The Effect of Triple Pelvic Osteotomy on the Articular Contact Area of the Hip Joint in Dysplastic Dogs: An in Vitro Experimental Study

Objective —To investigate the effect of triple pelvic osteotomy (TPO) on articular contact area and acetabular coverage of dysplastic hip joints in dogs.
Study Design —Articular contact area and femoral head coverage by the acetabulum were computed in vitro in normal and dysplastic canine hips. The effect of TPO on articular contact and coverage was then analyzed in the dysplastic hips.
Sample Population—Five normal and six dysplastic canine cadaver specimens.
Methods —Contact area and coverage of loaded hips were computed using serial computed tomography scan images before and after TPO. Three angles of acetabular ventroversion (AVV) were studied (20°, 30°, and 40°). Using a custom-designed hinge plate, angles of spontaneous hip reduction in dysplastic hips were compared with previously recorded angles of reduction determined by the Ortolani test.
Results —Contact area significantly increased from 0° to 30° of AVV, then remained virtually unchanged. Coverage significantly increased from 0° to 20° of AVV. Both contact and coverage of normal hips were similar, yet significantly smaller than those of dysplastic hips once reduction had occurred. The experimental angles of reduction were significantly smaller and poorly correlated with the angles of reduction determined by the Ortolani test. Although coverage continued to increase with AVV, the actual joint contact area did not significantly vary after relocation of the femoral head.
Conclusions —This study suggests that increasing AVV beyond 20° does not significantly improve the beneficial effects of TPO and therefore should be carefully weighed against increased risks of postoperative complications associated with large angles of AVV.     

MORPHOMETRIC ASSESSMENT OF THE PROXIMAL PORTION OF THE TIBIA IN DOGS WITH AND WITHOUT CRANIAL CRUCIATE LIGAMENT RUPTURE

Based on the clinical observation that dogs with a steep tibial plateau slope had variable tibial morphology, we hypothesized that these dogs could be further characterized using measurements developed by examining computer generated models of specific proximal tibial malformations. A 3D tibial model was created from a normal canine tibia. The model was manipulated to reproduce two specific proximal tibial anomalies representing deformities originating from the tibial plateau or the proximal tibial shaft. Data from these models were used to create specific measurements that would characterize the shape of these anomalies. These measurements included the diaphyseal tibial axis (DTA)/proximal tibial axis (PTA) angle, which defined the orientation of the proximal portion of the shaft in relation to the tibial mid-shaft. These measurements were then made on radiographs of dogs with and without cranial cruciate ligament (CCL) rupture. Models with tibial plateau and proximal shaft deformities had a steep tibial plateau slope (TPS). Models with proximal shaft deformity had a markedly increased DTA/PTA angle. The model with a 10 degree proximal shaft deformity had a DTA/PTA angle of 11.23 degrees. Six dogs (9.0%) had a DTA/PTA angle larger than 11.23 degrees (range, 11.4-13.9 degrees). Dogs in this group had ruptured CCL and a steep TPS. Dogs with CCL rupture had higher TPS (mean, 31.8 +/- 4.1 degrees) and DTA/PTA angle (mean, 6.0 +/- 3.3 degrees) than dogs without CCL rupture (means, 23.6 +/- 3.4 degrees and 4.1 +/- 2.2 degrees, respectively). Dogs with proximal shaft deformity represented a distinct group, which could not be identified using the magnitude of the TPS alone. Characterizing more precisely the shape of the proximal portion of the tibia in dogs contributes to our understanding of the pathogenesis of steep TPS and may facilitate the optimization of the surgical management of dogs with CCL rupture.     

The Effect of Triple Pelvic Osteotomy on Hip Force in Dysplastic Dogs: A Theoretical Analysis

The effect of a triple pelvic osteotomy (TPO) procedure on the forces acting about the hip joint was examined in five dysplastic canine hips using a previously described theoretical analysis. Hip reaction force (F_h) and its angle of application (θ_h) were calculated from radiographic measurements made before and after TPO procedures which sequentially increased acetabular ventroversion from 0° to 20°, 30°, and 40°. The results of the in vitro study showed that F_h decreased with increasing acetabular ventroversion reaching an asymptotic value between 30° and 40°. The decrease in F_h corresponded to an increase in θ_h toward the vertical, with statistical significance found in both F_h and θ_h between 0° and 20°. The changes observed in F_h and θ_h after TPO were attributed to the medialization of the femoral head resulting from the reduction of the subluxated head. The results of this study suggest that the noted reduction in the magnitude of the forces acting on the hip joint may act in concert with increased coverage of the femoral head to effect the beneficial clinical results observed with the TPO procedure.     

Increased sacral screw purchase minimizes screw loosening in canine triple pelvic osteotomy

OBJECTIVE: To determine if screw loosening in triple pelvic osteotomies (TPO) is minimized when screws cranial to the ilial osteotomy had maximal sacral purchase. STUDY DESIGN: Prospective study. ANIMALS: Forty-six dogs with decreased acetabular coverage of the femoral head and minimal degenerative joint changes. METHODS: TPOs were performed where screws cranial to the ilial osteotomy were inserted to maximally engage sacral bone. Data collected were: use of ilial and ischial cerclage wire, screw length, ventrodorsal radiographic sacral width (most caudal aspect), pelvic canal diameter, and sacral penetration of the 3 cranial screws. On all subsequent radiographs, changes in screw position, pelvic canal diameter, and sacral purchase were noted. RESULTS: For 69 TPOs, 414 screws were used. Mean radiographic cranial screw length was 34.54 mm. Combined sacral depth of all 3 screws was 93.3% of sacral width. All osteotomies healed uneventfully. Twenty-four screws (6%) loosened with 12 being in the most cranial positions. Use of ischial or ilial cerclage wires did not statistically influence screw loosening. Pelvic diameter decreased by a mean of 7.79% from postoperative radiographs to the last radiographic recheck. CONCLUSIONS: By sufficiently engaging the sacrum with screws cranial to the ilial osteotomy, implant failures can be avoided and screw loosening minimized when a 6-hole TPO plate is used. CLINICAL RELEVANCE: To minimize screw-loosening in TPO, screws inserted cranial to the ilial osteotomy should be inserted to maximum sacral depth without penetrating the vertebral canal.     

Comparison of femoral inclination angle measurements in dysplastic and nondysplastic dogs of different breeds

In this study, inclination angle of the femoral head and neck was measured on 484 limbs of 242 dogs belonging to 7 breeds, examined for hip dysplasia. These inclination angles were compared according to age, sex and joint laxity, evaluated with Subluxation Index (SI) and Norberg angle (NA) results. The findings indicate that (a) there was a minimal (nonsignificant) difference in femoral inclination angle between the dysplastic and nondysplastic dogs belonging to 7 breeds; (b) although there was no significant difference in femoral inclination angle between the nondysplastic dogs belonging to 4 breeds (Pointer, Irish Setter, Golden Retriever and German Shepherd), a significant difference was observed between Doberman and Labrador, and between Anatolian Karabash and the other six breeds (p < 0.001). Age and sex did not affect the femoral neck angle.     

Effects of static fixation and dynamization after interlocking femoral nailing locked with an external fixator: an experimental study in dogs

OBJECTIVE: To determine bone healing at 20 weeks, after either static fixation (SG) or after dynamization (DG) at 4 weeks in osteotomized canine femurs repaired with an interlocking nail (ILN) secured with a type I external skeletal fixator (ESF). STUDY DESIGN: Experimental study. ANIMALS: Ten adult beagle dogs. METHODS: After mid-diaphyseal femoral osteotomy, femurs in 10 dogs were repaired with an ILN secured with 4 (2 proximal, 2 distal) threaded custom pins (TP; 2.7-mm-diameter cortical screw with a 2-mm shaft attached to the screw head) to which 2 parallel connecting bars were attached in a type I ESF configuration. In 5 dogs, dynamization was performed at 4 weeks by removing the connecting bars and 2 distal screws. Limb function, range of motion of the stifle joint (ROMSJ), radiographic evidence of bone healing, and complications were studied for 20 weeks. RESULTS: Full limb function was achieved between 8 and 10 weeks in SG dogs, but a decreased ROMSJ was observed from 5 to 8 weeks. In DG dogs, full limb function occurred between 5 and 6 weeks except in 1 dog, and ROMSJ was considered normal in all dogs. Bone healing was not affected by dynamization. Average healing time for SG was 12.8 weeks, and for DG it was 13.6 weeks. Periosteal reaction at TP insertion points, osteolysis around the thread and head of TPs were observed in both groups. A windshield-wiper effect was observed at the tip of 1 ILN. CONCLUSION: ILN locked with a type I ESF can be used for fixation of mid-shaft femoral fractures. Dynamization at 4 weeks did not affect bone healing but did prevent stifle ankylosis and promoted earlier limb function. CLINICAL RELEVANCE: ILN locked with a type I ESF is seemingly a feasible method for repair of mid-shaft femoral fractures and may decrease risk of nail failure.     

Long-term outcome of juvenile pubic symphysiodesis and triple pelvic osteotomy in dogs with hip dysplasia

OBJECTIVE: To compare long-term outcomes of juvenile pubic symphysiodesis (JPS) and triple pelvic osteotomy (TPO) in dogs with hip dysplasia. DESIGN: Prospective clinical trial. ANIMALS: 18 dogs with hip dysplasia (ie, distraction index > or = 0.5 in at least 1 hip joint and no, mild, or moderate radiographic evidence of degenerative joint disease [DJD]). PROCEDURES: Dogs between 4 and 5.5 months old at enrollment were assigned to undergo JPS, and dogs between 5 and 12 months old were assigned to undergo TPO. All dogs were reexamined at 2 years of age. RESULTS: At 2 years of age, there were no significant differences between groups in regard to lameness scores, angle of extension of the hip joints, distraction index, peak vertical force, acetabular angle, radiographic DJD score, or owner-assigned scores of clinical function. Dorsal acetabular rim angle was significantly higher in dogs that underwent JPS than in dogs that underwent TPO. For dogs that underwent TPO, dorsal acetabular rim angle was significantly decreased and acetabular angle was significantly increased at 2 years of age, compared with values obtained prior to surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that JPS and TPO have similar effects on hip joint conformation in dogs with moderate to severe hip dysplasia but that neither procedure eliminates the hip joint laxity characteristic of hip dysplasia or the progression of degenerative changes.     

Changes in the Proximal Femur and Coxofemoral Joint Following Intramedullary Pinning of Diaphyseal Fractures in Young Dogs

We report radiographic changes and clinical results seen in the proximal femur and coxofemoral joint of 7 young dogs following intramedullary pinning. Changes seen radiographically included coxa valga, a small malformed femoral head, a short thin femoral neck, and coxofemoral subluxation. Epiphyseal trauma, ischemia, and mechanical impairment of normal femoral neck growth due to presence of the intramedullary pin are discussed as possible etiologic factors.     

Determination of Pelvic Limb Alignment in the Large‐Breed Dog: A Cadaveric Radiographic Study in the Frontal Plane

Objectives— To report a method for radiographic determination of the mechanical axis of the canine pelvic limb and its relationship to the joints and bone axes. To report reference ranges for the relationships between the axes of the pelvic limb and for joint position relative to the pelvic limb axis. Study Design— Cadaveric radiographic anatomic study. Animals— Pelvic limbs (n=101) from normal midsized to large breed dogs; tibiae (n=105) from dogs with cranial cruciate ligament disease (previous study). Methods— Extended full‐limb radiography was performed and images analyzed to determine: mechanical joint reference angles (femur, tibia), pelvic limb axis, tibiofemoral and metatarsotibial angle, mechanical axis—femur/metatarsus angle, and mechanical axis deviation (MAD) of the stifle/tarsus. Results— Mean mechanical angles were: lateral proximal femoral (103.7°±5.4°), lateral distal femoral (98.6°±2.5°), medial proximal tibial (92.2°±1.8°), medial distal tibial (95.9°±2.2°), tibiofemoral (9.1° varus ±2.8°), metatarsotibial (0.6° valgus ±2.1°). Mean mechanical axis—femur and—metatarsus angles were 5.6° (±1.7°) and 2.9° (±1.5°), respectively. Mean MAD of the stifle and tarsus were 3.6% (±1.1%) and 1.2% (±0.6%), respectively. Tibial angles were not different between dogs with and without cranial cruciate ligament disease. Conclusions— Mechanical axes of the canine pelvic limb and their relationship to the joints can be determined by full‐limb radiography. Clinical Relevance— Techniques and reference ranges may be useful for diagnosis, surgical planning, and postoperative assessment of pelvic limb deformities.     

Comparison of measurements of dorsolateral subluxation of the femoral head and maximal passive laxity for evaluation of the coxofemoral joint in dogs

OBJECTIVE: To determine whether dorsolateral subluxation (DLS) of the femoral head reflects osseous conformation of the coxofemoral (hip) joint and represents a property distinct from maximum passive laxity of the hip joint in dogs. ANIMALS: 14 Labrador Retrievers, 16 Greyhounds, 58 Greyhound-Labrador Retriever mixed-breed dogs, and 1 Rottweiler. PROCEDURES: DLS of the femoral head (DLS score) and passive laxity of the hip joint (distraction index) were determined radiographically in 3 groups of dogs: not treated (167 joints of 84 dogs); before and after injecting 2 ml of hyaluronan into 25 hip joints of 13 dogs; and before and after unilateral triple pelvic osteotomy in 5 dogs. Results of the 2 methods were compared for each group. RESULTS: In untreated dogs, the correlation coefficient (r) of DLS score versus distraction index was -0.73 and -0.69 for 84 left and 83 right hip joints, respectively. Mean coefficient of determination (r2) for both hips was 0.5. Mean DLS score did not differ before and after intra-articular injection of hyaluronan into either hip joint, whereas mean distraction index increased significantly after intra-articular injection. Unilateral triple pelvic osteotomy resulted in a significant increase in DLS score, compared with values obtained before surgery. However, distraction index before and after surgery did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE: The DLS test assesses the congruity of the acetabulum and the femoral head in a canine hip joint and thus represents a characteristic distinct from maximum passive laxity. The DLS score and the distraction index evaluate different components of hip joint stability.     

Spontaneous bilateral coxofemoral luxation in four dogs

Spontaneous bilateral coxofemoral luxations and their clinical managements are described in four dogs. Luxations in each case occurred while the patient was in a controlled environment with no possibility of trauma. While all cases had bilateral luxations, the luxations occurred in a staged fashion in two of the four cases. Treatment varied with each case, but included closed reduction, triple pelvic osteotomy, prosthetic capsulorrhaphy, toggle pin, ischioilial pinning, total hip replacement, and femoral head and neck ostectomy. Other than femoral head and neck ostectomy, results were uniformly poor, with reluxation being the most common complication. Evidence of pre-existing degenerative changes was minimal, particularly considering the ages of the patients (range, three to 12 yrs). Histopathological evaluation of joint capsules, round ligaments, and femoral heads are warranted in future cases.     

Histomorphometric analysis of the proximal portion of the femur in dogs with osteoarthritis

OBJECTIVE: To describe cancellous architecture of the proximal portion of the femur in dogs with osteoarthritis. ANIMALS: 30 dogs with coxofemoral osteoarthritis. PROCEDURE: All dogs had femoral head and neck excision or total hip arthroplasty. Histomorphometry software was used to analyze computer images of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur. Histologic preparations of coronal and transverse sections of articular cartilage were graded. RESULTS: Bone volume/total volume, trabecular thickness, trabecular number, and bone surface/total volume were significantly higher in the femoral head than femoral neck. Trabecular alignment (anisotropy) and separation were significantly higher in the femoral neck than femoral head. Anisotropy was significantly increased in the medial portion of the femoral head in the coronal plane and in the cranial portion of the femoral neck in the transverse plane, compared with healthy dogs. The medial half of femoral head cartilage that overlies the proximomedial cancellous bone region had significantly more degraded cartilage than the lateral half. Histologic grades for cranial and caudal halves of femoral head articular cartilage were similar. CONCLUSIONS AND CLINICAL RELEVANCE: Most findings were similar to those in healthy dogs. Greater trabecular alignment in the proximomedial region of the femoral head and craniolateral region of the femoral neck in dogs with osteoarthritis suggests an altered transfer of load through the coxofemoral joint. Greater cartilage degradation on the medial half of the femoral head supports an association between increased trabecular alignment and cartilage degradation.     

Effects of degree of acetabular rotation after triple pelvic osteotomy on the position of the femoral head in relationship to the acetabulum

OBJECTIVE: To assess the effect of rotating the acetabulum 20 degrees and 30 degrees on percent coverage (PC) of the femoral head by the acetabulum and Norberg angle (NA) after triple pelvic osteotomy (TPO). STUDY DESIGN: Retrospective study. ANIMAL POPULATION: Fifty-six client-owned dogs. METHODS: PC and NA were measured from preoperative, immediate postoperative, first recheck, and second recheck radiographs to compare the effects of 20 degrees and 30 degrees of rotation of the acetabulum after TPO for treatment of hip dysplasia. RESULTS: Within the 20 degrees rotation group, PC and NA values were significantly greater at each subsequent evaluation time starting at the preoperative measurement except for NA between the first and second recheck times. Within the 30 degrees rotation group, PC and NA values were significantly greater at each subsequent evaluation time starting at the preoperative measurement except for PC and NA between the first and second recheck times. No significant differences between the 20 degrees and 30 degrees rotation groups were found at any corresponding times for either PC or NA. CONCLUSIONS: Acetabular rotation of 20 degrees provided the same degree of improvement in acetabular femoral head coverage as 30 degrees of rotation after TPO at the immediate postoperative, first recheck, and second recheck evaluation times. CLINICAL RELEVANCE: Based on PC and NA, 20 degrees rotation of the acetabulum provides as much benefit as 30 degrees of acetabular rotation when performing a TPO.     

A radiographic stress technique for evaluation of coxofemoral joint laxity in dogs

OBJECTIVE: To develop a radiographic stress technique to quantify hip joint laxity in dogs. STUDY DESIGN: Prospective study on client-owned dogs presented for hip dysplasia screening. ANIMAL POPULATION: 302 nonselected dogs (63 breeds). METHODS: Dogs were sedated and placed in dorsal recumbency. During pelvic radiography, the femoral heads were displaced manually in a craniodorsal direction. On these stress radiographs, the degree of lateral displacement of the femoral heads was assessed in terms of a subluxation index (SI) and compared with the degree of femoral head subluxation and the severity of hip dysplasia found on conventional extended hindlimb radiographs. RESULTS: The degree of subluxation on stress radiographs was significantly greater than on conventional radiographs. Correlation between the severity of canine hip dysplasia (CHD), graded according to conventional techniques, and the degree of subluxation, induced by radiographic stress technique, was positive (r = .57; P<.0001). Two critical SI values were noted. Of the dogs with an SI value of 0.3 or less, 99% were classified as CHD grade normal, borderline, or mildly dysplastic. In dogs with an SI value between 0.3 and 0.5, CHD grading ranged from normal to severely dysplastic. Of the dogs with an SI value greater than 0.5, 95% had dysplastic hip joints. CONCLUSIONS: Hip joint laxity cannot be quantified precisely on standard position radiographs. The proposed stress technique yields significantly higher degrees of femoral head subluxation than the standard position.     

Femoral head and neck excision in the management of canine hip dysplasia.

Degenerative joint disease as a sequela to pathology of the coxofemoral joint can cause considerable pain. In dogs weighing less than 20 km, excision of the femoral head and neck is sufficient to control this pain. A pseudoarthrosis functions effectively as a salvage hip joint. In dogs weighing more than 20 km, additional surgery is required to ensure painfree use of the hip. Postoperatively, the weight of these larger animals appears to cause striking of the proximally excised femoral shaft with the pelvis during exercise. This contact causes pain that limits the use of the joint. The inclusion of a biceps femoris muscle sling to prevent this striking and the resultant pain is outlined.     

Coxofemoral arthroscopy and total hip arthroplasty for management of intermediate grade fibrosarcoma in a dog

OBJECTIVE: To report the use of arthroscopy and total hip arthroplasty (THA) for management of intermediate grade fibrosarcoma of the femoral head in a dog. STUDY DESIGN: Clinical case report. ANIMAL: A 6-year-old spayed female Rottweiler presented for evaluation of acute-onset of lameness of the right pelvic limb of approximately 10 days duration. METHODS: Coxofemoral arthroscopy was performed to obtain fine needle aspiration and Jamshidi biopsy of a lytic lesion of the femoral head. A cemented THA was performed removing as much of the femoral neck and proximal femur as possible while not compromising implant or joint stability. RESULTS: Histologic evaluation of specimens from the femoral head and neck remnants confirmed an intermediate grade fibrosarcoma. Fifteen months after THA, subjectively there was normal use of the right limb with only limited decrease in range of motion and mild muscular atrophy. Radiographs demonstrated stationary positioning of the THA implants. CONCLUSIONS: Arthroscopy of the coxofemoral joint is an effective diagnostic tool for evaluation of disease of the articular structures and canine total hip replacement may be an appropriate means of limb salvage in rare cases of disease of the femoral head. CLINICAL RELEVANCE: This case provides support for the use of coxofemoral arthroscopy as a diagnostic tool as well as an aid in acquiring representative intraarticular tissue samples. Additionally, the case presented demonstrates the potential use of THA as a limb sparing technique in cases of disease affecting the femoral head of dogs.     

Changes of hip joint congruity after triple pelvic osteotomy in the dog with hip dysplasia

Changes in hip joint congruity was evaluated in dogs with hip dysplasia before and after triple pelvic osteotomy by computed tomography examination in the standing position. Lateral center edge angle significantly increased, and center distance (CD) significantly decreased after surgery compared to the values before surgery, respectively. There was an inverse proportion between the postoperative period and the change in the ratio of CD. These results suggested that joint laxity was improved with time after surgery, providing evidence of the clinical usefulness of this surgery.     

Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy

Fragmented coronoid process in 13 elbows (10 dogs) was treated by medial elbow arthrotomy plus osteotomy of the proximal ulnar diaphysis. All the dogs were skeletally immature and had a lameness of at least four weeks' duration. An attempt was made to measure the disease-modifying effect of this procedure by estimating the development of osteophytosis. Complications were infrequent and never serious. Clinical outcome, overall, was good. This preliminary work indicates that proximal ulnar diaphyseal osteotomy may have a place in the management of fragmented coronoid process in young dogs.     

Evaluation of a method for experimental induction of osteoarthritis of the hip joints in dogs

OBJECTIVE: To evaluate a method for experimental induction of osteoarthritis in the hip joints of dogs. ANIMALS: 12 mixed-breed dogs. PROCEDURE: A unilateral triple pelvic osteotomy was performed. In 6 dogs, the iliac osteotomy was repaired with 45 degrees of internal rotation, reducing coverage of the femoral head by the acetabulum. In the other 6 dogs, the fragments were repaired in anatomic alignment. Radiography, force plate evaluations, and subjective lameness evaluations were performed before and after surgery. Dogs were euthanatized 7 months after surgery, and samples of cartilage and joint capsule were examined histologically. RESULTS: Subjective lameness scores, radiographic appearance of the hip joints, and Norberg angles were not significantly different between groups; however, force plate evaluations did reveal significant differences in vertical ground reaction forces. Femoral head coverage was significantly decreased with rotation of the acetabulum. Mild inflammatory changes were discernible in the joint capsule and articular cartilage of some dogs in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that 45 degrees internal rotation of the acetabulum does not consistently induce biologically important osteoarthritic changes in the hip joints of dogs.     

Acetabular ventroversion with double pelvic osteotomy versus triple pelvic osteotomy: a cadaveric study in dogs

Objective: To determine which of 3 different plate angles (20°, 25°, 30°) used in double pelvic osteotomy (DPO) would result in the most similar acetabular angle (AA) achieved with a 20° triple pelvic osteotomy (TPO) technique in dogs. Study Design: Experimental anatomic study. Animals: Cadaveric canine pelves (n=8). Methods: Transverse plane computed tomographic images of cadaveric pelves with intact sacroiliac joints, mounted in a custom jig, were made (baseline) and again after DPO (20°, 25°, 30°) and TPO (20°) and pelvic angles measured in 6 transverse planes. Pelvic angles of the 3 DPO techniques were compared with TPO using concordance correlation to determine which DPO angle resulted in an acetabular ventroversion angle closest to TPO. Results: Mean ± SD AAs were 32.89 ± 2.23 (baseline), 47.39 ± 4.39 (20° DPO), 51.43 ± 5.06 (25° DPO), 54.75 ± 4.38 (30° DPO), and 50.20 ± 5.76 (20° TPO). Concordance correlations for the AA compared with 20° TPO were 0.027 (baseline), 0.721 (20° DPO), 0.902 (25° DPO), and 0.593 (30° DPO). A concordance correlation of ≥0.8 indicates good correlation. Conclusions: A 25° DPO is most similar in acetabular ventroversion to 20° TPO (concordance correlation, 0.902).