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Coxa Profunda: Is the Deep Acetabulum Overcovered?

  • Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Coxa profunda, or a deep acetabular socket, is often used to diagnose pincer femoroacetabular impingement (FAI). Radiographically, coxa profunda is the finding of an acetabular fossa medial to the ilioischial line. However, the relative position of the acetabular fossa to the pelvis may not be indicative of acetabular coverage.

Questions/purposes

We therefore determined the incidence of coxa profunda and evaluated associations between coxa profunda and other radiographic parameters of acetabular coverage commonly used to diagnose pincer FAI and acetabular dysplasia.

Methods

We evaluated the radiographs of three cohorts for coxa profunda, lateral center edge (LCE) angle, acetabular index, posterior wall sign, and crossover sign. Data from 67 collegiate football players were collected prospectively (Cohort 1). We identified two patient cohorts through retrospective review of all 179 hips undergoing hip preservation surgery from 2002 to 2008 (83 periacetabular osteotomies [Cohort 2] and 96 surgical dislocation and osteochondroplasties [Cohort 3]).

Results

In all three cohorts, we detected no difference in the LCE angle or acetabular index between hips with and without coxa profunda. Coxa profunda existed in hips representing the spectrum of acetabular coverage measured by LCE angle (−18° to 60°) and acetabular orientation determined by the crossover sign.

Conclusions

Coxa profunda was a common radiographic finding in both symptomatic patients and asymptomatic football players. Coxa profunda existed in hips representing the spectrum of acetabular coverage and was not associated with an overcovered acetabulum. We conclude coxa profunda is unrelated to overcoverage and suggest its use in diagnosis of pincer FAI be abandoned in favor of other determinants of focal or general overcoverage.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We acknowledge support from the University of Utah Department of Orthopaedics for assistance with funding, technical support, and facilities for the radiographs acquired for the football player cohort of this study. Additionally, we acknowledge Lee Phillips MD for help with radiographic reads, Andrew Anderson PhD with manuscript preparation, and Jill Erickson PA-C for maintaining the database used for the patient cohorts of this study.

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Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Lucas A. Anderson MD, Ashley L. Kapron BS, Stephen K. Aoki MD & Christopher L. Peters MD

  2. Department of Biomechanics, University of Utah, Salt Lake City, UT, USA

    Ashley L. Kapron BS

Authors
  1. Lucas A. Anderson MD
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  2. Ashley L. Kapron BS
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  3. Stephen K. Aoki MD
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  4. Christopher L. Peters MD
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Corresponding author

Correspondence to Christopher L. Peters MD.

Additional information

The institution or one or more of the authors (LAA, ALK, SKA, CLP) has received, during the study period, funding from Biomet Inc (Warsaw, IN, USA), ArthroCare (Austin, TX, USA), Smith & Nephew Inc (Memphis, TN, USA), and the NIH (R01AR053344-02). One of the authors (SKA) certifies that he has received or may receive payments or benefits, during the study period, an amount of less than $10,000 from Smith & Nephew and ArthroCare. One of the authors (CLP) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,001 to $1,000,000 from Biomet Inc.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Anderson, L.A., Kapron, A.L., Aoki, S.K. et al. Coxa Profunda: Is the Deep Acetabulum Overcovered?. Clin Orthop Relat Res 470, 3375–3382 (2012). https://doi.org/10.1007/s11999-012-2509-y

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  • DOI: https://doi.org/10.1007/s11999-012-2509-y

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