and the patients can be counseled regarding disease prognosis and treatment options.

References

Introduction | Materials and Methods | Results | Discussion | References

Aronson J. Osteoarthritis of the young adult hip: etiology and treatment. Instr Course Lect. 1986;35:119-28. [PubMed]

Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20-33. [PubMed]

Murphy SB; Ganz R; Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985-9. [PubMed]

Stulberg SD; Cordell LD; Harris WH; Ramsey PL; MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The Hip. Proceedings of the Third Open Scientific Meeting of The Hip Society. St. Louis: C.V. Mosby; 1975. p 212-20.

Stulberg SD; Harris WH. Acetabular dysplasia and development of osteoarthritis of the hip. In: Harris WH, editor. The hip. Proceedings of the Second Open Scientific Meeting of the Hip Society. St. Louis: CV Mosby; 1974. p82-93.

Weinstein SL; Mubarak SJ; Wenger DR. Developmental hip dysplasia and dislocation: part II. Instr Course Lect. 2004;53:531-42. [PubMed]

Weinstein SL; Mubarak SJ; Wenger DR. Developmental hip dysplasia and dislocation: part I. Instr Course Lect. 2004;53:523-30. [PubMed]

Clohisy JC; Barrett SE; Gordon JE; Delgado ED; Schoenecker PL. Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1(Pt 1):65-83. [CrossRef][PubMed]

Ganz R; Klaue K; Vinh TS; Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res. 1988;232:26-36. [PubMed]

Leunig M; Siebenrock KA; Ganz R. Rationale of periacetabular osteotomy and background work. Instr Course Lect. 2001;50:229-38. [PubMed]

Ninomiya S. Rotational acetabular osteotomy for the severely dysplastic hip in the adolescent and adult. Clin Orthop Relat Res. 1989;247:127-37. [PubMed]

Salter RB; Hansson G; Thompson GH. Innominate osteotomy in the management of residual congenital subluxation of the hip in young adults. Clin Orthop Relat Res. 1984;182:53-68. [PubMed]

Steel HH. Triple osteotomy of the innominate bone. J Bone Joint Surg Am. 1973;55:343-50. [PubMed]

Sutherland DH; Greenfield R. Double innominate osteotomy. J Bone Joint Surg Am. 1977;59:1082-91. [PubMed]

Sutherland DH; Moore M. Clinical and radiographic outcome of patients treated with double innominate osteotomy for congenital hip dysplasia. J Pediatr Orthop. 1991;11:143-8. [CrossRef][PubMed]

Wagner H. Experiences with spherical acetabular osteotomy for the correction of the dysplastic acetabulum. New York: Springer; 1978.

Clohisy JC; Schutz AL; St John L; Schoenecker PL; Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009;467:2041-52. [CrossRef][PubMed]

Trousdale RT; Ekkernkamp A; Ganz R; Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am. 1995;77:73-85. [PubMed]

Burnett RS; Della Rocca GJ; Prather H; Curry M; Maloney WJ; Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448-57. [CrossRef][PubMed]

Clohisy JC; Knaus ER; Hunt DM; Lesher JM; Harris-Hayes M; Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638-44. [CrossRef][PubMed]

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55. [PubMed]

MacDonald SJ; Garbuz D; Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplasty. 1997;8:3-9.

Söderman P; Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement?Clin Orthop Relat Res. 2001;384:189-97. [CrossRef][PubMed]

Lequesne M; de Sèze . [False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies]. Rev Rhum Mal Osteoartic. 1961;28:643-52. French. [PubMed]

Nepple JJ; Carlisle JC; Nunley RM; Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2010 Nov 23 [Epub ahead of print].

Tönnis D; Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747-70. [PubMed]

Delaunay S; Dussault RG; Kaplan PA; Alford BA. Radiographic measurements of dysplastic adult hips. Skeletal Radiol. 1997;26:75-81. [CrossRef][PubMed]

Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand. 1939;83:7-38.

Clohisy JC; Barrett SE; Gordon JE; Delgado ED; Schoenecker PL. Medial translation of the hip joint center associated with the Bernese periacetabular osteotomy. Iowa Orthop J. 2004;24:43-8. [PubMed]

Matsui M; Masuhara K; Nakata K; Nishii T; Sugano N; Ochi T. Early deterioration after modified rotational acetabular osteotomy for the dysplastic hip. J Bone Joint Surg Br. 1997;79:220-4. [CrossRef][PubMed]

Giori NJ; Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:263-9. [PubMed]

Mast JW; Brunner RL; Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48-53. [CrossRef][PubMed]

Reikerås O; Bjerkreim I; Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand. 1983;54:18-23. [CrossRef][PubMed]

Reynolds D; Lucas J; Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281-8. [CrossRef][PubMed]

Siebenrock KA; Schoeniger R; Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278-86. [PubMed]

Eijer H; Myers SR; Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma. 2001;15:475-81. [CrossRef][PubMed]

Klaue K; Durnin CW; Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423-9. [PubMed]

Topics

lameness ; hip region ; hip dislocation, congenital ; hip joint ; pain ; hip pain ; acetabular dysplasia ; periacetabular osteotomy

Username

Password

Access for Patients

Forgot Password?

Have a subscription to the print edition?

Not a Subscriber?

Buy this Article

Get online access for 30 days for $35

New to JBJS?

Subscribe to the online edition for 30 days for $75

Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.

Have a subscription to the print edition?

Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.

Activate your online account now

Forgot your password?

Enter your username and email address. We'll send you a reminder to the email address on record.

Username:*

Email Address:*

Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
by your institution, please contact you librarian or administrator for username and password information. Institutional
administrators, to reset your institution's master username or password, please contact subs@jbjs.org

References

Accreditation Statement

These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

CME Activities Associated with This Article

Submit a Comment

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

* = Required Field

Comment Author(s) * (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
PDF
Email

Recipient(s) will receive an email with a link (good for 5 days) to 'Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients'.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*

Separate multiple email address with semi-colons (up to 5).

Subject:* 's The Journal of Bone & Joint Surgery: 'Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients'
Subject for your email.

Message:

(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The Journal of Bone & Joint Surgery, Inc. (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to Journal of Bone & Joint Surgery, Inc.'s Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The Journal of Bone & Joint Surgery Inc.'s Privacy Policy for further information.

Copyright © The Journal of Bone & Joint Surgery Inc. All rights reserved.
Share
Get Citation

Ryan M. Nunley, Heidi Prather, Devyani Hunt, Perry L. Schoenecker, John C. Clohisy; Clinical Presentation of Symptomatic Acetabular Dysplasia in Skeletally Mature Patients. The Journal of Bone & Joint Surgery. 2011 May;93(Supplement_2):17-21.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © The Journal of Bone and Joint Surgery, Inc.
Rights & Permissions
Article Alerts

Processing your request... Please Wait.
Submit a Comment