EP4.1 The Low-Volume Acetabulum: A CT-Based Method for Characterizing a Variant of Acetabular Dysplasia with Normal Lateral Center-Edge Angles

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ID: 331277
2026
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Abstract
Abstract Introduction The lateral center-edge angle (LCEA) is the most common radiographic parameter for characterizing acetabular dysplasia. Given the three-dimensional (3-D) nature of the acetabulum, however, a single metric for defining dysplasia may be insufficient. The purpose of the present study is to define the low volume acetabulum (LVA) by comparing 3-D computed tomography (CT) reconstruction data in a population of patients undergoing periacetabular osteotomy (PAO) for dysplasia (LCEA ≤18) to a population of patients with normal acetabular coverage (LCEA 30-40) undergoing hip arthroscopy. A secondary goal was to apply this threshold to patients with borderline hip dysplasia (BHD) to determine if it was predictive of various radiographic parameters and intraoperative findings associated with instability. Methods Data was reviewed and analyzed for patients with preoperative CT scans with 3-D reconstructions for preoperative planning who underwent hip preservation surgery between November 2019 and December 2024. Patients undergoing hip arthroscopy with a LCEA of 30-40° were included in the normal coverage group and patients undergoing periacetabular osteotomy with a LCEA ≤18 were included in the dysplastic group. A receiver operating characteristic (ROC) curve was constructed to identify the threshold of femoral head coverage predictive of frank dysplasia. This LVA threshold was then applied to a population of patients with BHD (LCEA 19-25) to identify patients in this group that had concomitant LVA. A secondary analysis was then conducted to identify and characterize LVA hips in a BHD population. Results A total of 793 hips were included in the primary analysis, 12 in the dysplastic group and 781 in the normal coverage group. The acetabular coverage threshold for LVA was defined as <51.5% with excellent discrimination (AUC=0.950). A total of 156 hips were included in the secondary analysis of BHD hips, 113 LVA (72%) and 43 (28%) that did not have LVA based on the 51.5% threshold. The BHD-LVA group had a significantly higher rates of ligamentum teres tears 10.6% vs 0% (p=0.04). On preoperative imaging, the BHD-LVA group had significantly lower LCEA (22.4° vs 24.1°) and acetabular surface area (3877.6 mm2 vs 4106.8mm2), as well as a significantly higher tonnis angle (14.1° vs 11.1°) and acetabular version (18.8° vs 16.2°) compared to the BHD control group (p<0.05). Conclusion A CT-based model defined LVA as acetabular coverage <51.5%. In a BHD population, 72% of hips were defined as low volume which demonstrated significant differences in radiographic measures of dysplasia, as well as intraoperative findings associated with instability when compared to the 28% of BHD hips that had more normal volume. These findings suggest the importance of 3-D imaging for surgical decision making in BHD.
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Authors Elizabeth Walsh, Etan P. Sugarman, Benjamin D. Kuhns, Benjamin Domb
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.335
URL
https://doi.org/10.1093/jhps/hnag043.335
Keywords Keywords not found

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