If you have ever heard of the term ACEtabular dysplasia, you might have wondered what exactly it is. A BDH injury occurs when the bone in the lower part of the acetabulum becomes damaged. This condition is often caused by a fracture or an accident. If you have been diagnosed with it, you should seek medical attention as soon as possible.
Patients with BDH and DDH are often found to have co-existing femoral head deformities. In up to 70% of cases, the femoral head is ellipsoid in shape. Radiographs, CT and MRI images may reveal an increased alpha angle and reduced head-neck offset ratio. Instability is also commonly observed and may be indicative of impingement.
Patients with acetabular dysplasia often exhibit significant anterosuperior and posterosuperior deficiencies, although some cases may be more global. Imaging with multiplanar and 3-D capabilities is helpful for assessing the extent of the deficiency, and can provide a more accurate preoperative plan. Using CT data, proprietary software programs can be used to plan precise surgical reorientation of the acetabulum.
Surgical management of BHD varies according to the technique used. Arthroscopic procedures include debridement, femoroplasty, chondroplasty, and ligamentum teres debridement. Arthroscopic surgery may also be performed to repair the labrum.
Radiographic measurements of the acetabular wall can help determine the severity of the disease. In addition to a lateral center edge angle, a false-profile radiograph can help determine the extent of acetabular coverage. The angle is measured from the femoral head to the superior acetabulum. A normal angle is above 25 degrees. If the angle is below 20 degrees, there is likely a dysplastic hip.
Researchers have compared athletes with ACEtabular dysplasia to those with normal acetabular coverage in a large cohort of athletes. The results suggest that borderline patients are 3.5 times more likely to develop classic acetabular dysplasia than patients with classic acetabular dysplasia.
Untreated, ACEtabular dysplasia can lead to cartilage damage inside the hip joint and, eventually, to arthritis of the hip. It typically presents with anterior hip pain that worsens with high-level activities. In most cases, diagnosis is made with X-rays. The treatment for ACEtabular dysplasia is surgery called an acetabular osteotomy. Often, this surgery is combined with hip arthroscopy to correct the problem.
Treatment options vary widely. Hip arthroscopy has gained wider acceptance as a method to treat mild cases of BDH and borderline BDH with FAI. Besides treating the injury itself, hip arthroscopy can also address other comorbid soft tissue and bony intra-articular pathologies.
The results of hip arthroscopy for BDH have been promising. The majority of patients who undergo the procedure have good outcomes in the short and mid term. However, residual structural deformity is a frequent cause of revision hip preservation surgery. Further studies are required to determine which procedures are best for patients with BDH and FAI.