EP2.2 Imaging and Pathological Characteristics of the True and False Acetabulum in Developmental Dysplasia of the Hip: A Diagnostic Cohort Study

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ID: 331252
2026
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Abstract
Abstract Objective Current classification of developmental dysplasia of the hip (DDH) primarily relies on the degree of displacement and morphological parameters. This study aimed to define and validate a novel classification system for differentiating the "False Acetabulum" from the "Ture Acetabulum" in DDH with Hatofilakidis type I or Tonnis type I/II, based on imaging and pathological evidence. Methods From December 2024 to December 2025, 40 DDH hips with Hatofilakidis type I or Tonnis type I/II were included in this study. Using unilateral hip MRI scans from DDH patients, three-dimensional (3D) reconstructions of the acetabulum and labrum were performed with ITK-SNAP software to visually assess their spatial relationship. The unilateral hip MRI data of DDH patients were included. Diagnoses of true and false acetabulum were made by two senior attending physicians from our team. Inter-observer agreement with an independent observer was calculated, a confusion matrix was constructed, and the kappa (κ) coefficient was determined. Furthermore, cartilage and subchondral bone samples from both the true and false acetabulum regions were collected using a biopsy needle and examined via Masson staining. Results Imaging analysis confirmed that the region medial to the labrum is the true acetabulum, while the region lateral to the labrum is the false acetabulum. In cases with a false acetabulum, the weight-bearing articular interface for the femoral head was typically the false acetabulum region, with the true acetabulum being non-functional. Masson's trichrome staining revealed that the true acetabulum region consisted of hyaline cartilage, whereas the false acetabulum region was composed of fibrocartilage. The proposed diagnostic method demonstrated almost perfect inter-observer agreement (κ = 0.95). Conclusion The "True Acetabulum" and "False Acetabulum" in DDH represent two distinct anatomical entities with different anatomical locations and histological foundations. This novel classification system is reliable and shows high inter-observer agreement. We recommend that the differentiation between the "True" and "False" Acetabulum be considered a new key factor in the preoperative assessment and surgical planning for PAO. Keywords: Developmental dysplasia of the hip; Periacetabular osteotomy; False Acetabulum; Ture Acetabulum; Acetabular labrum
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Authors Dianzhong Luo, Hong Zhang, Xin Zhi, XU Ziyin
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.283
URL
https://doi.org/10.1093/jhps/hnag043.283
Keywords Keywords not found

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