Evolution of acetabular retroversion studies in Perthes disease

Abstract

Perthes disease is a hip lesion caused by vascular disorders in the femoral head of children. Although the disease is a self-limited disease, but often residualvary degrees of femoral head deformity, leading to early osteoarthritis. It is currently believed that the lesions of Perthes disease are mainly located in the femoral head.However, some studies demonstrated that patients with Perthes disease also appearvary degrees of acetabular morphological changes. In recent years, the acetabular retroversions were found in 31-60% of patients with Perthes disease. The acetabular retroversion is a pathological anatomical variation of the acetabulum in the horizontal plan. It is related to the occurrence of the femoracetabular impingement and osteoarthritis. Many studies showed that the patients with poor prognosis (Stulberg III, IV or V) are associated with a higher prevalence of acetabular retroversion.The grading and the age of onset of Perthes disease are important factors affectingprognosis. Although existing studies illustrate that the lateral column grading, gender and age are not associated with the acetabular retroversion of Perthes disease significantly, the cases of the studies are limited and further researches are expected. Surgery containment therapy is an important wayto treat Perthes disease. The pelvic osteotomy can directly change the shape of the acetabulum and cause the acetabular retroversion, which result inthe femoracetabular impingement. The acetabular retroversion should be avoided as much as possible intra-operatively. Further research should be focused on whether the surgical interventions and the subsequent biomechanical changes could induce the acetabular retroversion. The cause of the acetabular retroversion in patients with Perthes disease is unclear. In order to elucidate the occurrence and development of acetabular retroversionin Perthes disease, some scholars found thataccompanying femoral head deformity, acetabular anteversion angleand inclinationdecreased significantly, and thecoverage angle in the superior, posterior, and inferior quadrants alsogradually reduced in animal studies. This is similar to clinical observations. This article reviews the progress of acetabular retroversion in Perthes disease by summarizing the relevant literatures. We hope to givenew insights for the etiology and pathology of Perthes disease, and provide new ideas for the treatment and prevention of the femoracetabular impingement and early osteoarthritis.