Femoroacetabular Variations Are Predisposing Factors for Traumatic Posterior Hip Dislocation

Author:

Regenbogen Stephan12ORCID,Shafizadeh Sven3ORCID,Märdian Sven4ORCID,Blum Philipp1ORCID,Osten Philipp5ORCID,Fuchs Thomas6ORCID,Jaecker Vera45ORCID

Affiliation:

1. Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Germany

2. Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany

3. Department of Orthopedic Surgery and Sports Traumatology, Sana Medical Centre, Witten/Herdecke University, Cologne, Germany

4. Center for Musculoskeletal Surgery, Charitè–University Medicine Berlin, Berlin, Germany

5. Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany

6. Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany

Abstract

Background: Although high-energy trauma mechanisms are generally considered to cause traumatic posterior hip dislocations, femoroacetabular variations are assumed to contribute to low-impact hip dislocations. Thus, the present study aimed to identify morphologic femoral and acetabular risk factors that may also contribute to posterior hip dislocations in high-energy trauma mechanisms. Methods: The acetabular and femoral morphology of 83 hips with a traumatic posterior dislocation following a high-energy trauma mechanism were analyzed and matched to a control group of 83 patients who sustained high-energy trauma without a hip injury. The lateral center-edge angle, acetabular index, acetabular depth/width ratio, cranial and central acetabular version angles, and the anterior and posterior acetabular sector angles were measured on computed tomography to quantify femoroacetabular impingement (FAI) morphology, acetabular version, and coverage. The caput-collum-diaphyseal angle and the alpha angles in the coronal and axial planes were measured to detect cam-type FAI deformity. A receiver operating characteristic curve was utilized to determine threshold values for an increased risk of hip dislocation. Results: Acetabular retroversion and posterior acetabular undercoverage were significantly increased in patients with hip dislocations compared with controls (p < 0.001). The central acetabular version angle and posterior acetabular sector angle that indicated an increased risk of hip dislocation were ≤9° and ≤90°, respectively. Cam-type FAI deformity and coxa valga were significantly increased in the dislocation group (p < 0.001). The anterolateral alpha angle that indicated an increased dislocation risk was ≥47°. Conclusions: Acetabular retroversion, posterior acetabular undercoverage, and cam-type FAI morphology may be risk factors contributing to traumatic posterior hip dislocation in high-energy trauma mechanisms. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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