Acetabular Retroversion in Down Syndrome

The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Journal of pediatric orthopedics (Impact Factor: 1.47). 04/2012; 32(3):277-81. DOI: 10.1097/BPO.0b013e31824b27fc
Source: PubMed


The management of the unstable Down syndrome hip is challenging, and there is controversy about the anatomic factors that may contribute to the instability. It has been our observation that children with Down syndrome often have a deficient posterior acetabular wall. This is different from other congenital acetabular dysplasia where the anatomic deficiency is typically anterolateral. These observations suggest that the acetabulum in Down syndrome hip dysplasia may be relatively retroverted. The purpose of this study was to determine the acetabular version in children with Down syndrome and compare this with matched controls from both normal and developmental dysplasia of the hip (DDH) populations.
A cohort of Down patients treated surgically for acetabular dysplasia and/or hip instability was matched by age, sex, and side to a group of normal controls and compared with a cohort of patients who had undergone periacetabular osteotomy for DDH. For all patients, preoperative computed tomography scans were used to measure acetabular version through the joint center. Statistical differences were determined using analysis of variance with α=0.05.
We identified 16 subjects in each cohort. The average acetabular version in the normal control group was 13±5 degrees and in the DDH cohort was 21±7 degrees. In contrast, the mean version in the group of patients with Down syndrome was 2±11 degrees, indicating increased acetabular retroversion; this result was significantly different from both the normal group (P=0.02) and those with DDH (P<0.001). According to the criteria described by Tönnis for computed tomography measured retroversion, 10/16 patients with Down syndrome were severely retroverted compared with only 3/16 normal controls and 1/16 patients with DDH (P=0.002).
Patients with Down syndrome and hip instability seem to have more retroverted acetabula than normal controls and patients with DDH. In patients with Trisomy 21, axial imaging should be performed to evaluate acetabular version when planning the optimal corrective osteotomy for instability and/or acetabular deficiency.
Level III (prognostic, retrospective case-control).

Download full-text


Available from: Jonathan Schoenecker, Feb 09, 2014
1 Follower
37 Reads
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The pathogenesis and clinical course of hip dysplasia in cerebral palsy and Down syndrome is different than idiopathic developmental dysplasia of the hip. Unlike idiopathic developmental hip dysplasia, hip development in cerebral palsy and Down syndrome is typically normal in utero and instability develops after birth secondary to musculoskeletal disorders associated with the disease condition. For this reason, treatment protocols in Down syndrome and cerebral palsy hip dysplasia differ greatly from protocols designed to treat idiopathic hip dysplasia. The purpose of this review is to describe the pathologic hip morphology that results from cerebral palsy and Down syndrome.
    Journal of Pediatric Orthopaedics 06/2013; 33 Suppl 1(33):s29-32. DOI:10.1097/BPO.0b013e3182860034 · 1.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The most favorable mechanical environment for the hip is one that is free of both instability and impingement, creating a concentric articulation with optimum femoral head coverage by the acetabulum. Anatomic variations such as acetabular dysplasia with associated instability, and femoroacetabular impingement with abnormal constraint, will lead to abnormal joint mechanics, articular damage, and osteoarthritis. Surgical techniques such as periacetabular osteotomies, and femoral and acetabular osteoplasties enable correction of anatomic variations that cause mechanical damage to the hip joint, thereby potentially preventing or delaying development of osteoarthritis and subsequent need for joint replacement.
    Rheumatic diseases clinics of North America 02/2013; 39(1):189-202. DOI:10.1016/j.rdc.2012.11.004 · 2.69 Impact Factor
Show more