Acetabular dome retroversion: radiological appearance, incidence and relevance

Interest in acetabular version arose from the study of unstable developmental dysplastic hips (DDH). Initial studies and clinical observations described the dysplastic hip as being excessively anteverted. Doubts on this view arose from analysis of complications such as persistent posterior subluxation after acetabular reorienting procedures. Computed tomography fails to determine conclusively whether or not the dysplastic acetabulum is abnormally anteverted. Controversy evolves from different methods of measuring and from the fact that the acetabular opening gradually spirals from mild anteversion proximally to increasing anteversion distally. This renders the measurement of version dependent on pelvic inclination and the level of the transverse CT scan slice. On an orthograde pelvic radiograph, both pelvic inclination and rotation can be controlled. Therefore, acetabular version is best estimated based on the relationship of the anterior and posterior acetabular rims to each other on an orthograde pelvic radiograph. Acetabular retroversion has been found to be a characteristic feature of specific hip disorders such as post-traumatic dysplasia, proximal femoral focal deficiency and bladder exstrophy. In addition, acetabular retroversion has been described in DDH as well as in dysplastic hips in the context of neuromuscular and genetic disorders. Iatrogenic acetabular retroversion can also result from corrective pelvic osteotomies in childhood. Finally, retroverted acetabula may be found in otherwise nondysplastic hips. The relevance of acetabular retroversion is twofold: First, it demands a more individualized approach to acetabular dysplasia because the presence of retroversion will affect the manner in which the corrective osteotomy should be done. Second, the long-term effect of acetabular retroversion is harmful.