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Does Orientation of the Femoral Head Affect Acetabular Development? An Experimental Study in Lamb

Moraleda, Luis MD, PhD*; Bravo, Christian MD; Forriol, Francisco MD, PhD; Albiñana, Javier MD, PhD§

Journal of Pediatric Orthopaedics: September 2019 - Volume 39 - Issue 8 - p 416–421
doi: 10.1097/BPO.0000000000000974
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Background: Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth.

Methods: A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies. Results were compared with a control group (5 animals). Osteotomy was fixed with a screw-plate device. Version was controlled intraoperatively with K-wires. Animals were killed 3 months after surgical procedure. A morphometric study of both proximal femur and acetabulum was performed, including deepness, volume and diameters of the acetabulum, neck-shaft angle and femoral version.

Results: The average neck-shaft angle for the normal, anteversion, and retroversion groups was 129 degrees, whereas it was 110 degrees for the varus group and 149 degrees for the valgus group. The average femoral version for the normal, valgus, and varus groups was 21 degrees of anteversion, whereas it was 38 degrees of anteversion for the so-called anteversion group and 17 degrees of retroversion for the retroversion group. Nor the neck-shaft angle, nor the femoral version correlated with the acetabular anteroposterior diameter (P=0.698, 0.6, respectively), the acetabular inferosuperior diameter (P=0.083, 0.451, respectively) or the acetabular deepness (P=0.14, 0.371, respectively). The neck-shaft angle correlated significantly with acetabular volume (P=0.023), so that the lower the neck-shaft angle, the higher the acetabular volume (r=−0.453). The femoral version did not correlated with acetabular volume (P=0.381).

Conclusions: Decreasing the neck-shaft angle provokes an increase in acetabular volume, whereas changes in femoral version do not affect the acetabular growth. Extra-articular osteotomies that alter femoral orientation affect intra-articular gross morphology.

Level of Evidence: Level II—therapeutic study.

*Hospital Universitario La Paz, Unidad de Traumatología y Ortopedia Infantil

School of Medicine, San Pablo CEU University

§Hospital Universitario Quiron, Madrid, Spain

Hospital del IESS Jose Carrasco Arteaga, Cuenca, Ecuador

Supported by Fundación MAPFRE. Study has not received any funding from the National Institutes of Health (NIH), the Wellcome Trust or the Howard Hughes Medical Institute (HHMI).

The authors declare no conflicts of interest.

Reprints: Luis Moraleda, MD, PhD, Hospital Universitario La Paz, Unidad de Traumatología y Ortopedia Infantil, Paseo de la Castellana 261, 28046, Madrid, Spain. E-mail: l.moraleda@yahoo.es.

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