EP1.54 Regional Femoral Head CT Bone Density Mirrors Acetabular Uncoverage in Acetabular Dysplasia

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ID: 331349
2026
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Abstract
Abstract Introduction Acetabular dysplasia results in region-specific undercoverage of the femoral head and altered joint loading. Percent femoral head coverage (%FHC) provides a 3-dimensional assessment of femoral head coverage, but its relationship with spatial femoral head CT bone density, measured in Hounsfield units (HU), remains unclear. The purpose of this study was to evaluate the associations between %FHC and femoral head CT bone density globally, laterally, and regionally in acetabular dysplasia. This was a cross-sectional study with Level 3 evidence. Methods This retrospective radiologic study included 40 patients with bilateral acetabular dysplastic morphology and complete bilateral CT imaging scheduled for periacetabular osteotomy (2023–2026) (80 hips). Three-dimensional total and regional %FHC (anterolateral [AL], anteromedial [AM], posteromedial [PM], posterolateral [PL]) were computed using a standardized CT protocol; lateral %FHC was defined as the mean of AL and PL coverage. Femoral head HU were sampled in 12 regions of interest (3 axial slices proximal to the physeal scar × 4 quadrants: AL/AM/PM/PL). Two observers performed two measurements per region. Slice-level HU values were averaged within each quadrant to generate UH_AL, UH_AM, UH_PM, and UH_PL; a lateral composite (UH_Lat) was defined as mean(UH_AL, UH_PL). Associations between HU outcomes and imaging parameters were assessed using age-adjusted linear mixed-effects models with a random intercept for participant. Results Reliability across the 12 regions was good-to-excellent intraobserver (observer 1 ICC range, 0.603–0.968; observer 2, 0.655–0.927) and good interobserver (ICC range, 0.612–0.800). Age was independently associated with lower HU values across models (approximately −2.9 to −3.9 HU/year; all P < .001). In age-adjusted models, lateral coverage (%FHC_Lat) was positively associated with UH_Lat (β = 10.68 HU per 1% increase; 95% CI, 3.51–17.84; P = .004). Regionally, %FHC_AL was positively associated with UH_AL (β = 10.59; 95% CI, 2.73–18.44; P = .009) and %FHC_PL with UH_PL (β = 7.36; 95% CI, 1.58–13.13; P = .013). Total %FHC was not significantly associated with global HU after age adjustment (β = 2.11; 95% CI, −0.45 to 4.67; P = .105), and AM/PM coverage was not associated with corresponding HU measures. Conclusion In acetabular dysplasia, femoral head CT bone density shows spatial concordance with acetabular undercoverage: lower lateral and regional %FHC are associated with lower lateral femoral head HU.
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Authors Pierre Laboudie
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.238
URL
https://doi.org/10.1093/jhps/hnag043.238
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