A Practical Approach to Determining the Center of the Femoral Head in Subluxated and Dislocated Hips.

Abstract

Mistaking the ossific nucleus as the surrogate for the center of the femoral head affects treatment decisions in hip dysplasia. Previous studies of ossific nucleus position within the femoral head have been qualitative, or, have not included both subluxated and dislocated hips. The purpose of this study was, first, to determine the most accurate radiographic landmark to define the center of the immature femoral head in hip dysplasia, and, second, to quantitatively analyze the position of the ossific nucleus relative to the center of the femoral head. The center of the femoral head was determined from hip arthrograms for 19 consecutive patients with untreated hip dysplasia. Three radiographic proxies for the center were defined on each film: (1) the center of the proximal physis; (2) the center of the ossific nucleus; and (3) a modification of Mose's concentric circles. Each point was compared with the true center of the head on an arthrogram. Nineteen patients of an average age of 35.5 months (range, 9 to 76 mo) yielded 22 dysplastic hips. Modified Mose circle was the most accurate technique. In subluxated hips, the center of the femoral physis was equally accurate. The ossific nucleus was the poorest estimation of the center of the femoral head. All of the ossific nuclei were located cephalad and lateral to the center of the femoral head as determined on arthrogram. The modified Mose technique is the most accurate technique for determining the center of the femoral head. In subluxated hips, the center of the physis is a practical, equivalent, technique. The ossific nucleus is a poor proxy for the center of the head in hip dysplasia. A modification of Mose's technique is the most accurate assessment of the center of the femoral head in both subluxated and dislocated hips. The center of the physis is a practical, reliable, surrogate for the center of the head in subluxated hips without requiring an arthrogram.