Acetabular coverage analysis of the proximal femoral head accurately characterizes dysplastic acetabular morphology

This study aimed to (1) measure acetabular sector angle (ASA) from proximal to distal positions along the axial femoral head axis, (2) identify acetabular deficiency patterns, and (3) correlate ASA at different axial positions with other radiological measurements in acetabular dysplasia. We identified 30 hips with dysplasia (lateral center edge angle [LCEA] <20°) and 30 hips without dysplasia (LCEA >25°) from a retrospective cohort. Anterior and posterior ASA (AASA, PASA) were measured in the axial computed tomography plane through the femoral head center (equatorial) and two axial positions above the equatorial line (intermediate and proximal). Deficiency patterns were identified using ASA cut-off values determined from receiver operating characteristic curves. Pearson's coefficients were used for correlations. Compared to non-dysplastic hips, AASA in dysplastic hips was significantly smaller in all levels: equatorial (46.1 ± 7.3 vs. 54.9 ± 8.5,° p < 0.001), intermediate (62.1 ± 11.2 vs. 69.0 ± 10.6,° p = 0.02), and proximal (102.9 ± 14.2 vs. 128.3 ± 23.0,° p < 0.001). According to proximal ASA (Pro-ASA) cut-off values in dysplastic hips, global deficiency was most prevalent (19/30, 63.3%), followed by anterior (6/30, 20%) and posterior (3/30, 10%) deficiency. There were strong correlations between acetabular anteversion and Eq-AASA (r = -0.74, p < 0.001) and LCEA and pro-PASA (r = 0.82, p < 0.001). Clinical significance: Acetabular sector angle provides insight into acetabular morphology and patterns of deficiency, providing essential information for precise acetabular reorientation.