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Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion

Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion
Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion
Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two-dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the crossover sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion. COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT-based method using 3-D models was developed to measure the COS, PWS, true acetabular version and pelvic tilt relative to the anterior pelvic plane. The new CT-based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging. A low level of agreement for COS and PWS was found between radiographs and CT scans. A positive COS strongly correlated with pelvic tilt. These results suggest that COS and PWS determined from anteroposterior (AP) radiographs are considerably limited by pelvic tilt and inherent limitations of radiographs. Their use as the sole basis for deciding whether or not surgical intervention is indicated seems questionable
hip, femoroacetabular impingement (FAI), crossover sign, posterior wall sign, three-dimensional analysis
0736-0266
1369-1376
Wassilew, Georgi I.
b8226f26-299a-42c2-be01-4ccd32235cdf
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Diederichs, Gerd
2fd977fb-4479-4bcf-8209-1dbc43847d77
Janz, Viktor
279dc6bd-848e-4d83-99b6-d976efe10bdd
Wenzl, Marcus
6c2119ce-a171-4937-91aa-b3262bdf2b96
Perka, Carsten
50eac0cf-e710-45df-a04b-b8af775eace1
Wassilew, Georgi I.
b8226f26-299a-42c2-be01-4ccd32235cdf
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Diederichs, Gerd
2fd977fb-4479-4bcf-8209-1dbc43847d77
Janz, Viktor
279dc6bd-848e-4d83-99b6-d976efe10bdd
Wenzl, Marcus
6c2119ce-a171-4937-91aa-b3262bdf2b96
Perka, Carsten
50eac0cf-e710-45df-a04b-b8af775eace1

Wassilew, Georgi I., Heller, Markus O., Diederichs, Gerd, Janz, Viktor, Wenzl, Marcus and Perka, Carsten (2012) Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion. Journal of Orthopaedic Research, 30 (9), 1369-1376. (doi:10.1002/jor.22086). (PMID:22411574)

Record type: Article

Abstract

Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two-dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the crossover sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion. COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT-based method using 3-D models was developed to measure the COS, PWS, true acetabular version and pelvic tilt relative to the anterior pelvic plane. The new CT-based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging. A low level of agreement for COS and PWS was found between radiographs and CT scans. A positive COS strongly correlated with pelvic tilt. These results suggest that COS and PWS determined from anteroposterior (AP) radiographs are considerably limited by pelvic tilt and inherent limitations of radiographs. Their use as the sole basis for deciding whether or not surgical intervention is indicated seems questionable

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More information

Published date: 2012
Keywords: hip, femoroacetabular impingement (FAI), crossover sign, posterior wall sign, three-dimensional analysis
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348543
URI: https://eprints.soton.ac.uk/id/eprint/348543
ISSN: 0736-0266
PURE UUID: 99e14735-1bce-45da-8655-a00cf377cbba
ORCID for Markus O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

Catalogue record

Date deposited: 14 Feb 2013 09:52
Last modified: 20 Jul 2019 00:41

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