AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Acetabular Retroversion – Reorientation vs. Arthroscopic Acetabuloplasty

Acetabular Retroversion – Reorientation vs. Arthroscopic Acetabuloplasty_-Joseph Schwab, MD

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This presentation by Dr. Joseph M. Schwab discusses acetabular retroversion and compares treatment approaches: reorientation via periacetabular osteotomy (PAO) versus acetabuloplasty (rim trimming).<br /><br />Hip dysplasia diagnosis relies on radiographic angles like the lateral center-edge angle and acetabular index, with lower values indicating dysplasia. PAO is the gold standard for correcting hip dysplasia; it surgically reorients the acetabulum to normalize joint load and prevent cartilage/labrum damage. While effective, PAO is invasive, requiring specialized surgeons and significant recovery time. Long-term studies show PAO offers a 20-year survival rate around 60%, with better outcomes in younger patients without advanced arthritis. Poor outcomes associate with age over 30, preexisting osteoarthritis, positive anterior impingement signs, and improper correction. Arthroscopy may address labral and cartilage pathology temporarily but does not correct structural deformity and often leads to progressive osteoarthritis, thus it is not first-line treatment.<br /><br />Acetabular retroversion involves abnormal anterior wall coverage often identified by crossover sign and other radiographic markers. An important metric is the acetabular wall index, which assesses anterior and posterior wall coverage; balance (A:P ratio ~0.4-0.5) is critical. Rim trimming removes acetabular bone to relieve impingement but risks causing iatrogenic dysplasia or over-resection, increasing joint contact pressures.<br /><br />Anteverting PAO (APAO) directly reorients the acetabulum to correct retroversion, avoiding complications of excessive rim trimming. APAO shows excellent 10-year results with 90% good outcomes and 100% survivorship, outperforming rim trimming in longer-term joint survival. However, risks include overcorrection causing posterior impingement and recurrent anterior impingement if cam deformities are not addressed.<br /><br />Management of the labrum in dysplasia/retroversion remains controversial with three approaches: direct open repair during osteotomy, arthroscopic repair pre/post-osteotomy, or conservative management unless clearly indicated.<br /><br />In summary, PAO reorientation offers superior long-term outcomes for acetabular retroversion and dysplasia compared to acetabuloplasty, though it is more invasive. Arthroscopy serves as a temporary measure when PAO is declined. Labral treatment strategies vary and remain debated.

Keywords

acetabular retroversion

periacetabular osteotomy

acetabuloplasty

hip dysplasia

lateral center-edge angle

acetabular index

rim trimming

acetabular wall index

anteverting PAO

labral management