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CE Angle of Wiberg

- See: Radiographic Features of DDH

- Discussion:
    - CE angle provides useful information after the age of 5 years (may be used in adults);
    - angle formed by a line drawn from the center of the femoral head to the outer edge of the acetabular roof, and a verticle line drawn through the center of the femoral head;
    - angle greater than 25 deg are considered normal;
    - less than 20 deg indicates severe dysplasia;
    - Wiberg examined 44 patients with CE angles less than 20 deg (unselected group) that had no radiographic evidence of DHD;
         - in 17 patients (ages 13 to 60 yrs) DJD had developed over a period of 4-28 yrs;
         - DJD in the 4th decade had an average CE of 2 deg;
         - DJD in the 5th decade had an average CE of 5 deg;
         - DJD in the 6th decade had an average CE of 10 deg;
         - DJD in the 7th decade had an average CE of 12 deg;
         - key point of his study was that patients with subluxation were not separated from patients who only had dysplasia;
                - review of these hips showed that most had subluxation;

Cooperman, et al (1983)
    - followed 20 adult patients (32 hips) for avg 22 years.
    - 15 women and 5 men.
    - all patients had CE angle of less than 20 deg, all had intact Shenton's line, and none had evidence of DJD;
    - average initial age was 43 years (27-57 yrs);
    - average follow up age was 65 years;
    - measurement variables included:
          - CE angle
          - acetabular angle of Sharp
          - percentage of femoral head coverage
          - acetabular depth
          - inclination of lateral lip of acetabulum.
    - none of these variables was predictive for DJD.
    - most patients developed DJD but a linear relationship between DJD and CE (or other variables) could not be developed.
    - males tended to remain free of DJD longer than females.
    - 9 hips remained free of DJD in the 6th decade.
          - 6 of these were male.
    - 7 patients developed severe DJD (during 4th, 5th, 6th, 7th and 8th decades).
          - 4th and 5th decade: 4 hips w/ av CE of 6 deg;
          - 6th decade: 3 hips w/ av CE of 6 deg;
          - 7th decade: 7 hips w/ av CE of 9 deg;
          - 8th decade: 7 hips w/ av CE of 4 deg 
    - Acetabular Dyplasia in the Adult

Studies on Dysplastic Acetabula and Congenital Subluxation of the Hip Joint. Wiberg G. Acta Chir Scand. 1939;(83) Suppl 58:7.