Journal of Medical Society

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 32  |  Issue : 3  |  Page : 195--198

Morphometric evaluation of acetabular dimensions: A computed tomography-based study from a tertiary care center in rural North-West India


Narvir Singh Chauhan1, Lokesh Thakur2, Surjeet Singh2, Bhanu Awasthi2, Sunil Kumar Raina3,  
1 Department of Radiodiagnosis, Dr. RPGMC, Kangra, Himachal Pradesh, India
2 Department of Orthopaedics, Dr. RPGMC, Kangra, Himachal Pradesh, India
3 Department of Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India

Correspondence Address:
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
India

Abstract

Introduction: The success of total hip replacement depends on the ideal placement of both acetabular and femoral component, so having a complete awareness regarding acetabular parameters including its morphology is an important requirement for successful surgery. Materials and Methods: A hospital-based observational study was conducted on all patients in the age group of 18 years, and above submitting to the Department of Radiodiagnosis for either abdominal, lower spinal, or nonorthopedic pathology of pelvic and hip region were included in this study. Acetabular dimensions (acetabular depth [Ac.D] and acetabular width [Ac.W]) were evaluated with the help of digital scale of computed tomography console room monitor. Results: The findings from the current study show that the Ac.D and Ac.W in the study population was 14.6 and 50.2 mm, respectively. The study shows no side-to-side difference in values. However, it was observed that values were larger in men as compared to women in the study population. Conclusions: There is a need to develop templates for arthroplasty which are sex specific and not universal.



How to cite this article:
Chauhan NS, Thakur L, Singh S, Awasthi B, Raina SK. Morphometric evaluation of acetabular dimensions: A computed tomography-based study from a tertiary care center in rural North-West India.J Med Soc 2018;32:195-198


How to cite this URL:
Chauhan NS, Thakur L, Singh S, Awasthi B, Raina SK. Morphometric evaluation of acetabular dimensions: A computed tomography-based study from a tertiary care center in rural North-West India. J Med Soc [serial online] 2018 [cited 2020 Sep 23 ];32:195-198
Available from: http://www.jmedsoc.org/text.asp?2018/32/3/195/251993


Full Text

 Introduction



Hip joint is a functional unit with complex biomechanical construction. With the advance in orthopedics, total hip replacement (THR) appears to have become a routine surgery. However, the success of THR depends on the ideal placement of both acetabular and femoral components, so having a complete awareness regarding acetabular parameters including its morphology is an important requirement for successful surgery. Computed tomography (CT) has been widely used in the assessment of acetabular morphology. However, there is a great variation in acetabular morphology across individuals, and the range of normal acetabular variation may differ between different races or ethnicities.[1] Accordingly, an understanding of the normal range of acetabular parameters is important as this will distinguish acetabular deformity from normal anatomical variation.

Some of the commonly used acetabular parameters include acetabular width (Ac.W) and acetabular depth (Ac.D) for measuring the morphology of the acetabulum. Based on these parameters, the acetabular index is obtained by depth/width ×100.[1]

Implant manufacturers approximate the shape of the normal acetabular cup to simple hemisphere, and therefore, for more than 50 years, orthopedic surgeons have implanted hemispheric cup for total hip arthroplasty, but geometric discrepancy between implant and anatomy often result in partial prosthetic overlap of acetabular rim. This discrepancy is known to lead to complication of iliopsoas impingement because of the chronic friction between the iliopsoas tendon and rim of the implant.[2] This study was planned with the aim to evaluate the morphometry of acetabular dimensions using CT.

 Materials and Methods



This study was conducted in the Department of Orthopedics and Radiodiagnosis of a tertiary care center in a rural area of North-West India. The study was conducted as a hospital-based observational study using a cross-sectional study design. All patients in the age group of 18 years and above submitting to the Department of Radiodiagnosis for either abdominal, lower spinal, or nonorthopedic pathology of pelvic and hip region were included in this study. Patients with fracture neck of femur, fracture of acetabulum, pelvic fracture, old-operated cases of above-mentioned fractures, patient with deformity in the hip, osteoarthritis of hip, and patients denying consent were excluded from the study.

Written informed consent was obtained from all the patients, and attendants included in the study and the study was approved by the Institutional Ethics Committee.

The identification of the following parameters was conducted in each patient:

Ac.DAc.W.

These measurements (in mm) were taken with the help of digital scale of CT console room monitor.

 Results



[Table 1] shows the age and sex distribution of patients in different age groups. Majority of the patients were in the age group ranging from 46 to 60 years (n = 318/960; 33.10%), and the lowest number of patients were in the age group of <30 years (n = 125/960; 13.00%). The study had total 960 patients; 463 males and 497 females. [Table 2] shows the distribution of Ac.D in females of different age groups. Mean of the right Ac.D in females is 14.5 ± 2.0 mm standard deviation (SD) and mean of the left Ac.D in females is 14.4 ± 2.0 mm SD with an interquartile range of 2.3 mm. There is no significant side-to-side change (P ≥ 0.05, not significant). The highest value was observed in the age group of 31–45 years, and lowest in the group of <30 years. [Table 3] shows the distribution of Ac.D in males of different age groups. Mean of the right Ac.D in males is 14.7 ± 2.1 mm SD and mean of the left Ac.D in male is 14.7 ± 2.1 mm SD with an interquartile range of 2.5 mm. There is no side-to-side difference in measurements as P > 0.05 (nonsignificant). The highest value was observed in age groups of 31–45 and 46–60 years, and lowest in the age group of <30 years. From [Table 2] and [Table 3], it is apparent that there are no differences in Ac.D in males and females.{Table 1}{Table 2}{Table 3}

[Table 4] shows the distribution of Ac.W in females of different age groups. Mean of the right Ac.W in females is 49.3 ± 3.8 mm SD and mean of the left Ac.W in females is 49.4 ± 3.8 mm SD with an interquartile range of 3.8 mm on the left and 4.5 mm on the right side. The widest acetabulum was found to be present in the age group 60 years and above; 49.9 ± 3.6 mm SD on the left side and 49.7 ± 3.7 mm SD on the right side. There is a significant side-to-side difference (P <0.05). [Table 5] shows the distribution of Ac.W in males of different age groups. Mean of the right Ac.W in males is 51.2 ± 3.9 mm SD, and mean of the left Ac.W in males is 51.3 ± 3.9 mm SD with an interquartile range of 3.8 mm on the left and 4 mm on the right. The highest value was found to be 51.5 ± 3.7 mm SD on the left side in the age group of 31–45 years and 51.4 ± 3.8 mm SD on the right side in age groups 31–45 years and 60 years and above. The lowest values were observed in the age group of <30 years. There is no significant side-to-side difference (P > 0.05). From [Table 4] and [Table 5], it is apparent that there is difference in Ac.W in male and female. Width is found to be more in males as compared to females.{Table 4}{Table 5}

 Discussion



The present study was conducted to perform a morphometric evaluation of Ac.W, and depth using plain CT scan in patients 18 years and above submitting either with abdominal, lower spinal, or nonorthopedic pathology of pelvic region, to the Department of Radiodiagnosis and fulfilling the inclusion criteria. An extensive PubMed search has revealed a paucity of data in this regard. Furthermore, no study reports on the data from a rural area.

The findings from the current study show that the Ac.D and width in the study population were 14.6 and 50.2 mm, respectively. The study shows no side-to-side difference in values. However, it was observed that values were larger in men as compared to women in the study population. These findings are in agreement with earlier studied conducted to find the acetabular dimensions. The earlier studies showed that the Ac.W and depth are significantly larger in men than in women.[2],[3] Our study confirms this. The analysis from a study in China revealed that body height contributed independently to the acetabular dimensions. The correlation between body height and acetabular size has also been reported in a study conducted previously.[4]

As we are aware that males are generally significantly taller than females, therefore, the sex difference in acetabular dimensions may be attributed to the difference in body height.[5] Men have been known to be about five inches taller than women on average. However, a large-scale study in our study may be needed before a conclusion in this regard is drawn.

 Conclusions



There is an urgent need to develop templates for arthroplasty which are sex-specific and not universal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Zeng Y, Wang Y, Zhu Z, Tang T, Dai K, Qiu S. Difference in acetabular morphology related to side and sex in a Chinese population. J Anat 2012;220:256-62.
2Vandenbussche E, Saffarini M, Taillieu F, Mutschler C. The asymmetric profile of the acetabulum. Clin Orthop Relat Res 2008;466:417-23.
3Murtha PE, Hafez MA, Jaramaz B, DiGioia AM 3rd. Variations in acetabular anatomy with reference to total hip replacement. J Bone Joint Surg Br 2008;90:308-13.
4Daysal GA, Goker B, Gonen E, Demirag MD, Haznedaroglu S, Ozturk MA, et al. The relationship between hip joint space width, center edge angle and acetabular depth. Osteoarthritis Cartilage 2007;15:1446-51.
5Height Chart of Men and Women in Different Countries-Disabled World. Available from: https://www.disabled-world.com/artman/publish/height-chart.shtml. [Last accessed on 2017 Dec 13].