Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Sex Differences in Cartilage Topography and Orientation of the Developing Acetabulum: Implications for Hip Preservation Surgery

Jonathan B. Peterson MD, Josh Doan MEng, James D. Bomar MPH, Dennis R. Wenger MD, Andrew T. Pennock MD, Vidyadhar V. Upasani MD



Increased attention is being placed on hip preservation surgery in the early adolescent. An understanding of three-dimensional (3-D) acetabular development as children approach maturity is essential. Changes in acetabular orientation and cartilage topography have not previously been quantified as the adolescent acetabulum completes development.


We used a novel 3-D CT analysis of acetabular development in children and adolescents to determine (1) if there were sex-specific differences in the growth rate or surface area of the acetabular articular cartilage; (2) if there were sex-specific differences in acetabular version or tilt; and (3) whether the amount of version and tilt present correlated with acetabular coverage.


We assessed acetabular morphology in 157 patients (314 hips); 71 patients were male and 86 were female. Patient ages ranged from 8 years to 17 years. A 3-D surface reconstruction of each pelvis was created from CT data using MIMICs software. Custom MATLAB software was used to obtain data from the 3-D reconstructions. We calculated articular surface area, acetabular version, and acetabular tilt as well as novel measurements of acetabular morphology, which we termed “coverage angles.” These were measured in a radial fashion in all regions of the acetabulum. Data were organized into three age groups: 8 to 10 years old, 10 to 13 years old, and 13 to 17 years old.


Male patients had less acetabular anteversion in all three age groups, including at maturity (7° versus 13°, p < 0.001; 10° versus 17°, p < 0.001; 14° versus 20°, p < 0.001). Males had less acetabular tilt in all three age groups (32° versus 34°, p = 0.03; 34° versus 38°, p < 0.001; 39° versus 41°, p = 0.023). Increases in anteversion correlated with increased posterior coverage angles (r = 0.805; p < 0.001). Increases in tilt were correlated with increases in superior coverage angles (r = 0.797; p < 0.001). The posterosuperior regions of the acetabulum were the last to develop and this process occurred earlier in females compared with males. Articular surface area increased from 18 (8–10 years) to 24 mm(13–17 years) in males and from 17 (8–10 years) to 21 mm(13–17 years) in females. Articular surface area was higher in males beginning in the 10- to 13-year-old age group (p = 0.001).


Using a novel technique to analyze acetabular morphology, we found that acetabular development occurs earlier in females than males. The posterosuperior region of the acetabulum is the final region to develop. The articular cartilage surface area and articular cartilage coverage of the femoral head are increasing in addition to total coverage of the femoral head during the final stages of acetabular development.

Level of Evidence

Level III, prognostic study.

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