EP1.41 Sagittal Orientation of the Acetabulum in Hip Dysplasia: A Missing Parameter in Periacetabular Osteotomy Planning

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ID: 331093
2026
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Abstract
Abstract Introduction Current surgical correction of dysplastic hips via periacetabular osteotomy (PAO) primarily addresses deformities in the coronal and axial planes; however, the sagittal position of the acetabulum is frequently neglected in clinical practice. The present study evaluates the sagittal orientation of the acetabulum (SAO) across a spectrum of hip morphologies, ranging from dysplasia to overcoverage. Methods The study group was composed of 60 female patients/hips, 20 with acetabular dysplasia (lateral center edge angle ≤18°), 20 with acetabular overcoverage (LCEA ≥39°), and 20 with normal acetabular coverage (LCEA > 25 and < 39 degrees). The SOA was defined as the angle between 2 references: (1) a line running from the distal limit of the anterior acetabular horn to the posterior acetabular horn and (2) the plane perpendicular to the anterior pelvic plane (APP), defined by the right and left anterosuperior iliac spines and most anterior pubis). The functional SA was also measured and defined as the angle between 2 references: (1) a line running from the distal limit of the anterior acetabular horn to the posterior acetabular horn and (2) the plane perpendicular to the CT acquisition table. Results Mean SOA was 34.35° ± 12.73° (dysplastic), 27.25° ± 6.35° (normal coverage), and 23.15° ± 6.56° (overcoverage). One-way ANOVA revealed a statistically significant difference among groups (F = 7.85, p = 0.001). Post-hoc analysis demonstrated that dysplastic hips exhibited significantly higher SOA values compared to both normal hips (mean difference = 7.10°, 95% CI [0.22, 13.98], p = 0.042) and overcovered hips (mean difference = 11.20°, 95% CI [4.32, 18.08], p = 0.001). No significant difference was observed between normal and overcovered groups (mean difference = 4.10°, 95% CI [-2.78, 10.98], p = 0.331). Conclusion Dysplastic hips exhibit significantly higher SOA compared to those with normal or excessive coverage. These findings suggest that sagittal plane orientation should be integrated into the planning of periacetabular osteotomy to achieve a more anatomical and patient-specific correction.
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Authors Munif Hatem, Michael Pan, Soham Naik, Bryan Czajkowski, Travis H. Matheney, Young-Jo Kim, Michael Brian Millis, Sarah Dantzler Bixby
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.225
URL
https://doi.org/10.1093/jhps/hnag043.225
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