Evaluation of translation in the normal and dysplastic hip using three-dimensional magnetic resonance imaging and voxel-based registration.

OBJECTIVE

To elucidate in vivo hip instability by comparing normal hips to hips with acetabular dysplasia by evaluating three-dimensional (3D) translations of the femoral head center (FHC) at different hip positions using magnetic resonance imaging (MRI).

DESIGN

Forty normal hips and 22 dysplastic female hips were examined. MRI was performed at four different positions bilaterally: neutral, 45° of flexion, 15° of extension, and the Patrick position. Femoral and pelvic bones were separately extracted at the neutral position and superimposed over the images of each different position using voxel-based registration. The distance between the acetabular center and FHC at neutral position was defined as 3D-migration. The distance between FHC at neutral position and that at each different position was defined as 3D-translation. Two-way repeated measures analysis of variance was performed to consider the dependency between right and left-side data, and multiple linear regression analyses were performed to assess independent relationships.

RESULTS

The center-edge (CE) angle was the determinant for 3D-migration (β=-0.415, P=0.001), and there was a statistical significant difference in 3D-migration between normal female hips and dysplastic hips (P=0.047). From neutral to the Patrick position, the FHC of normal and dysplastic hips translated postero-infero-medially by 1.12±0.39mm (0.45-1.85mm) and 1.97±0.84mm (0.95-4.34mm), respectively, and the difference between the groups was statistically significant (P=0.005). CE angle was the determinant for 3D-translation from neutral to the Patrick position (β=-0.730, P<0.001). The average root mean square error in 3D-translation was 0.172mm and 0.193mm for intra- and interobserver reproducibility, respectively.

CONCLUSIONS

Hip instability was increased in proportion to the severity of acetabular dysplasia. A 3D MRI voxel-based registration technique can show in vivo morphology and kinematics of the native hip without exposure to radioactivity.