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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 140-143

An observational study of human fetal acetabulum in Western Tamilnadu


1 Assistant Professor, Department of Anatomy, Karpagam Faculty of Medical Science and Research, Coimbatore, Tamil Nadu, India
2 Professor and HOD, Department of Anatomy, Karpagam Faculty of Medical Science and Research, Coimbatore, Tamil Nadu, India
3 Professor, Department of Anatomy, PSG IMS and R, Coimbatore, Tamil Nadu, India

Date of Submission25-Dec-2020
Date of Decision30-Jan-2021
Date of Acceptance15-Mar-2021
Date of Web Publication30-Jul-2021

Correspondence Address:
Dharmalingam Mathivanan
Department of Anatomy, Karpagam Faculty of Medical Science and Research, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_92_20

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  Abstract 


Background: Ten percent of congenital dislocation of hip (CDH) is familial. Many previous studies attribute shallow acetabular cavity (dysplasia trait) as the main reason. Anthropological studies revealed different observations of fetal acetabulum, regarding the side and gender involvement of CDH due to varied geographical conditions and genetical traits. With this backdrop, the study was designed to assess the morphological and morphometric parameters of fetal acetabulum in western Tamil Nadu population. Methodology: Thirty fetuses (15 males and 15 females) were obtained from the O and G Department of PSG Institute of Medical Sciences and Research. Fetuses were grouped into three groups under the age criteria as 12–20 weeks, 21–30 weeks, and 31–40 weeks. The diameter, depth, and shape of the acetabulum were observed and documented for gender and side variations. Results: In our study, there was a significant correlation between the parameters taken. With advance in the gestational, there was a significant increase in diameter of the acetabulum. The acetabular cavity had become shallower with an increase in age of the fetus. Conclusions: In our study, there were no significant differences observed in the morphology & morphometry of acetabulum wrt side and gender of the fetuses.

Keywords: Congenital dislocation of hip, dysplasia, fetal acetabulum, morphometry


How to cite this article:
Mathivanan D, Nirmaladevi M, Jamuna M. An observational study of human fetal acetabulum in Western Tamilnadu. Natl J Clin Anat 2021;10:140-3

How to cite this URL:
Mathivanan D, Nirmaladevi M, Jamuna M. An observational study of human fetal acetabulum in Western Tamilnadu. Natl J Clin Anat [serial online] 2021 [cited 2021 Sep 21];10:140-3. Available from: http://www.njca.info/text.asp?2021/10/3/140/322812




  Introduction Top


Acetabulum (acetum – vinegar and abulum – saucer or cup) literally “a vinegar cup,” also called a cotyle (any cup-shaped structure), is a bony component of hip bone or innominate bone. It is formed by the convergence of three parts of hip bone, namely the ilium, the ischium, and the pubis. Embryological significance of the bony components had genetical backdrop. Arsic et al., in their study, proposed that prenatally and postnatally, the shape of the acetabulum was altered due to pressure effects and a developmental disorder.[1] Standring explained that the complete fusion of acetabulum takes place between 16 and 18 years.[2] Walker et al. reported that ten percent of congenital dislocation of hip (CDH) was familial, with the incidence of one in thousand live births, and he attributed the report toward the shallow acetabular cavity. Shallow acetabular cavity is called a dysplasia trait. Walker study revealed that there was no sexual preponderance over CDH and there was no significance of the same condition over the sidedness.[3],[4] Masłoń et al. observed no significant orientation change in fetal acetabular development.[5] Developmental dysplasia of hip (DDH) was evaluated and discussed with standard parameters for a given population by many cadaveric and radiological studies.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] Conybeare, Price, and Jin imposed the importance of acetabular anteversion in children which plays a significant role in diagnosing DDH, which may lead to premature arthritis.[17],[18],[19] The significance of anthropological studies revealed different observations of fetal acetabulum, regarding the side and gender involvement of CDH due to varied geographical conditions and genetical traits. With this backdrop, the study was designed to assess the morphological and morphometrical parameters of fetal acetabulum in western Tamil Nadu population.


  Methodology Top


In an observational study done in PSG Institute of Medical Sciences and Research, thirty fetuses (15 males and 15 females) were grouped under the age criteria as 12–20 weeks, 21–30 weeks, and 31–40 weeks. Age was assessed by using crown–rump length measurement correlated with ultrasound measured gestational age obtained from the OBG Department. The lowest week was 12 and the highest was 38. Fetuses were also grouped under trimesters (second and third trimesters). Due approval from the Institutional Human Ethics Committee of PSG IMS and R was obtained for the study (project no: 14/157) of fetuses (cadaveric dissection).

All available aborted fetuses of gestational age from 12 to 40 weeks were included. Fetuses with limb body wall defects or those with hip joint deformities or injuries were excluded.

The dissection methodology was proceeded in such a way that first, all the muscles plus the capsule around the hip joint were removed; second, the labrum was kept intact; third, the ligament of the head of the femur was cut; and finally, the acetabular cavity was visualized in toto. Fetuses were analyzed for structural defects as mentioned earlier; the acetabulum was dissected out after removing the muscles and the capsule (labrum was preserved).[20] By using two marker needles and digital Vernier caliper (precision 0.01 mm), the following parameters were noted:

  1. Diameter of the acetabulum (width of the acetabulum): the greatest transverse diameter was taken with the marker needle [Figure 1]a and measured using digital Vernier caliper [Figure 1]b. The measurement obtained was taken as the diameter of the acetabulum (a1)[20]
  2. Depth of the acetabulum: one of the marker needles was kept across the diameter of the acetabulum; the other marker needle is placed vertically downward at right angles to the first needle, till it reaches the floor of the acetabulum [Figure 2]a. The distance in the needle was measured with Vernier caliper [Figure 2]b and was taken as the depth of the acetabulum (a2)[20]
  3. The shape of the acetabulum in different age groups was assessed by the depth to width (diameter) percentage, which was calculated as a2/a1 × 100 (depth/width ×100). If it was <50%, then the acetabular cavity is getting less hemispherical, favoring increased mobility, increasing the chance of congenital dislocation.[20]
Figure 1: (a) Transverse diameter of acetabulum – placing the marker needle. (b) Measurement of greatest transverse diameter using Vernier caliper

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Figure 2: (a) Depth of the acetabulum – placing the marker needles. Measurement of depth using Vernier caliper

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Statistical evaluation

All continuous data were expressed as mean and standard deviation. Any differences between right, left and male, female measurements were evaluated with independent t-test and Pearson correlation test for correlations among parameters using SPSS software, version 19 (IBM Corp., Armonk, NY). P < 0.05 was taken as statistically significant.


  Results Top


The average values of diameter, depth, and shape of the acetabulum are 9.82 mm ± 4.84 mm, 4.57 mm ± 1.61 mm, and 53.01 mm ± 13.67, respectively. [Table 1] shows the diameter, depth, and shape of the acetabulum in three groups. There was a significant increase in average fetal acetabular diameter and depth as the age advanced. The acetabular cavity became less hemispherical, as the age advanced. The shape of the acetabulum showed a remarkable change of negative correlation with age and made the acetabular cavity less spherical making it susceptible for dislocation.
Table 1: Measurements of fetal acetabular parameters

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There was no statistical significance between males and females as well as between the right side and left side in acetabular parameters noted. All the three parameters had a very strong correlation with each other. Between diameter and depth, it was r = 0.972 (P < 0.01); between diameter and shape; there was a strong negative correlation (r = −0.935, P < 0.01); and between depth and shape, there was a strong negative correlation (r = −0.964, P < 0.01).


  Discussion Top


In our study, with the advancement of age of the fetus, the acetabular depth and diameter increased, thereby making the shape of acetabulum shallower (negative correlation), and this whole process attributes to a statement “stability is sacrificed for mobility” during birth. However, it carries a high risk for CDH, but in our study, we could not statistically derive any significance toward the occurrence of CDH in a particular side of the acetabulum or in a particular sex of the fetuses taken. The impingement of the femur with its head during development after birth would make the acetabular cavity deeper, such that stability too is attained.

Rális et al.,[20] Walker and Goldsmith.,[4] and Uysal et al.[8] reported similar findings of the diameter and depth of the fetal acetabulum correlation with age. We did not observe the measurements after birth as of Rális et al.[20] The preponderance of CDH was seen in both studies, and in both, gender and side significance toward CDH was not seen. Masłoń et al.,[5] in their study, included fetal femur's neck-shaft angle and ante torsion angle and compared with acetabular anteversion angle and slope angle. Their study inferred no orientation difference with respect to acetabulum. However, this was due to concomitant comparison with femur angles, whereas we measured only the linear morphometry and confined ourself with acetabular growth, which reflected acetabular shallowness and the possibility of CDH.

Limitations

The present study evaluated only two parameters (diameter and depth) from the dissection of the fetal lower limb. Assessment of neck-shaft angle, femoral antetorsion angle, acetabulum anteversion angle, and other related parameters would have provided a deeper understanding of the relative anatomy of acetabulum and head of the femur. Assessment of overall orientation of the acetabular cavity in relation to the other parts of hip bone would have added much value to the parameters evaluated in the study. The diameter and depth of the acetabulum provide only a superficial understanding of the factors influencing CDH. The study outcomes may not further the understanding of the myriad of external and internal factors leading to CDH. Evaluation of these parameters in larger samples would have provided more meaningful normative values.


  Conclusions Top


In our study, we did not find any morphometric differences in the right and left, and the male and female fetal acetabulum. Hence preponderance of CDH may be attributed to clinical conditions of mothers like oligohydramnios which may have affected the fetal movements, in such manner we infer that no clinical predisposition shall be made toward gender or side for CDH or DDH.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Arsic S, Ilic D, Mitkovic M, Tufegdzic M. The study of morphological parameters of human acetabulum significant for hip arthroplasty. APW 2013;1:313.  Back to cited text no. 1
    
2.
Standring S. In: Gray's Anatomy, the Anatomical Basis of Clinical Practice. 40th ed. London: Churchill Livingstone; 2008. p. 1352-60.  Back to cited text no. 2
    
3.
Walker JM. Histological study of the fetal development of the human acetabulum and labrum: Significance in congenital hip disease. Yale J Biol Med 1981;54:255-63.  Back to cited text no. 3
    
4.
Walker JM, Goldsmith CH. Morphometric study of the fetal development of the human hip joint: Significance for congenital hip disease. Yale J Biol Med 1981;54:411-37.  Back to cited text no. 4
    
5.
Masłoń A, Sibiński M, Topol M, Krajewski K, Grzegorzewski A. Development of human hip joint in the second and the third trimester of pregnancy; a cadaveric study. BMC Dev Biol 2013;13:19.  Back to cited text no. 5
    
6.
Vidyadhar V, James U, Parikh G, Harish H. Reliability of plain radiographic parameters for developmental dysplasia of the hip children. J Child Orthop 2012;6:173-6.  Back to cited text no. 6
    
7.
Portinaro NM, Murray DW, Benson KD. Microanatomy of the acetabular cavity and its relationto growth. J Bone Joint Surg 2000;83:377-83.  Back to cited text no. 7
    
8.
Uysal LL, Salbacacak A, Kapicioglu MI, Buyukmumcu M, Seker M, Ciceksibasi AE. An investigation of the acetabulum, the femoral head and the ligament of femoral head in human fetuses. Turk J Med Sci 2004;34:301-7.  Back to cited text no. 8
    
9.
von Rosen S. Diagnosis and treatment of congenital dislocation of the hip joint in the newborn. J Bone Joint Surg 1962;44:284-91.  Back to cited text no. 9
    
10.
Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg 1962;44:292-301.  Back to cited text no. 10
    
11.
Boere-Boonekamp MM, Verkerk PH. Screening for developmental dysplasia of the hip. Semin Neonatal 1998;3:49-59.  Back to cited text no. 11
    
12.
Kolb A, Chiari C, Schreiner M, Heisinger S, Willegger M, Rettl G, et al. Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns. Sci Rep 2020;10:16407.  Back to cited text no. 12
    
13.
Lehmann HP, Hinton R, Morello P, Santoli J. Developmental dysplasia of the hip practice guideline: Technical report. Committee on Quality Improvement, and Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 2000;105:E57.  Back to cited text no. 13
    
14.
Lambeek AF, De Hundt M, Vlemmix F, Akerboom BM, Bais JM, Papatsonis DN, et al. Risk of developmental dysplasia of the hip in breech presentation: The effect of successful external cephalic version. BJOG 2013;120:607-12.  Back to cited text no. 14
    
15.
Hall AJ, Barker DJ, Dangerfield PH, Taylor JF. Perthes' disease of the hip in Liverpool. Br Med J (Clin Res Ed) 1983;287:1757-9.  Back to cited text no. 15
    
16.
Beáta B, Pánti Z, Zsuzsanna P, Buruian M, Pavai Z. Morphological changes of the fetal hip joint and their effect on the stability of the joint during its intrauterine development. AMM 2012;58:6.  Back to cited text no. 16
    
17.
Conybeare M. The early diagnosis of developmental dysplasia of the hip. Curr Orthop 2002;16:57-64.  Back to cited text no. 17
    
18.
Jin JG, Li LY, Zhao Q, Liu X. Three dimensional CT evaluation of femoral neck anteversion, acetabular anteversion and combined anteversion in unilateral DDH in an early walking age group. SICOT 2012;36:119-24.  Back to cited text no. 18
    
19.
Price KR, Dove R, Hunter JB. The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip. J Child Orthop 2011;5:195-200.  Back to cited text no. 19
    
20.
Rális Z, McKibbin B. Changes in shape of the human hip joint during its development and their relation to its stability. J Bone Joint Surg Br 1973;55:780-5.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1]



 

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