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Musculoskeletal Imaging

E1161. Imaging of Hip Dysplasia and Periacetabular Osteotomy: What the Orthopedist Wants to Know

Vossen J,  Berl S,  Haar P,  Hoover K,  Hayes C. Virginia Commonwealth University Medical Center, Richmond, VA

Address correspondence to J. Vossen (josephina.vossen@gmail.com)

Background Information: Developmental dysplasia of the hip is a common condition that is associated with pain, functional limitations, and secondary osteoarthritis. Acetabular deformity results in structural instability and increased stress on the acetabular labrum. Developmental dysplasia of the hip represents a significant disease burden and is thought to lead to the development of osteoarthrosis in 25–50% of patients by the age of 50 years.

Educational Goals/Teaching Points: The purpose of our exhibit is to explain the pathophysiology of hip dysplasia, to accurately quantify the extent of hip dysplasia using radiographs, CT, and (MRI), to understand the radiographic measurements associated with the hip dysplasia, and to recognize the reconstructive surgical techniques for correcting hip dysplasia with emphasis on the periacetabular osteotomy and its normal and abnormal postoperative imaging appearance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present pathophysiology of hip dysplasia, including anatomic review of the hip joint, etiologies of hip dysplasia, and factors predicting pain related to hip dysplasia. We show assessment of hip dysplasia using radiographs, CT, and MRI, and provide a review of various methods for measuring hip dysplasia. We conclude with surgical approaches for correcting hip dysplasia with emphasis on periacetabular osteotomy and the normal and abnormal postoperative imaging findings.

Conclusion: Delayed diagnosis of hip dysplasia is an important cause of secondary osteoarthritis. The radiographic diagnosis of hip dysplasia in the young adult may be subtle. CT and MRI can provide additional morphologic information about acetabular deficiency in hip dysplasia. Familiarity with the radiographic and cross-sectional imaging findings of dysplasia may allow timely implementation of appropriate treatment strategies to prevent the development of early osteoarthritis of the hip in the young adult population. In well-selected patients, reconstructive osteotomy should be considered safe and effective in alleviating pain and improving hip function.