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Manyak GA, Ren BO, Morris WZ, Liu RW. Alpha Angle and Anterior Femoral Neck Offset Identify Different Cohorts of Cam Morphology: An Osteologic Study. Arthroscopy 2025; 41:1381-1389. [PMID: 39069024 DOI: 10.1016/j.arthro.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To explore differences in cam morphology defined by alpha angle (AA) and anterior femoral neck offset (AFNO) in the context of other anthropometric parameters in an osteologic collection to further elucidate whether each measurement tool is identifying the same underlying pathology. METHODS Anthropometric measurements of 992 cadaveric hips from the Hamann-Todd Osteological Collection were analyzed. Femurs with cam morphology were identified by AA >55° or AFNO <7 mm. Anthropometric parameters stratified by cam morphology were assessed with Wilcoxon rank-sum and Pearson χ2 tests. Multivariate logistic regressions were performed on significant variables in univariate analysis to examine the predictive ability of anthropometric variables to cam morphology. RESULTS Cam morphology was identified in 242 hips via AA, 344 hips via AFNO, and 123 hips via both measures. Multivariate logarithmic regression analysis demonstrated that sex negatively predicted AA (females with less pathology, β = -0.14, P = .04), race negatively predicted AA (Blacks with less pathology, β = -0.21, P < .01), and proximal femoral osteoarthritis was positively associated with AA (β = 0.16, P = .02), while none of these were associated with AFNO. On the other hand, right-side specimens were associated with AA (β = 0.15, P = .02) and AFNO (β = 0.25, P < .01), whereas the combined version was unassociated with both measures. CONCLUSIONS In conclusion, cam morphology was identified in a modest percentage of osteologic specimens by both AA and AFNO in our study. Further, associations of multiple demographic, anthropometric, and anatomical parameters to AA and AFNO suggest they may identify different subsets of cam morphology. CLINICAL RELEVANCE Cam morphology identified by AA versus AFNO may represent 2 different pathologic entities. Future studies should assess differences between these measures in a clinical cohort and determine whether these 2 definitions of cam morphology identify different clinical populations.
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Affiliation(s)
- Grigory A Manyak
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan O Ren
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, U.S.A.; University of Michigan Hospital, Ann Arbor, Michigan, U.S.A
| | - William Z Morris
- University of Texas, Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Raymond W Liu
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, U.S.A..
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Uzun E, Ferrer-Rivero J, Lizano X, Cabello J, Gürsu S, Pons MT. High satisfaction and low conversion rate to total hip arthroplasty after hip arthroscopy for femoroacetabular impingement syndrome and risk factors affecting survival at long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2025; 33:1507-1514. [PMID: 39749742 DOI: 10.1002/ksa.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 11/27/2024] [Accepted: 11/29/2024] [Indexed: 01/04/2025]
Abstract
PURPOSE Studies evaluating the long-term survival rate, patient satisfaction, and conversion to total hip arthroplasty (THA) are limited. The aim of this study was to evaluate satisfaction and hip survival at a minimum 10-year follow-up in patients following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS A total of 164 patients underwent hip arthroscopy for FAIS between 2007 and 2012; of these, 76 (49 men and 27 women; mean age, 40.7 ± 11.2 years; range, 15-69 years) patients could be clinically examined or reached by phone or email and included in the study. Prospectively collected data of these patients who followed for a minimum of 10 years were retrospectively analysed. Patients who had previous trauma or surgery on the hip or were younger than 15 years were excluded. Of the 76 patients, 37 (48.7%) had mixed type, where 29 (38.2%) had cam and 10 (13.2%) had pincer type FAIS. Patient demographics, Tonnis grade for osteoarthritis and intraoperative findings were reviewed. Outcome measures of interest included reoperations (re-arthroscopy, conversion to THA), patient satisfaction, ability to return to sports, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS) and some possible factors associated with conversion to THA. RESULTS The mean follow-up was 12.4 ± 1.8 (10-16 years). Twenty-one per cent required conversion to THA, with a mean time requiring THA of 4.8 ± 1.7 years (2-8 years). Mean age of the patients requiring THA was 47.8 ± 8.2 years. Two (2.6%) patients required re-arthroscopy. Fifty-eight (76.3%) patients did not undergo any revision surgery or other treatments. Forty-seven (61.8%) patients were completely satisfied with the results, where 5 (6.6%) patients were very satisfied and 4 (5.3%) patients were satisfied. Overall satisfaction rate was 73.7%. Mean postoperative mHHS score was 76.5 ± 15.5 and the mean WOMAC score was 84.0 ± 16.0. Return-to-sports rate was 85%, and the return to the old sport level was 67.1%. Age over 40 years (p = 0.004), a Tonnis Grade >1 (p < 0.001) and a full-thickness acetabular chondral lesion (p = 0.001) were identified as factors for failure and conversion to THA. CONCLUSIONS Hip arthroscopy for FAIS resulted in high satisfaction of patients who did not eventually require THA. Higher rates of conversion to THA were seen in older patients, patients treated with higher Tonnis grade and full-thickness acetabular chondral lesions. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | | | | | | | - Sarper Gürsu
- Department of Orthopedics and Traumatology, University of Health Sciences, M. S. (Metin Sabancı) Baltalimani Bone and Joint Diseases Research Hospital, Istanbul, Turkey
| | - Marc Tey Pons
- Hospital Parc Taulí, Imove Traumatología, Barcelona, Spain
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Cantarelli Rodrigues T, Morais AQD, Cabrita HABDA, Godoy IRB, Skaf A. Femoroacetabular Impingement: Preoperative Evaluation and Postoperative Imaging. Semin Musculoskelet Radiol 2025; 29:17-33. [PMID: 39933538 DOI: 10.1055/s-0044-1791835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Femoroacetabular impingement (FAI) is a significant orthopaedic condition that primarily affects young active adults. It is characterized by abnormal contact between the femoral head and the acetabulum, leading to joint damage and osteoarthritis. This syndrome presents in three forms: pincer, cam, and mixed impingement, each with distinct morphological characteristics that can cause labral tears and cartilage damage. Over the last 20 years, the diagnosis and management of FAI has evolved considerably with advancements in imaging technologies and surgical techniques, especially hip arthroscopy.This article reviews the pathophysiology, diagnostic imaging criteria, surgical treatments, and postoperative outcomes of FAI, providing essential insights for radiologists and surgeons. The importance of early and accurate diagnosis through advanced imaging is emphasized to prevent the progression of FAI and to plan effective surgical interventions aimed at joint preservation. Challenges remain in the postoperative setting, where residual symptoms can require revision surgeries. Future directions in the management of FAI will likely focus on refining imaging protocols and surgical techniques to enhance the success rates of primary procedures and reduce the need for subsequent interventions.
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Affiliation(s)
| | | | | | - Ivan Rodrigues Barros Godoy
- Department of Radiology, ALTA Diagnostic Center (DASA Group), Hospital do Coração (HCor), São Paulo, SP, Brazil
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Abdalla Skaf
- Department of Radiology, ALTA Diagnostic Center (DASA Group), Hospital do Coração (HCor), São Paulo, SP, Brazil
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Mimura T, Furuya Y, Kumagai K, Amano Y, Miyahara S, Uemura R, Horikawa S, Saito H, Umeda K, Ushiyama F, Ogata Y, Yayama T, Mori K, Imai S. The ability of plain radiography to accurately describe the bone surface at the head-neck junction of the femur: a study using human bone models. J Hip Preserv Surg 2025; 12:65-73. [PMID: 40331075 PMCID: PMC12051853 DOI: 10.1093/jhps/hnae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/17/2024] [Accepted: 12/21/2024] [Indexed: 05/08/2025] Open
Abstract
In evaluations of a cam deformity on femoroacetabular impingement, the head-neck junction (HNJ) must be accurately assessed. We conducted this study to determine the ability of plain radiography to visualize the end-to-end bone surface of the HNJ. We used six human bone models. Ten examiners evaluated the degree to which attached stainless wire marker at the 1:00, 1:30, and 2:00 radial plane defined in reconstructed computed tomography can be accurately detected on the bone surface on plain radiographies. We employed 13 plain radiographies: the cross-table lateral view, frog-leg lateral view, Espié frog-leg lateral view, false-profile view, modified false-profile view, 30° Dunn view (DV), 45° DV, 60° DV, 90° DV, 30° modified Dunn view (MDV), 45° MDV, 60° MDV, and 90° MDV. Examiners scored the degree to which the radiographic images accurately detected the stainless wire marker on the bone surface of the HNJ on a scale of 1 point (0% match) to 5 points (almost 100% match). The highest score for the 1:00 plane was 4.98 points on the 45° DV. Similarly, the highest scores of the 1:30 and 2:00 planes were 4.98 points for the 45° MDV and 4.68 points for the 90° MDV, respectively. On these bone model studies, the most suitable plain radiography for describing the HNJ at the 1:00, 1:30, and 2:00 planes were both the 45° DV, the 45° MDV, and the 90° MDV, respectively.
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Affiliation(s)
- Tomohiro Mimura
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Yuki Furuya
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Kosuke Kumagai
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Yasutaka Amano
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Shunichi Miyahara
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Ryota Uemura
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Sadafumi Horikawa
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Hideki Saito
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Kohei Umeda
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Fumitaka Ushiyama
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Yugen Ogata
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Takafumi Yayama
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Kanji Mori
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
| | - Shinji Imai
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan
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Lucenti L, Maffulli N, Bardazzi T, Pipino G, Pappalardo G, Migliorini F. No Effect of Cigarette Smoking in the Outcome of Arthroscopic Management for Femoroacetabular Impingement: A Systematic Review. J Clin Med 2024; 13:7214. [PMID: 39685673 DOI: 10.3390/jcm13237214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 11/21/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Background: The impact of smoking in arthroscopic surgery for femoroacetabolar impingement (FAI) is controversial. This systematic review updates and discusses current evidence on the influence of cigarette smoking on the outcome of arthroscopic management of FAI. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. Methods: The present systematic review followed the PRISMA guidelines. Embase, Web of Science, and PubMed were accessed in June 2024 without additional filters or temporal constraints. All the clinical investigations comparing smokers versus nonsmokers in patients who underwent arthroscopic management for FAI were considered. The risk of bias in nonrandomised controlled trials was assessed using the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I). Results: Data from 368 patients were retrieved. The mean length of follow-up was 34.1 ± 7.1 months. The mean age was 40.4 ± 4.0 years and the mean BMI was 27.1 ± 1.6 kg/m2. No significant difference was evidenced in the visual analogue scale, Harris hip score, Hip Outcome Score-Sport subscale, and Non-Arthritic Hip Score. No difference was observed in the complication rate: reoperation (p = 0.6) and progression to THA (p = 0.4). Conclusions: Tobacco smoking does not appear to influence the outcomes of arthroscopic management for FAI. At approximately 34 months of follow-up, no difference was found in pain, PROMs, reoperation rate, and progression to THA.
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Affiliation(s)
- Ludovico Lucenti
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", 00185 Rome, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent ST4 7QB, UK
| | - Tommaso Bardazzi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Gennaro Pipino
- Department of Orthopedics and Trauma Surgery, Villa Erbosa Hospital, San Raffaele University of Milan, 20132 Milano, Italy
| | - Gaetano Pappalardo
- Department of Orthopedic Surgery, Oberlinklinik GmbH, 14482 Potsdam, Germany
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165 Rome, Italy
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Rynecki ND, Kingery MT, Roller R, Berzolla E, Colasanti CA, Youm T. Late-Onset Femoroacetabular Impingement Syndrome Following Knee Arthroscopy in a Retrospective Cohort. J Clin Med 2024; 13:6992. [PMID: 39598136 PMCID: PMC11594966 DOI: 10.3390/jcm13226992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/05/2024] [Accepted: 11/19/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Hip-knee coupling is a well-documented phenomenon, and interventions to one joint can alter biomechanics at the other. The purpose of this study was to investigate if knee surgery is associated with later onset of femoroacetabular impingement syndrome (FAIS). Methods: A retrospective chart review was conducted regarding patients at a single academic institution who underwent hip arthroscopy for FAIS between January 2011-October 2021. Patient charts were queried for past surgical history of knee arthroscopy before hip arthroscopy. Patients who previously underwent hip arthroscopy with no history of knee arthroscopy served as controls. Details about demographics and the onset of hip symptoms were abstracted from patient charts. Statistical analysis was conducted using Mann-Whitney testing and binary logistic regression. Results: Of the 1569 patients identified, 127 had a history of knee arthroscopy and reported no hip symptoms at or prior to the time of surgery. Patients who had undergone prior knee arthroscopy were significantly older at onset of initial hip symptoms (42.15 ± 11.80 years versus 34.62 ± 12.49 years, p < 0.001) and at the time of hip arthroscopy (44.12 ± 11.85 years versus 36.90 ± 12.14 years, p < 0.001) when controlling for age, sex, and BMI. These patients first developed hip symptoms at a mean of 8.57 ± 8.53 years following knee arthroscopy (median 6.10 years) and underwent operative treatment 1.76 ± 1.96 years later. Conclusions: Patients with a history of prior knee arthroscopy are older at the time of hip symptom onset and subsequent hip arthroscopy for the treatment of FAIS.
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Affiliation(s)
- Nicole D. Rynecki
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10010, USA; (N.D.R.); (M.T.K.); (C.A.C.); (T.Y.)
| | - Matthew T. Kingery
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10010, USA; (N.D.R.); (M.T.K.); (C.A.C.); (T.Y.)
| | - Rachel Roller
- Department of Orthopedic Surgery, Stanford University, 430 Broadway Street, Redwood City, CA 94063, USA;
| | - Emily Berzolla
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10010, USA; (N.D.R.); (M.T.K.); (C.A.C.); (T.Y.)
| | - Christopher A. Colasanti
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10010, USA; (N.D.R.); (M.T.K.); (C.A.C.); (T.Y.)
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10010, USA; (N.D.R.); (M.T.K.); (C.A.C.); (T.Y.)
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Bartlett GE, Stephens AS, Norton MR, Darren Fern E. High incidence of femoroacetabular impingement deformity in bi-column acetabular fractures. Hip Int 2024; 34:789-796. [PMID: 39129237 DOI: 10.1177/11207000241266911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Dynamic interaction of cam and pincer deformities can result in pathological contact forces in femoroacetabular impingement (FAI) syndrome. Similar deformities were noted during acetabular fracture reconstruction. We hypothesise that the prevalence of FAI deformity is higher in patients sustaining acetabular fractures than in a control group. METHODS This retrospective radiographic study compared the parameters that define FAI deformity in 100 patients consecutively admitted to a trauma unit with an acetabular fracture and a control group of 100 patients with lateral compression pelvic fracture without acetabular injury. Both underwent identical clinical imaging. Centre-edge angles (CEA) and alpha angles were used to define patients with pincer, cam, or mixed FAI deformity. RESULTS There were significantly more patients with FAI deformity in the acetabular fracture group than in the control group (71% vs. 18%, p < 0.0001). There were considerably more fractures involving both anterior and posterior acetabular columns in patients with 'pincer' sockets (p = 0.02, OR = 2.95, 95% CI, 1.12-7.78). CONCLUSIONS There is a high prevalence of cam and pincer deformities in patients with acetabular fractures, particularly bi-column fractures.
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Lewis CL, Shefelbine SJ. Lost in research translation: Female athletes are not male athletes, especially at the hip. J Orthop Res 2024; 42:2054-2060. [PMID: 38644357 DOI: 10.1002/jor.25860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male-dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control-factors which affect hip structure development and loading. Without female-focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life-long hip health for females.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
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Tey-Pons M, Sanchis-Alfonso V, Parra-Calabuig L, Griffin DR, Espregueira-Mendes J, Monllau JC. Anterior knee pain patients without structural knee abnormalities and normal lower limb skeletal alignment have a higher prevalence of cam-femoroacetabular impingement syndrome than the general population. J ISAKOS 2024; 9:497-501. [PMID: 38490438 DOI: 10.1016/j.jisako.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/21/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES This study aimed to ascertain the prevalence of cam femoroacetabular impingement syndrome (cam-FAIS) in anterior knee pain (AKP) patients devoid of both structural patellofemoral joint abnormalities and lower limb skeletal malalignment. A secondary objective was to examine pain and disability differences between AKP patients with and without cam-FAIS. METHODS A total of 209 AKP patients were screened for eligibility. Inclusion criteria were normal imaging studies and normal lower limb alignment, and exclusion criteria were previous knee surgery and knee and/or hip osteoarthritis. Of those, 49 (23.4%) were eligible and this number matched a previous power analysis to detect statistically significant differences in prevalence of cam-FAIS in a population of AKP patients. The first step in the study sequence was to ask the patient whether they had groin pain. If so, the impingement test was done. Then, the femoral cam morphology defined by an alpha angle greater than or equal to 55° in a 45° Dunn axial view of the hip was ruled out. Additionally, patients completed Kujala and International Knee Documentation Committee (IKDC) functional knee scores for disability assessment. General population control group was obtained from literature. RESULTS The study included 9 males and 40 females, with an average age of 36 (20-50, ±SD 8.03) years. Groin pain and positive impingement test were found in 26/49 patients (53%). An alpha angle ≥55° was observed in 35/49 patients (71%). A combination of groin pain, positive impingement test and an alpha angle ≥55° was seen in 18/49 patients (37%). The AKP patients with groin pain, a positive impingement test and an alpha angle ≥55° exhibited statistically similar pain and disability levels as AKP patients without cam-FAIS. CONCLUSION The results of this study suggest that AKP patients without structural abnormalities in the patellofemoral joint and without lower limbs malalignment have a statistically significantly higher prevalence of cam-FAIS than the general population. Moreover, AKP patients with cam-FAIS have a statistically similar degree of pain and disability than AKP patients without it. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marc Tey-Pons
- Universitat Pompeu Fabra, Hospital Parc Tauli 08208 Sabadell, iMove Barcelona, 08017 Barcelona, Spain
| | | | | | - Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK; University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal; School of Medicine, University of Minho, 4710-057, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratoryō, 4710-057, Braga, Guimarães, Portugal; 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4806-909, Barco, Guimarães, Portugal
| | - Joan Carles Monllau
- Orthopedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain; Institut Català de Traumatologia, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain
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Harris MD, Gaffney BM, Clohisy JC, Pascual-Garrido C. Femurs in patients with hip dysplasia have fundamental shape differences compared with cam femoroacetabular impingement. J Hip Preserv Surg 2024; 11:132-139. [PMID: 39070210 PMCID: PMC11272640 DOI: 10.1093/jhps/hnae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/08/2024] [Accepted: 01/24/2024] [Indexed: 07/30/2024] Open
Abstract
Femoral deformities are common in developmental dysplasia of the hip (DDH), but decisions about how to treat them are not standardized. Of interest are deformities that may be akin to cam femoroacetabular impingement (FAI). We used three-dimensional and two-dimensional measures to clarify the similarities and differences in proximal femur shape variation among female patients with DDH (n = 68) or cam FAI (n = 60). Three-dimensional measures included femoral head asphericity, as well as shape variation using statistical shape modeling and principal component analysis (PCA). Two-dimensional measures included the α-angle, head-neck offset (HNO) and the neck-shaft angle (NSA). Significant shape variations were captured in the first five PCA modes, with the greatest shared variation between groups being the length from the lesser trochanter to the femoral head and greater trochanter height. Variations unique to DDH were irregularities at different areas of the femoral head, but not at the lateral femoral head-neck junction where variation was strong in FAI. The FAI group also had unique variations in greater trochanter shape. DDH femoral heads were less spherical, as indicated by larger sphere-fitting errors (P < 0.001). Radiographically, the DDH group had significantly smaller α-angles (P < 0.001), larger head-neck offsets (P = 0.02) and larger NSAs (P < 0.001). Both the articular and extra-articular regions of the proximal femur have distinct shape features in DDH and cam FAI that can uniquely affect the biomechanics of each disorder. Accordingly, approaches to addressing each disorder should be unique.
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Affiliation(s)
- Michael D Harris
- Program in Physical Therapy, Department of Orthopaedic Surgery, Washington University School of Medicine, 4444 Forest Park Ave, St Louis, MO 63108, USA
| | - Brecca M.M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, 1200 Larimer St North Classroom Bldg, Denver, CO 80204, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110, USA
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11
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Bischoff CJ, Woodard DR, Pringle LC, DeFroda SF. Imaging Modalities in the Preoperative Assessment of Femoroacetabular Impingement and Hip Dysplasia: Determining Best Practices. JBJS Rev 2024; 12:01874474-202407000-00006. [PMID: 38991089 DOI: 10.2106/jbjs.rvw.24.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
» In the last decade, significant progress has been made in understanding hip pain, especially related to femoroacetabular impingement (FAI) and hip dysplasia (HD), which collectively affect over 20% of the population.» Preoperative imaging, including plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), plays a pivotal role in diagnosing FAI and HD. Imaging precision, standardized techniques, and accurate interpretation are crucial for effective treatment planning.» The continual advancements in imaging techniques, especially seen in MRI (arthrograms, application of leg traction, and delayed gadolinium-enhanced MRI of cartilage), represent important strides in the precise assessment of pathology associated with FAI and HD.» By incorporating these advancements into routine imaging protocols, healthcare providers can ensure a comprehensive understanding of hip joint dynamics, enabling more accurate diagnosis and effective management strategies for patients with FAI and HD, ultimately leading to improved clinical outcomes.
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Affiliation(s)
- Caleb J Bischoff
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - David R Woodard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | | | - Steven F DeFroda
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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12
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AlMousa SA, Hegazi T, AlKhamis HA, AlTayyar ZA, AlMutairi MD, AlGhamdi SA, Almuhaish MI, Alzaid MM, Alsubaie SS, Alzahrani MM. Cam-type hip morphology in asymptomatic patients. Hip Int 2024; 34:372-377. [PMID: 38263909 DOI: 10.1177/11207000231225184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The alpha angle has been widely used in the assessment of cam-type of impingement, but recent studies have shown that this angle may also be high in asymptomatic patients. The aim of this study is to report the prevalence of cam-type morphology in asymptomatic volunteers and explore its correlation with hip clinical and radiological parameters. METHODS This single-centre prospective study included 48 asymptomatic male volunteers (96 hips). All candidates fulfilled the inclusion and exclusion criteria. Physical examination and 1.5 -T MRI imaging were done for bilateral hips on the same day. Alpha angle measurements were obtained from 4 different positions and cam-type morphology was considered positive using 2 different cut points >55° and >60°. Descriptive statistics were analysed and correlations were performed where appropriate and p-value < 0.05 was considered to be significant. RESULTS The prevalence of cam-type morphology using alpha angle >55° was 68.8%, 87.5%, 50% and 34.4% in the 12, 1, 2 and 3 o'clock positions respectively. While it was 38.5%, 69.8%, 26% and 12.5% in the 12, 1, 2 and 3 o'clock positions of the studied hips respectively using alpha angle >60°. The maximum alpha angle was more frequently prevalent at the 1 o'clock position in 71 (74%). Labral tear was detected in 26 (27.1%) hips and impingement test was positive in 12 (12.5%) hips. There was no correlation between the presence of cam-type morphology and range of motion of the hip, presence of positive impingement test nor labral tears. CONCLUSIONS Cam-type morphology prevalence is high among asymptomatic males, and mostly pronounced at the 1 o'clock position. A correlation between high alpha angle and positive impingement test or labral tear was not found in our cohort. Future studies are required to determine the natural history of asymptomatic cam-type morphology and risk of hip derangement.
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Affiliation(s)
- Sulaiman A AlMousa
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tarek Hegazi
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hashem A AlKhamis
- Department of Orthopaedic Surgery, Asir Central Hospital, Abha, Saudi Arabia
| | - Ziyad A AlTayyar
- Department of Family Medicine and Community Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq D AlMutairi
- Department of Orthopaedic Surgery, King Fahd Military Medical Complex, Dhahran, Eastern Province, Saudi Arabia
| | - Salim A AlGhamdi
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona I Almuhaish
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed M Alzaid
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shayma S Alsubaie
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad M Alzahrani
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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13
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Thirumaran AJ, Murphy NJ, Fu K, Hunter DJ. Femoroacetabular impingement - What the rheumatologist needs to know. Best Pract Res Clin Rheumatol 2024; 38:101932. [PMID: 38336510 DOI: 10.1016/j.berh.2024.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Femoroacetabular impingement (FAI) syndrome is a common cause of hip and groin pain in young individuals. FAI syndrome is a triad of signs, symptoms, and imaging findings. Necessary but not sufficient for the diagnosis of FAI syndrome is the presence of cam and/or pincer morphology of the hip. However, pathological thresholds for cam and pincer morphologies are not well-established. Management of FAI syndrome is typically through either physiotherapist-led therapy or surgical intervention. Physiotherapist-led management involves exercises aimed to optimise movement patterns of the hip and pelvis to prevent impingement from occurring, activity modification and analgesia, whereas surgical management involves arthroscopic resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions or ligamentum teres tears. Careful consideration of intervention is required given that FAI syndrome may predispose those affected to developing future osteoarthritis of the hip. In most clinical trials, hip arthroscopy has been found to provide greater improvement in patient-reported outcomes in the short-term compared to physiotherapy, however it is unknown whether this is sustained in the long-term or affects the future development of hip osteoarthritis.
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Affiliation(s)
- Aricia Jieqi Thirumaran
- Nepean Hospital, Kingswood, NSW, 2747, Australia; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; University of Newcastle and Department of Orthopaedic Surgery, John Hunter Hospital, New Lambton, NSW, 2305, Australia
| | - Kai Fu
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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14
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Arriaza R, Saavedra-García M, Arriaza A, Cruz-Cámara A, Leyes M, Cerezal L, Maestro A. Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players. BMC Musculoskelet Disord 2024; 25:166. [PMID: 38383359 PMCID: PMC10880309 DOI: 10.1186/s12891-024-07247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.
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Affiliation(s)
- Rafael Arriaza
- Instituto Médico Arriaza y Asociados, A Coruña, Spain.
- Grupo INCIDE-Universidade da Coruña, A Coruña, Spain.
| | | | - Alvaro Arriaza
- Instituto Médico Arriaza y Asociados, A Coruña, Spain
- Centro Traumatólogos Santander, Cantabria, Spain
| | | | | | - Luis Cerezal
- Centro Diagnóstico Médico Cantabria, Santander, Spain
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15
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Tomomatsu K, Taniguchi T, Hashizume H, Harada T, Iidaka T, Asai Y, Oka H, Muraki S, Akune T, Kawaguchi H, Nakamura K, Yoshida M, Tanaka S, Yoshimura N, Yamada H. Factors associated with cam deformity in Japanese local residents. Sci Rep 2024; 14:1585. [PMID: 38238438 PMCID: PMC10796762 DOI: 10.1038/s41598-024-51876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
Femoroacetabular impingement has increasingly been recognized as a cause of primary hip osteoarthritis; however, its epidemiological indications remain unclear. We aimed to clarify the epidemiological indications and factors associated with cam deformity in a large-scale population-based cohort in Japan. Overall, 1480 participants (2960 hips) (491 men, 989 women; mean age, 65.3 years) analyzed in the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability study were included. The α angle and spinopelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence) were radiographically measured. Cam deformity was defined as α angle ≥ 60°. Overall, the cam deformity prevalence was 147/2960 (5.0%). Cam deformity prevalence tended to increase with age; in the univariate analysis, a higher percentage of men was observed in the group with cam deformity than in the group without it. No relationship was observed between cam deformity and hip pain. Factors associated with α angle were examined via multiple regression analysis for each gender; α angle was significantly associated with age and BMI in each gender. The α angle and PT were correlated in women. Thus, α angle and cam deformity prevalence increase with age in Japanese individuals. Accordingly, cam deformity can be considered a developmental disease.
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Affiliation(s)
- Koichi Tomomatsu
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan
| | - Takaya Taniguchi
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan.
| | - Hiroshi Hashizume
- School of Health and Nursing Science, Wakayama Medical University, 590 Mikazura, Wakayama City, Wakayama, Japan
| | - Teiji Harada
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811‑1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical &Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons With Disabilities, 4‑1 Namiki, Tokorozawa City, Saitama, Japan
| | | | - Kozo Nakamura
- Department of Orthopaedic Surgery, Towa Hospital, 4‑7‑10 Towa, Adachi‑ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Sumiya Orthopedic Hospital, 337 Yoshida, Wakayama City, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811‑1 Kimiidera, Wakayama City, Wakayama, Japan
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16
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Lin HY, Chiang ER, Wu SL, Wu CL, Chiou HJ, Wu HT. The correlation between hip alpha angle and acetabular labral tear location and size: A cross-sectional study. J Chin Med Assoc 2024; 87:119-125. [PMID: 37962357 DOI: 10.1097/jcma.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Explore the correlation between hip morphology and labral tear location/size. METHODS This retrospective study analyzed patients with hip pain who received magnetic resonance (MR) arthrography at our institution, between January 2017 and December 2020. Imaging analysis includes labral tear location and size, and hip morphology measurement with alpha angle, lateral center-edge (CE) angle, anterior CE angle, and femoral neck version. The correlation between hip morphology angles and labral tear location/size was evaluated using multiple regression, followed by stratification analysis with Chi-square test to investigate interactions between the variables. RESULTS A total of 103 patients (105 hips) with hip pain who received MR arthrography (mean age, 50 years ± 15 [SD]) were included, with mean alpha angle of 57.7° ± 9.9° [SD], mean lateral CE angle of 32.6° ± 6.8° [SD], mean anterior CE angle of 58.2° ± 8.1° [SD], mean femoral neck version of 17.1° ± 8.2° [SD]. Large alpha angle (>57°) and older age were both correlated with superior and posterosuperior labral tear incidence ( p < 0.05) and larger tear size ( p < 0.05). Furthermore, alpha angle is significantly correlated with superior labral tear incidence in young-age subgroup (age <45 years) ( p < 0.05), also significantly correlated with posterosuperior labral tear incidence and larger tear size in middle-age subgroup (45 ≤ age ≤ 60 years) ( p < 0.05). CONCLUSION A large alpha angle (>57°) is significantly correlated with increased incidence of superior and posterosuperior labral tear, and larger tear size in patients with hip pain, and the relationships depend on age.
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Affiliation(s)
- Han-Ying Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - En-Rung Chiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shang-Liang Wu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Ta Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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17
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Sinkler MA, Morris WZ, Yuh RT, Fowers CA, Xie K, Cooperman DR, Liu RW. Association of Idiopathic Cam Morphology With Femoral and Acetabular Version: Analysis of 986 Cadaveric Hips. Orthop J Sports Med 2024; 12:23259671231223185. [PMID: 38213506 PMCID: PMC10782882 DOI: 10.1177/23259671231223185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 01/13/2024] Open
Abstract
Background Studies have correlated symptomatic femoroacetabular impingement (FAI) with femoral retroversion and cam lesions. Purpose To investigate any association between femoral and acetabular versions with cam deformity in a largely asymptomatic population. Study Design Descriptive laboratory study. Methods A total of 986 cadaveric hips were selected from a historical osteologic collection. Each hip was assessed to determine the femoral and acetabular versions, anterior offset, and alpha angle. Cam morphology was defined as an alpha angle >60°. Multiple regression analysis was performed to determine the relationship between age, femoral version, acetabular version, and either alpha angle or anterior femoral offset. Results The mean alpha angle and anterior offset for the sample population were 48.1°± 10.4° and 0.77 ± 0.17 cm, respectively, with cam morphology in 149 of the 986 (15.1%) specimens. No significant difference was observed between hips with and without cam morphology with respect to the femoral (10.8°± 10° vs 10.3°± 9.6°; P = .58) or acetabular versions (17.4°± 6° vs 18.2°± 6.3°; P = .14). Multiple regression analysis did not demonstrate an association between the femoral or acetabular versions and the alpha angle, and it showed a small association between the increasing femoral and acetabular versions and a decreased anterior femoral offset (both P < .01). Conclusion In a large random sample of cadaveric hips, cam morphology was not associated with femoral or acetabular retroversion. Combined with the existing literature, these findings suggest that retroversion is not associated with cam development. Clinical Relevance This study provides insight into the development of cam morphology, which may eventually aid in the evaluation and treatment of FAI.
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Affiliation(s)
| | | | - Roger T. Yuh
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Cody A. Fowers
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Katherine Xie
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | | | - Raymond W. Liu
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
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Chen CM, Lin SC, Wu CT, Chan YS. Development of a simulation system for femoroacetabular impingement detection based on 3D images. J Hip Preserv Surg 2024; 11:20-29. [PMID: 38606325 PMCID: PMC11005768 DOI: 10.1093/jhps/hnad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/17/2023] [Accepted: 11/08/2023] [Indexed: 04/13/2024] Open
Abstract
Image-based criteria have been adopted to diagnose femoroacetabular impingement (FAI). However, the overlapping property of the two-dimensional X-ray outlines and static and supine posture of taking computed tomography (CT) and magnetic resonance imaging images potentially affect the accuracy of the criteria. This study developed a CT image-based dynamic criterion to effectively simulate FAI, thereby providing a basis for physicians to perform pre-operative planning for arthroscopic surgery. Post-operative CT images of 20 patients with satisfactory surgical results were collected, and 10 sets of models were used to define the flexion rotation centre (FRC) of the three-dimensional FAI model. First, let these 10 groups of models simulate the FAI detection action and find the best centre offset, and then FRC is the result of averaging these 10 groups of best displacements. The model was validated in 10 additional patients. Finally, through the adjustment basis of FRC, the remaining 10 sets of models can find out the potential position of FAI during the dynamic simulation process. Rotational collisions detected using FRC indicate that the patient's post-operative flexion angle may reach 120° or greater, which is close to the actual result. The recommended surgical range of the diagnostic system (average length of 6.4 mm, width of 4.1 mm and depth of 3.2 mm) is smaller than the actual surgical results, which prevents the doctor from performing excessive resection operations, which may preserve more bones. The FRC diagnostic system detects the distribution of FAI in a simple manner. It can be used as a pre-operative diagnosis reference for clinicians, hoping to improve the effect and accuracy of debridement surgery.
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Affiliation(s)
- Chun-Ming Chen
- Taiwan High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Rd., Da’an Dist., Taipei, Taiwan
| | - Shang-Chih Lin
- Taiwan High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Rd., Da’an Dist., Taipei, Taiwan
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Rd., Da’an Dist., Taipei, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyaun, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, Taiwan
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19
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Ross KA, Mojica ES, Lott A, Carter C, Gonzalez-Lomas G. Characterization of pincer-type Hip impingement in professional women's ice hockey players. PHYSICIAN SPORTSMED 2023; 51:610-614. [PMID: 36503339 DOI: 10.1080/00913847.2022.2157683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Femoroacetabular impingement (FAI) appears common in ice hockey, but there is a lack of data examining pincer-type impingement in women's ice hockey athletes. The objective of this study was to assess the prevalence of pincer-type impingement in National Women's Hockey League (NWHL) athletes. Our hypothesis was that there would be an increased prevalence of pincer impingement in these athletes. METHODS Data were gathered for a team of NWHL players, and age, gender, and body mass index (BMI) matched controls were also retrospectively collected. All subjects were above 18 years of age. Control patients were excluded if they had undergone prior hip surgery, were greater than age 30, or had BMI greater than 35. Radiographs of both groups were assessed for lateral center edge angle (LCEA), Tönnis angle, and crossover sign. Tönnis angle <0 or LCEA >40 degrees was considered pincer morphology. An alpha angle >55 degrees was considered cam morphology. RESULTS Thirty-seven NWHL players and 37 female controls were included. Overall 32% of the players had a pincer lesion in either hip based on LCEA, 8% had a Tönnis angle <0, and 22% had a crossover sign in either hip compared to 9%, 19%, and 13% for the controls, respectively. None of these findings were significantly different between the groups (p > 0.05). An alpha angle ≥55 degrees in either hip was found in 84% of players, but lateral Dunn images for alpha angle measurements were not available for the control group. CONCLUSIONS Pincer-type morphology and crossover signs were present in a larger portion of NWHL players than has been reported in the general population, but these findings were not statistically different than in the control group. Cam-type morphology was even more prevalent in these athletes and may be related to age at menarche due impingement at the physis prior to closure.
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Affiliation(s)
- Keir A Ross
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Cordelia Carter
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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20
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Husen M, Leland DP, Melugin HP, Poudel K, Hevesi M, Levy BA, Krych AJ. Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients. Am J Sports Med 2023; 51:2986-2995. [PMID: 37551688 DOI: 10.1177/03635465231188114] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. PURPOSE To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. RESULTS A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). CONCLUSION At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.
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Affiliation(s)
- Martin Husen
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heath P Melugin
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Keshav Poudel
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Graesser EA, Schwabe MT, Clohisy JC, Nepple JJ. Defining the Borderline Dysplastic Hip: High Variability in Acetabular Coverage and Femoral Morphology on Low-Dose Computed Tomography. Am J Sports Med 2023; 51:2551-2558. [PMID: 37434506 DOI: 10.1177/03635465231184395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Borderline acetabular dysplasia is commonly radiographically defined as a lateral center-edge angle (LCEA) of 20° to 25°. While the variability of plain radiographic assessment of this population has been reported, an understanding of the variability of 3-dimensional (3D) hip morphology remains to be better defined. PURPOSE To investigate the variability of 3D hip morphology present on low-dose computed tomography (CT) in the setting of symptomatic borderline acetabular dysplasia and to determine if plain radiographic parameters correlate with 3D coverage. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A total of 70 consecutive hips with borderline acetabular dysplasia undergoing hip preservation surgery were included in the current study. Plain radiographic evaluation included LCEA, acetabular inclination, anterior center-edge angle (ACEA), anterior wall index (AWI), posterior wall index (PWI), and alpha angles on anteroposterior, 45° Dunn, and frog-leg views. All patients underwent low-dose pelvic CT for preoperative planning, which allowed detailed characterization of 3D morphology relative to normative data. Acetabular morphology was assessed with radial acetabular coverage (RAC) calculated according to standardized clockface positions from 8:00 (posterior) to 4:00 (anterior). Coverages at 10:00, 12:00, and 2:00 were classified as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative RAC values. Femoral morphology was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Correlation was assessed with the Pearson correlation coefficient (r). RESULTS Lateral coverage (12:00 RAC) was deficient in 74.1% of hips with borderline dysplasia. Anterior coverage (2:00 RAC) was highly variable, with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (10:00 RAC) was also highly variable, with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The 3 most common patterns of coverage were isolated lateral undercoverage (31.4%), normal coverage (18.6%), and combined lateral and posterior undercoverage (17.1%). The mean femoral version was 19.7°± 10.6° (range, -4° to 59°), with 47.1% of hips having increased femoral version (>20°). The mean maximum alpha angle was 57.2° (range, 43°-81°), with 48.6% of hips having an alpha angle ≥ 55°. The ACEA and AWI were poorly correlated with radial anterior coverage (r = 0.059 and 0.311, respectively), while the PWI was strongly correlated with radial posterior coverage (r = 0.774). CONCLUSION Patients with borderline acetabular dysplasia demonstrate highly variable 3D deformities, including anterior, lateral, and posterior acetabular coverage; femoral version; and alpha angle. Plain radiographic assessments of anterior coverage are poorly correlated with anterior 3D coverage on low-dose CT.
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Affiliation(s)
| | - Maria T Schwabe
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
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Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. J Orthop Sports Phys Ther 2023; 53:CPG1-CPG70. [PMID: 37383013 DOI: 10.2519/jospt.2023.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). This is an update to the 2014 Clinical Practice Guideline (CPG) for Hip Pain and Movement Dysfunction Associated with Nonarthritic Hip Joint Pain. The goals of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. This current CPG covers pathoanatomical features, clinical course, prognosis, diagnosis, examination, and physical therapy interventions in the management of nonarthritic hip joint pain. J Orthop Sports Phys Ther 2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302.
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Cho BW, Kwon HM, Park JY, Park KK, Kim T, Lee WS. Sex differences in the anatomy of the anterior-superior acetabular rim in relation to pincer-type femoroacetabular impingement in Koreans: a three-dimensional quantitative analysis. J Orthop Surg Res 2023; 18:161. [PMID: 36864441 PMCID: PMC9983210 DOI: 10.1186/s13018-023-03526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE The aim of this study was to compare the anatomical structures of the acetabular rim around the anterior inferior iliac spine (AIIS) ridge that indicate anterior focal coverage of acetabulum between the sexes using a three-dimensional (3D) model. METHODS 3D models of 71 adults (38 men and 33 women) with normal hip joints were used. Based on the location of the inflection point (IP) of the acetabular rim around the AIIS ridge, the patients were classified into anterior and posterior types, and the ratios thereof for each sex were compared. Coordinates for the IP, the most anterior point (MAP), and the most lateral point (MLP) were obtained and compared between the sexes and between anterior and posterior types. RESULTS Coordinates for IPs in men were located anterior and inferior to those in women. MAP coordinates for men were located inferior to those for women, and MLP coordinates for men were located lateral and inferior to those for women. Comparing AIIS ridge types, we noted that coordinates for IPs of the anterior type were located medial, anterior, and inferior to those of the posterior type. Meanwhile, MAP coordinates of the anterior type were located inferior to those of the posterior type, and MLP coordinates of the anterior type were located lateral and inferior to those of the posterior type. CONCLUSION Anterior focal coverage of the acetabulum appears to differ between the sexes, and this difference may affect the development of pincer-type femoroacetabular impingement (FAI). Additionally, we found that anterior focal coverage differs according to anterior or posterior positioning of the bony prominence around the AIIS ridge, which may affect development of FAI.
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Affiliation(s)
- Byung Woo Cho
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Jun Young Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do Republic of Korea
| | - Kwan Kyu Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Taehyun Kim
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea.
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Sahr ME, Endo Y, Sink EL, Miller TT. Dynamic ultrasound assessment of hip instability and anterior and posterior hip impingement. Skeletal Radiol 2023; 52:1385-1393. [PMID: 36598522 DOI: 10.1007/s00256-022-04264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In this technical report, we describe our protocol for the dynamic sonographic evaluation of the hip and assess reliability of the ultrasound assessment of hip microinstability. MATERIALS AND METHODS Our clinical experience with a standardized dynamic ultrasound of the hip performed in a series of 27 patients with imaging performed by an experienced musculoskeletal radiologist during physical examination by an orthopedic surgeon specializing in hip preservation is illustrated with clinical photographs and ultrasound images from volunteers and selected patients. Interrater reliability for the diagnosis of microinstability was calculated. RESULTS Dynamic ultrasound technique and findings of hip instability, femoroacetabular impingement, and ischiofemoral impingement with corresponding clinical photos showing the necessary physical examination maneuvers are described. Interrater agreement for the diagnosis of microinstability was substantial (κ 0.606 [0.221-0.991]). CONCLUSION At our institution, dynamic ultrasound of the hip during physical examination complements information gathered from static imaging by providing real-time correlation of symptoms with what is occurring anatomically.
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Affiliation(s)
- Meghan E Sahr
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA.
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Ernest L Sink
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70Th St, New York, NY, 10021, USA
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Seijas R, Pérez A, Barastegui D, Revilla E, López de Celis C, Català J. The natural history of alpha angle in the last seventeen centuries. Arch Orthop Trauma Surg 2022; 142:2819-2825. [PMID: 34825963 DOI: 10.1007/s00402-021-04268-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hip osteoarthritis is one of the most important and debilitating diseases affecting thousands of people all over the world. On the other hand, femoroacetabular impingement (FAI) is one of the known important causes of hip osteoarthritis. Cam deformity frequently presents in FAI showing an increased alpha angle. Increased alpha angle has been observed among young patients involved in demanding physical activities such as in sports (40-60%), whereas among the non-athletic population, increased alpha angle was observed in 15-20%. Although femoroacetabular pathology has been described over the recent years, it is not possible to determine when the angle increase actually begins prior to diagnosis. The aim of our study is to evaluate the femoral alpha angle in different human femurs in different civilization eras in West Mediterranean area. MATERIALS AND METHODS Available ancient femurs were selected from the Collection Center belonging to the archeological archives (ancient necropolis) from the fourth, fourteenth and eighteenth centuries. A comparison of the alpha angle was made of the measurements from the different groups accompanied by a sample of present-day femurs from the radiology database of CT scans. Data from 243 femoral bones were collected, 50 of which from the fourth century, 26 from the fourteenth century, 68 from the eighteenth century, and 99 femurs from the 20/twenty-first century. RESULTS Alpha angles in all historical samples showed pathological values (> 55º) up to a maximum of 11.5% of the cases. Meanwhile, the actual series showed pathological alpha angle in 60.1% of the cases with statistical significant differences. CONCLUSION The studied femurs of the western Mediterranean region from the fourth, fourteenth and eighteenth centuries showed pathological alpha angles in a smaller proportion than the actual sample. LEVEL OF EVIDENCE Level III, retrospective studies.
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Affiliation(s)
- Roberto Seijas
- Instituto Cugat, Hospital Quiron Barcelona Floor-1, Pza. Alfonso Comín 5, 08023, Barcelona, Spain. .,Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain. .,Garcia Cugat Foundation, Barcelona, Spain.
| | - Albert Pérez
- Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
| | - David Barastegui
- Instituto Cugat, Hospital Quiron Barcelona Floor-1, Pza. Alfonso Comín 5, 08023, Barcelona, Spain.,Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain.,Garcia Cugat Foundation, Barcelona, Spain
| | - Emili Revilla
- Archaeological Archive of Collection Centre of MUHBA (Museu d'Història de Barcelona), Barcelona, Spain
| | - Carlos López de Celis
- Basic Sciences Department. Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Spain
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Khan AZ, Abu-Amer W, Thapa S, Parilla FW, Pascual-Garrido C, Clohisy JC, Nepple JJ. Factors Associated With Disease Progression in the Contralateral Hip of Patients With Symptomatic Femoroacetabular Impingement: A Minimum 5-Year Analysis. Am J Sports Med 2022; 50:3174-3183. [PMID: 36018805 DOI: 10.1177/03635465221119509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is one of the most common causes of hip osteoarthritis, yet the factors controlling disease progression are poorly understood. PURPOSE To investigate rates of initial and subsequent symptoms in the contralateral hip of patients with FAI, and identify predictors of disease progression (symptom development and surgical intervention) in the contralateral hip. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This prospective study included a minimum 5-year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) and surgical progression were monitored. Univariate and multivariate analyses compared patient-specific and imaging characteristics of symptomatic patients with those who remained asymptomatic to identify factors associated with disease progression. RESULTS A total of 150 patients (84% follow-up) were followed for a mean of 7.1 years (range, 5-11 years). Thirty-nine of these patients (26% [39/150]) had contralateral hip symptoms at initial evaluation. Of those without contralateral hip symptoms at initial evaluation, 32% (36/111) had developed contralateral hip symptoms by latest follow-up. Those who developed symptoms during the study period had a lower anteroposterior head-neck offset ratio (0.153 vs 0.165; P = .005), decreased total arc of rotation in 90° of flexion (39.9° vs 51.1°; P = .005), and decreased external rotation in 90° of flexion (28.6° vs 37.1°; P = .003) compared with those who never developed symptoms. Age, sex, body mass index, alpha angle, lateral center-edge angle, internal rotation in flexion, and University of California, Los Angeles (UCLA), activity score were similar between these groups. Those with contralateral symptoms at initial evaluation progressed to contralateral surgery at a rate of 41% (16/39) and those who developed contralateral symptoms during the study period progressed to contralateral surgery at a rate of 28% (10/36). Among those with contalateral hip symptoms (either present initially or developed during study period)), younger age (24.6 vs 34.1 years; P < .001) and baseline UCLA activity score ≥9 (P = .003) were associated with progression to surgery. By Kaplan-Meier analysis, 64%, 54%, and 48% of patients remained free of contralateral hip symptoms at 2, 5, and 10 years. CONCLUSION At a mean follow-up of 7.1 years, significant symptoms in the contralateral hip of patients with FAI were present in approximately 50% of patients. FAI disease progression (symptom development and surgical intervention) was associated with decreased hip rotation arc, decreased external rotation, and decreased head-neck offset ratio. In symptomatic patients, younger age and UCLA activity score ≥9 were associated with progression to surgery. These findings represent important factors for patient counseling and risk modeling in FAI.
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Affiliation(s)
- Adam Z Khan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wahid Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan Thapa
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Hilfiker R, Hunkeler M, Limacher A, Leunig M, Bonel H, Egger M, Jüni P, Reichenbach S. Is Internal Rotation Measurement of the Hip Useful for Ruling in Cam or Pincer Morphology in Asymptomatic Males? A Diagnostic Accuracy Study. Clin Orthop Relat Res 2022; 480:1989-1998. [PMID: 35700433 PMCID: PMC9473784 DOI: 10.1097/corr.0000000000002244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cam and pincer morphologies are associated with limited internal rotation. However, the routine clinical examination for hip rotation has limited reliability. A more standardized method of measuring hip rotation might increase test-retest and interobserver reliability and might be useful as a screening test to detect different hip morphologies without the need for imaging. We developed an examination chair to standardize the measurement of internal hip rotation, which improved interobserver reliability. However, the diagnostic test accuracy for this test is unknown. QUESTION/PURPOSE Is a standardized method of determining internal hip rotation using an examination chair useful in detecting cam and pincer morphology with MRI as a reference standard? METHODS A diagnostic test accuracy study was conducted in a sample of asymptomatic males. Using an examination chair with a standardized seated position, internal rotation was measured in 1080 men aged 18 to 21 years who had been conscripted for the Swiss army. The chair prevents compensatory movement by stabilizing the pelvis and the thighs with belts. The force to produce the internal rotation was standardized with a pulley system. Previous results showed that the measurements with the examination chair are similar to clinical assessment but with higher interobserver agreement. A random sample of 430 asymptomatic males was invited to undergo hip MRI. Of those, 244 White European males responded to the invitation and had a mean age of 20 ± 0.7 years and a mean internal rotation of the hip of 33° ± 8.5°. Using MRI as the reference standard, 69% (169 of 244) had a normal hip, 24% (59 of 244) a definite cam morphology (Grades 2 and 3), 3% (8 of 244) an increased acetabular depth, and 3% (8 of 244) a combination of both. One experienced radiologist graded cam morphology as follows: 0 = normal, 1 = mild, 2 = moderate, and 3 = severe. Pincer morphology was defined by increased acetabular depth (≤ 3 mm distance between the center of the femoral neck and the line connecting the anterior and posterior acetabular rims). The intraobserver agreement was substantial (weighted κ of 0.65). A receiver operating characteristic (ROC) curve was fitted, and sensitivity, specificity, and likelihood ratios were estimated for different internal rotation cutoffs. RESULTS For cam morphology, the area under the ROC curve was 0.75 (95% CI 0.67 to 0.82). Internal hip rotation of less than 20° yielded a positive likelihood ratio of 9.57 (sensitivity 0.13, specificity 0.99), and a value of 40° or more resulted in a negative likelihood ratio of 0.36 (sensitivity 0.93, specificity 0.20). The area under the curve for detecting the combination of cam and pincer morphologies was 0.87 (95% CI 0.74 to 1.0). A cutoff of 20° yielded a positive likelihood ratio of 9.03 (sensitivity 0.33, specificity 0.96). CONCLUSION This examination chair showed moderate-to-good diagnostic value to rule in hip cam morphology in White European males. However, at the extremes of the 95% confidence intervals, diagnostic performance would be poor. Nonetheless, we believe this test can contribute to identifying cam morphologies, and we hope that future, larger studies-ideally in more diverse patient populations-will seek to validate this to arrive at more precise estimates of the diagnostic performance of this test. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Roger Hilfiker
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marc Hunkeler
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | - Harald Bonel
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Switzerland
- Campus Stiftung Lindenhof, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ayeni OR. Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study. Pilot Feasibility Stud 2022; 8:201. [PMID: 36076280 PMCID: PMC9452871 DOI: 10.1186/s40814-022-01164-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this pilot study was to validate the feasibility of a definitive study aimed at determining if high-intensity physical activity during adolescence impacts the development of femoroacetabular impingement (FAI). Methods This prospective cohort pilot study had a sample size target of 50 volunteers between 12 and 14 years old at sites in Canada, South Korea, and the Netherlands. Participants were evaluated clinically and radiographically at baseline and at 2 years. The participants’ sport and physical activity were evaluated using the Habitual Activity Estimation Scale (HAES) and the American Orthopaedic Society for Sports Medicine (AOSSM) criteria for sport specialization. The primary outcome was feasibility and secondary outcomes included the incidence of radiographic FAI and hip range of motion, function (Hip Outcome Score, HOS), and quality of life (Pediatric Quality of Life questionnaire, PedsQL) at 24 months. Study groups were defined at the completion of follow-up, given the changes in participant activity levels over time. Results Of the 54 participants enrolled, there were 36 (33% female) included in the final analysis. At baseline, those classified as highly active and played at least one organized sport had a higher incidence of asymptomatic radiographic FAI markers (from 6/32, 18.8% at baseline to 19/32, 59.4% at 24 months) compared to those classified as low activity (1/4, 25% maintained at baseline and 24 months). The incidence of radiographic FAI markers was higher among sport specialists (12/19, 63.2%) compared to non-sport specialists (8/17, 47.1%) at 24 months. The HOS and PedsQL scores were slightly higher (better) among those that were highly active and played a sport compared to those who did not at 2 years (mean difference (95% confidence interval): HOS-ADL subscale 4.56 (− 7.57, 16.70); HOS-Sport subscale 5.97 (− 6.91, 18.84); PedsQL Physical Function 7.42 (− 0.79, 15.64); PedsQL Psychosocial Health Summary 6.51 (− 5.75, 18.77)). Conclusion Our pilot study demonstrated some feasibility for a larger scale, definitive cohort study. The preliminary descriptive data suggest that adolescents engaged in higher levels of activity in sports may have a higher risk of developing asymptomatic hip deformities related to FAI but also better quality of life over the 2-year study period. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01164-3.
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Affiliation(s)
- Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, Ontario, L8N 3Z5, Canada.
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Yang F, Huang HJ, He ZY, Xu Y, Zhang X, Wang JQ. Extent of Cam Resection Relative to Epiphyseal Line and Its Association With Clinical Outcomes After Arthroscopic Treatment for Femoroacetabular Syndrome. Orthop J Sports Med 2022; 10:23259671221125509. [PMID: 36199833 PMCID: PMC9528010 DOI: 10.1177/23259671221125509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Inadequate resection of cam lesions can cause inferior outcomes after hip arthroscopy and result in revision surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To evaluate the association between postoperative cam lesions measured using the proximal boundaries of resection area (PBRE) relative to the epiphyseal line and 2-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients with FAIS who had undergone primary hip arthroscopy between 2016 and 2018. The PBRE was calculated by measuring the linear distance from the PBRE to the epiphyseal line, dividing it by the diameter of the femoral head, and multiplying by 100; PBRE measurements were made at the 12-, 1-, and 2-o’clock positions on postoperative hip computed tomography. Within each clockface position, patients were divided into subgroups depending on whether their postoperative PBRE was greater than a half standard deviation above the mean (adequate resection) or less than or equal to a half standard deviation above the mean (inadequate resection). Patient-reported outcomes (PROs; Hip Outcome Score–Activities of Daily Living [HOS-ADL], International Hip Outcome Tool–Short Form [iHOT-12], modified Harris Hip Score [mHHS], and pain visual analog scale [VAS]) and rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were compared among the subgroups. Results: Included were 80 pairs of hips at 12 o’clock, 81 pairs of hips at 1 o’clock, and 80 pairs of hips at 2 o’clock. All subgroups demonstrated significant improvements in PRO scores at a minimum 2-year follow-up compared with preoperatively. At the 12-o’clock position, the subgroup with adequate resection had significantly superior HOS-ADL ( P = .004), iHOT-12 ( P < .001), and mHHS ( P < .001) scores and were more likely to achieve the MCID for the iHOT-12 score ( P = .035) and the PASS for the HOS-ADL ( P = .003), iHOT-12 ( P = .007), and mHHS ( P < .001) scores compared with the matched subgroup. There were no significant differences in PRO scores or rates of MCID and PASS for the 1- or 2-o’clock groups. Conclusion: The epiphyseal line may be a useful and reproducible landmark measurement for cam-type deformity. Patients considered to have inadequate resection at 12 o’clock had lower outcome scores at a minimum 2-year follow-up.
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Affiliation(s)
- Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zi-Yi He
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Uquillas CA, Sun Y, Van Sice W, ElAttrache NS, Banffy MB. Prevalence of femoroacetabular impingement in elite baseball players. J Hip Preserv Surg 2022; 9:145-150. [PMID: 35992028 PMCID: PMC9389915 DOI: 10.1093/jhps/hnac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.
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Affiliation(s)
- Carlos A Uquillas
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Yuhang Sun
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Wade Van Sice
- Kerlan Jobe Orthopedic Clinic, 2055 Military Trail #204 , Jupiter, FL 33458, USA
| | - Neal S ElAttrache
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Michael B Banffy
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
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Morphological Parameters of the Hip Joint and Its Relation to Gender, Joint Side and Age-A CT-Based Study. Diagnostics (Basel) 2022; 12:diagnostics12081774. [PMID: 35892485 PMCID: PMC9332566 DOI: 10.3390/diagnostics12081774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Physiological reference values for morphological parameters of the hip (MPH) are of clinical importance for the treatment of painful, degenerated or fractured hip joints, as well as to detect morphological deformities, which could result in early osteoarthritis of the hip. Currently, sufficient data for MPH are lacking. Therefore, it remains unclear if age-dependent alterations in adult hip morphology are physiological and if there are side- and gender-dependent differences. The aim of the study was to analyze MPH according to gender, side and age in a large-scaled cohort by CT scans. Methods: A total of 1576 hip joints from 788 patients (female: 257, male: 531; mean age: 58.3 years (±18.9; 18−92 years)) were analyzed by CT. For all hips, acetabular anteversion (AcetAV); lateral centrum edge angle (LCE); acetabular index (AI); femoral neck version (FNV); centrum-collum-diaphyseal angle (CCD); and anterior alpha angle (AαA) were measured. Results: The mean values in this cohort were: AcetAV 20.5° (±6.9); LCE 40.8° (±8.8); AI 0.3° (±5.3); FNV 11.0° (±9.8); CCD 129.9° (±7.4); and AαA 41.2° (±7.7). There was a detectable side-specific difference for AcetAV (p = 0.001); LCE (p < 0.001); CCD (p < 0.001); and AαA (p < 0.001). All the analyzed parameters showed a significant gender-specific difference, except for AI (p = 0.37). There was a significant correlation between age and AcetAV (r = 0.17; p < 0.001); LCE (r = 0.39; p < 0.001); AI (r = −0.25; p < 0.001); CCD (r = −0.15; p < 0.001); and AαA (r = 0.09; p < 0.001), except FNV (p = 0.79). Conclusions: There are side-, gender- and age-specific alterations in hip morphology, which have to be considered in treating hip joint pathologies.
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Verhaegen JC, Innmann M, Alves Batista N, Dion CA, Horton I, Pierrepont J, Merle C, Grammatopoulos G. Defining "Normal" Static and Dynamic Spinopelvic Characteristics: A Cross-Sectional Study. JB JS Open Access 2022; 7:e22.00007. [PMID: 35812809 PMCID: PMC9260734 DOI: 10.2106/jbjs.oa.22.00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spinopelvic characteristics influence the hip's biomechanical behavior. However, there is currently little knowledge regarding what "normal" characteristics are. This study aimed to determine how static and dynamic spinopelvic characteristics change with age, sex, and body mass index (BMI) among well-functioning volunteers. Methods This was a cross-sectional cohort study of 112 asymptomatic volunteers (age, 47.4 ± 17.7 years; 50.0% female; BMI, 27.3 ± 4.9 kg/m2). All participants underwent lateral spinopelvic radiography in the standing and deep-seated positions to determine maximum hip and lumbar flexion. Lumbar flexion (change in lumbar lordosis, ∆LL), hip flexion (change in pelvic-femoral angle, ∆PFA), and pelvic movement (change in pelvic tilt, ΔPT) were determined. The hip user index, which quantifies the relative contribution of the hip to overall sagittal movement, was calculated as (∆PFA/[∆PFA + ∆LL]) × 100%. Results There were decreases of 4.5° (9%) per decade of age in lumbar flexion (rho, -0.576; p < 0.001) and 3.6° (4%) per decade in hip flexion (rho, -0.365; p < 0.001). ∆LL could be predicted by younger age, low standing PFA, and high standing LL. Standing spinopelvic characteristics were similar between sexes. There was a trend toward men having less hip flexion (90.3° ± 16.4° versus 96.4° ± 18.1°; p = 0.065) and a lower hip user index (62.9% ± 8.2% versus 66.7% ± 8.3%; p = 0.015). BMI weakly correlated with ∆LL (rho, -0.307; p = 0.011) and ∆PFA (rho, -0.253; p = 0.039). Conclusions Spinopelvic characteristics were found to be age, sex, and BMI-dependent. The changes in the lumbar spine during aging (loss of lumbar lordosis and flexion) were greater than the changes in the hip, and as a result, the hip's relative contribution to overall sagittal movement increased. Men had a greater change in posterior pelvic tilt when moving from a standing to a deep-seated position in comparison with women, secondary to less hip flexion. The influence of BMI on spinopelvic parameters was low.
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Affiliation(s)
- Jeroen C.F. Verhaegen
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
- University Hospital Antwerp, Edegem, Belgium
| | - Moritz Innmann
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Orthopaedics and Trauma Surgery, Heidelberg University, Heidelberg, Germany
| | - Nuno Alves Batista
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Charles-Antoine Dion
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabel Horton
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, Heidelberg University, Heidelberg, Germany
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, Critical Care Wing, The Ottawa Hospital, Ottawa, Ontario, Canada
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Contribution of the Craig’s test to hip internal rotation among baseball players. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00958-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weber P, Gollwitzer H. [Treatment options for femoroacetabular impingement syndrome and osteoarthritis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:472-482. [PMID: 35925375 DOI: 10.1007/s00132-022-04254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a prearthritic deformity. Many patients with FAIS show signs of osteoarthritis at the time of initial presentation. Ideally, surgical correction of FAIS should stop the progression of osteoarthritis. However, biological changes in the joint, inflammatory processes, and patient-specific factors, which are not influenced by surgery, show a role in the progression of joint degeneration. Thus, it is not surprising that the results of joint-preserving surgery in FAIS and osteoarthritis Tönnis grade 2 and higher are bad, and patients often need to undergo total hip replacement (THR).Even in patients with initial osteoarthritis (Tönnis grade 1) the results of joint-preserving surgery are significantly worse in comparison to in patients without osteoarthritis. As this pathology occurs mainly in young patients, efforts should be made to avoid THR, as the risk of loosening and revision surgery is increased. Analysis of risk factors that lead to worse outcome in joint-preserving surgery can be helpful. Age > 45 years, adiposity, high alpha angle, CE angle < 25° and female sex are risk factors that lead to worse outcome in patients with risk factors and osteoarthritis Tönnis grade 1, the success rate of joint-preserving surgery after 5 years is below 50%. Therefore, we recommend non-surgical treatment. Promising is the use of mesenchymal progenitor cells (MPCs), even if their routine use has not been established. If conservative therapy is not successful, THR is indicated. With the use of modern bearings, a survival rate of THR of more than 90% after 15 years is reported in patients < 50 years. Patient satisfaction after THR is higher than after joint-preserving surgery.The combination of treatment modalities like joint-preserving surgery in combination with the application of MPCs to both correct the mechanical conflict and also influence progression of osteoarthritis is promising the from a biological point of view.
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Affiliation(s)
- Patrick Weber
- ECOM - Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Arabellastr. 17, 81925, München, Deutschland.
- ATOS Klinik München, München, Deutschland.
| | - Hans Gollwitzer
- ECOM - Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Arabellastr. 17, 81925, München, Deutschland
- ATOS Klinik München, München, Deutschland
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Vasavada K, Ross KA, Lott A, Shankar D, Marulanda D, Mojica ES, Carter CW, Borowski L, Gonzalez-Lomas G. Characterizing femoroacetabular impingement in professional Nordic Skiers. PHYSICIAN SPORTSMED 2022; 51:285-290. [PMID: 35324395 DOI: 10.1080/00913847.2022.2056770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Studies have shown a high prevalence of femoroacetabular impingement (FAI) among elite athletes yet there is a paucity of data on FAI in Nordic skiers. The purpose of this study was to determine the prevalence of radiographic FAI in professional Nordic Combined Skiers and Ski jumpers compared to controls and assess functional outcomes including hip range of motion (ROM) and pain in patients with radiographic evidence of FAI compared to those without it. METHODS A cohort of elite Nordic Skiers underwent medical history, physical examination, and pelvic radiographs at their visit with a fellowship-trained sports medicine physician. On pelvis radiographs, Alpha angle>55 degrees was deemed cam-positive, and positive crossover signs, Tönnis<0, or LCEA>40 were deemed pincer positive. Further stratification was performed by sex, ski event type, hip pain, presence of cam lesions, and presence of pincer lesions. Spearman correlation matrix was performed to measure the association between radiographic measurements and ROM. RESULTS Nineteen Nordic skiers and nineteen age, sex, and BMI matched controls were included in the study. There were no significant differences in age, sex, BMI, and hip pain between groups. While Nordic skiers demonstrated decreased ROM bilaterally on external rotation compared to controls, skiers had larger ROM bilaterally on extension, abduction, adduction compared to controls. Skiers were significantly more likely to have bilateral crossover sign and alpha angles>55 compared to controls. Subgroup analysis showed that Cam positive patients had higher flexion and adduction ROM and pincer positive patients had significantly higher flexion and abduction ROM compared to patients without cam and pincer lesions respectively. Patients with hip pain had significantly lower right hip abduction ROM compared to patients without hip pain. No significant correlations were seen between radiographic measurements and ROM. CONCLUSION Similar to other elite 'hip heavy' sport athletes, Nordic skiers gave a notably higher prevalence of radiographic cam and pincer type morphology and significantly higher ROM compared to nonathletic controls. Clinicians evaluating Nordic skiers should be aware of these baseline findings with respect to a possible elevated long-term risk of symptomatic FAI in these athletes as well as other conditions related to radiographic FAI.
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Affiliation(s)
- Kinjal Vasavada
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Keir Alexander Ross
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ariana Lott
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Dhruv Shankar
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - David Marulanda
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Cordelia W Carter
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Lauren Borowski
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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Cam Morphology Is Associated With Increased Femoral Version: Findings From a Collection of 1,321 Cadaveric Femurs. Arthroscopy 2022; 38:831-836. [PMID: 34371140 DOI: 10.1016/j.arthro.2021.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/15/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND To evaluate the relationship between femoral version (FV) and α angle (AA) in a large osteological collection of human femurs. METHODS The University of Iowa-Stanford osteological collection was used to evaluate the research aims. To measure FV and AA, axial photographs of the proximal femurs were taken, referenced from the posterior condylar axis. FV and AA measurements were obtained using ImageJ software, and the relationship between FV and AA was assessed with repeated-measures analysis of variance and generalized linear models. A P value of <.05 was considered statistically significant. RESULTS A total of 1321 cadaveric femurs (666 left and 655 right) in 721 cadavers were examined. The average AA for all femurs was 47.8° ± 10.9°, and the average FV for all femurs was 8.53° ± 8.09°. Overall, 191 femurs (14.5%) exhibited cam morphology (AA ≥ 60°). Of the 721 cadavers, 600 had both femurs available for side-to-side comparison. The average FV of femurs with cam morphology was significantly higher than that of femurs without cam morphology (11.70° ± 8.82° vs. 7.99° ± 8.82°, P < .001). Linear regression analysis demonstrated that increased AA was significantly correlated with increased FV (β ± standard error of the mean = 0.21 ± 0.02, P < .0001). CONCLUSION In a large osteological collection of human femurs, a significant positive relationship between AA and increasing FV was identified. CLINICAL RELEVANCE FAI and hip impingement morphology are more complex than cam or pincer morphology. Cam morphology with high femoral anteversion may allow for normal or near-normal hip mechanics without impingement, and this may partially explain the high rates of asymptomatic cam-type femoroacetabular impingement (FAI) morphology in active and general populations. Given the multiple morphological factors implicated in the development of FAI syndrome, these findings warrant further investigation.
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Dynamic Assessment of Femoroacetabular Impingement Syndrome Hips. Arthroscopy 2022; 38:404-416.e3. [PMID: 34126220 DOI: 10.1016/j.arthro.2021.05.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to compare lower extremity rotational kinematics and kinetics (angles, torques, and powers) and hip muscle electromyography (EMG) activity between cam-type femoroacetabular impingement syndrome (FAIS) and age- and sex-matched controls during walking, fast walking, stair ascent, stair descent, and sit-to-stand. METHODS This study included 10 males with unilateral FAIS and 10 control males with no FAIS. We measured kinematics, kinetics, and electromyographic signals during stair ascent/descent, sit-to-stand, self-selected walk, and fast walk. Peak signal differences between groups were compared with independent t-tests with statistical significance when P < .05. RESULTS FAIS hips showed significant differences compared to controls, including increased hip flexion during walking (+4.9°, P = .048) and stair ascent (+7.8°, P =.003); diminished trunk rotation during stair ascent (-3.4°; P = .015), increased knee flexion during self-selected walking (+5.1°, P = .009), stair ascent (+7.4°, P = .001), and descent (+5.3°, P = .038); and increased knee valgus during fast walking (+4.7°, P = .038). gMed and MedHam showed significantly decreased activation in FAIS during walking (gMed: -12.9%, P = .002; MedHam: -7.4%, P = .028) and stair ascent (gMed: -16.7%, P = .036; MedHam: -13.0%, P = .041); decreased gMed activation during sit-to-stand (-8.8%, P = .004) and decreased MedHam activation during stair descent (-8.0%, P = .039). CONCLUSIONS Three-dimensional motion analysis and EMG evaluation of functional kinematics and kinetics in subjects with symptomatic unilateral cam-type FAIS across a spectrum of provocative tasks demonstrated significant differences compared to controls in hip flexion, trunk rotation, knee flexion, and valgus. FAIS hips had significantly decreased gMed and MedHam activity. These findings may explain altered torso-pelvic, hip, and knee mechanics in FAIS patients and suggest that evaluation of FAIS should include the patient's hip, knee, and torso-pelvic relationships and muscle function. CLINICAL RELEVANCE The clinical and functional manifestation of FAIS hip pathomechanics is not entirely understood, and previous literature to date has not clearly described the alterations in gait and functional movements seen in patients with cam-type FAIS. The current study used 3D motion analysis and EMG evaluation of functional kinematics and kinetics to identify a number of differences between FAIS and control hips, which help us better understand the lower extremity kinematics and kinetics and muscle activation in FAIS.
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Griffin DR, Dickenson EJ, Achana F, Griffin J, Smith J, Wall PD, Realpe A, Parsons N, Hobson R, Fry J, Jepson M, Petrou S, Hutchinson C, Foster N, Donovan J. Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT. Health Technol Assess 2022; 26:1-236. [PMID: 35229713 PMCID: PMC8919110 DOI: 10.3310/fxii0508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. DESIGN The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. PARTICIPANTS Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. INTERVENTION Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. MAIN OUTCOME MEASURE The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. RESULTS Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (p = 0.0093). This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points). Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalised hip therapy group was not. Thirty-eight (24%) personalised hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomisation. Nineteen (12%) hip arthroscopy patients had a revision arthroscopy. Eleven (7%) personalised hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years. LIMITATIONS Study participants and treating clinicians were not blinded to the intervention arm. Delays were encountered in participants accessing treatment, particularly surgery. Follow-up lasted for 3 years. CONCLUSION Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement in quality of life than personalised hip therapy, and this difference was clinically significant at 12 months. This study does not demonstrate cost-effectiveness of hip arthroscopy compared with personalised hip therapy within the first 12 months. Further follow-up will reveal whether or not the clinical benefits of hip arthroscopy are maintained and whether or not it is cost-effective in the long term. TRIAL REGISTRATION Current Controlled Trials ISRCTN64081839. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Edward J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Smith
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nick Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Marcus Jepson
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences NIHR, Keele University, Keele, UK
| | - Jenny Donovan
- Bristol Medical School, University of Bristol, Bristol, UK
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Wilson DR, Zhang H, Jones CE, Gilbart MK, Masri BA. Effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. J Orthop Res 2022; 40:370-379. [PMID: 33734474 DOI: 10.1002/jor.25037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
It is not clear whether femoral neck osteochondroplasty achieves its objective of increasing femoroacetabular clearance. We used an upright open magnetic resonance imaging scanner to image the hip joint in multiple postures to explore the effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. We recruited 13 consecutive patients scheduled to undergo arthroscopic femoral neck osteochondroplasty and completed assessments on 10 patients. We scanned each subject before surgery and at 6 months post-op in supine and 3 other physiological postures: supine 90° flexion with adduction and internal rotation (FADIR), sitting deep (maximal flexion with internal rotation and adduction), and sitting crossed leg (maximal adduction with flexion and internal rotation). We measured the alpha angle, which describes the severity of cam deformity, and the beta angle, which defines joint clearance. We also evaluated hip flexion, internal rotation, and adduction before and after surgery. Femoral neck osteochondroplasty significantly decreased alpha angle by 23.9° ± 4.6° (p = 0.001) and increased beta angle across all postures by 28.1° ± 6.3° (p = 0.002). An increase in beta angle represented a decreased chance of impingement. Femoral neck osteochondroplasty significantly increased flexion by an average of 8.6° in the sitting deep posture after surgery (p = 0.007) which might indicate an improvement of joint function. These findings lend support to the hypothesis that arthroscopic osteochondroplasty accomplishes its stated goals of increasing bone-bone clearance in the hip joint and improving joint mechanics for the static postures assessed.
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Affiliation(s)
- David R Wilson
- Department of Orthopaedics, Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Honglin Zhang
- Department of Orthopaedics, Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carly E Jones
- Centre for Hip Health and Mobility, School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Gilbart
- Department of Orthopaedics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedics, The University of British Columbia, Vancouver, British Columbia, Canada
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40
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Femoral acetabular impingement labral pathology on MRI is correlated with greater hip flexion and decreased abduction in collegiate water polo players: A pilot study. J ISAKOS 2022; 7:7-12. [DOI: 10.1016/j.jisako.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hip joint range of motion is restricted by pain rather than mechanical impingement in individuals with femoroacetabular impingement syndrome. Arch Orthop Trauma Surg 2022; 142:1985-1994. [PMID: 34585303 PMCID: PMC9296409 DOI: 10.1007/s00402-021-04185-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Discerning whether range of motion (ROM) is restricted by morphology or other pain sources is challenging in patients with femoroacetabular impingement syndrome (FAIS). Computed tomography (CT) motion simulation provides a hypothetical ROM based on morphology. This study aimed to explore associations between ROM measured using CT motion simulation and maximum passive ROM measured clinically using three dimensional (3D) motion analysis in patients with FAIS, prior to and post arthroscopic hip surgery. MATERIALS AND METHODS Eight males with FAIS (in total 12 hip joints) were included in this explorative feasibility study. Participants were examined using CT according to a low-dose protocol prior to and 7-months post arthroscopic surgery. Software was used to simulate at which ROM the impingement would occur. With the hip in 90 degrees' flexion, maximum passive range of internal hip rotation, and maximum passive internal hip rotation coupled with adduction was examined clinically using 3D motion analysis pre- and postoperatively. Spearman rank correlation coefficients and linear regressions examined associations between methods. RESULTS Preoperatively, the correlation between maximum internal hip rotation measured using CT motion simulation and 3D motion analysis was strong (r = 0.71, p = 0.009). Linear regressions demonstrated that maximal internal rotation measured using CT motion simulation was predominantly larger than when measured using 3D motion analysis. Postoperatively, and when maximum internal rotation was coupled with adduction, no correlations were found between the two methods. CONCLUSIONS The hypothetical morphology restricted ROM is larger than clinically assessed pain restricted ROM, both prior to and post hip arthroscopy. These findings suggest that ROM is restricted by pain rather than mechanical, morphology-based impingement in individuals with FAIS.
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Bisciotti GN, Auci A, Bona S, Bisciotti A, Bisciotti A, Cassaghi G, DI Marzo F, DI Pietto F, Eirale C, Panascì M, Parra F, Zini R. Long-standing groin pain syndrome in athletic women: a multidisciplinary assessment in keeping with the italian consensus agreement. J Sports Med Phys Fitness 2021; 62:1199-1210. [PMID: 34931789 DOI: 10.23736/s0022-4707.21.13322-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-standing groin pain syndrome (LSGPS) is a form of groin pain syndrome in which the cohort of symptoms reported by patients is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. The aim of this prospective epidemiological study was to describe the clinical causes of LSGPS in 37 female athletic subjects in Italy through the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes classification and guidelines. METHODS Thirty-seven female athletes affected by LSGPS were evaluated following the guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes. RESULTS In the considered population, each patient presented only one pathological cause for LSGPS. The most frequent aetiologies were inguinal pathologies (54.05% of the cases), acetabular labrum tear (18.92%) and pelvic floor disorders (8.11%). Adductor tendinopathy represented only 2.70% of cases. CONCLUSIONS Female athletic patients affected by LSGPS show a similar incidence of inguinal and hip pathologies as in male populations. However, these clinical situations do not seem to be associated in women unlike in the male population. This difference is probably due to particular anatomical differences related to gender. For this reason, women affected by LSGPS represent an important subset of patients. Moreover, adductor tendinopathy is probably overrated as an etiopathogenetic source of LSGPS in women.
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Affiliation(s)
- Gian Nicola Bisciotti
- Paris Saint Germain FC, Paris, France - .,Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy -
| | - Alessio Auci
- Azienda USL Toscana Nord-Ovest, Massa Carrara, Italy
| | - Stefano Bona
- Humanitas Resarch Institute, Rozzano, Milan, Italy
| | | | - Andrea Bisciotti
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | | | | | | | | | | | - Federica Parra
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | - Raul Zini
- Università degli Studi di Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Scanaliato JP, Wells ME, Dunn JC, Garcia EJ. Overview of Sport-Specific Injuries. Sports Med Arthrosc Rev 2021; 29:185-190. [PMID: 34730116 DOI: 10.1097/jsa.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
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Westermann RW, Scott EJ, Schaver AL, Schneider A, Glass NA, Levy SM, Willey MC. Activity Level and Sport Type in Adolescents Correlate with the Development of Cam Morphology. JB JS Open Access 2021; 6:JBJSOA-D-21-00059. [PMID: 34841184 PMCID: PMC8613345 DOI: 10.2106/jbjs.oa.21.00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to evaluate the influence of the volume and type of sport on the development of cam-type femoroacetabular impingement and acetabular dysplasia.
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Affiliation(s)
- Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Elizabeth J Scott
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Andrew L Schaver
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Anthony Schneider
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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45
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Ko S, Pareek A, Jo C, Han HS, Lee MC, Krych AJ, Ro DH. Automated Risk Stratification of Hip Osteoarthritis Development in Patients With Femoroacetabular Impingement Using an Unsupervised Clustering Algorithm: A Study From the Rochester Epidemiology Project. Orthop J Sports Med 2021; 9:23259671211050613. [PMID: 34778477 PMCID: PMC8573500 DOI: 10.1177/23259671211050613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Studies evaluating the natural history of femoroacetabular impingement (FAI) are limited. Purpose: To stratify the risk of progression to osteoarthritis (OA) in patients with FAI using an unsupervised machine-learning algorithm, compare the characteristics of each subgroup, and validate the reproducibility of staging. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A geographic database from the Rochester Epidemiology Project was used to identify patients with hip pain between 2000 and 2016. Medical charts were reviewed to obtain characteristic information, physical examination findings, and imaging details. The patient data were randomly split into 2 mutually exclusive sets: train set (70%) for model development and test set (30%) for validation. The data were transformed via Uniform Manifold Approximation and Projection and were clustered using Hierarchical Density-based Spatial Clustering of Applications with Noise. Results: The study included 1071 patients with a mean follow-up period of 24.7 ± 12.5 years. The patients were clustered into 5 subgroups based on train set results: patients in cluster 1 were in their early 20s (20.9 ± 9.6 years), female dominant (84%), with low body mass index (<19
); patients in cluster 2 were in their early 20s (22.9 ± 6.7 years), female dominant (95%), and pincer-type FAI (100%) dominant; patients in cluster 3 were in their mid 20s (26.4 ± 9.7) and were mixed-type FAI dominant (92%); patients in cluster 4 were in their early 30s (32.7 ± 7.8), with high body mass index (≥29
), and diabetes (17%); and patients in cluster 5 were in their early 30s (30.0 ± 9.1), with a higher percentage of males (43%) compared with the other clusters and with limited internal rotation (14%). Mean survival for clusters 1 to 5 was 17.9 ± 0.6, 18.7 ± 0.3, 17.1 ± 0.4, 15.0 ± 0.5, and 15.6 ± 0.5 years, respectively, in the train set. The survival difference was significant between clusters 1 and 4 (P = .02), 2 and 4 (P < .005), 2 and 5 (P = .01), and 3 and 4 (P < .005) in the train set and between clusters 2 and 5 (P = .03) and 3 and 4 (P = .01) in the test set. Cluster characteristics and prognosis was well reproduced in the test set. Conclusion: Using the clustering algorithm, it was possible to determine the prognosis for OA progression in patients with FAI in the presence of conflicting risk factors acting in combination.
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Affiliation(s)
- Sunho Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Changwung Jo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Fischer M, Walter SS, Hepp T, Zimmer M, Notohamiprodjo M, Schick F, Yang B. Automated Morphometric Analysis of the Hip Joint on MRI from the German National Cohort Study. Radiol Artif Intell 2021; 3:e200213. [PMID: 34617023 DOI: 10.1148/ryai.2021200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 11/11/2022]
Abstract
Purpose To develop and validate an automated morphometric analysis framework for the quantitative analysis of geometric hip joint parameters in MR images from the German National Cohort (GNC) study. Materials and Methods A secondary analysis on 40 participants (mean age, 51 years; age range, 30-67 years; 25 women) from the prospective GNC MRI study (2015-2016) was performed. Based on a proton density-weighted three-dimensional fast spin-echo sequence, a morphometric analysis approach was developed, including deep learning-based landmark localization, bone segmentation of the femora and pelvis, and a shape model for annotation transfer. The centrum-collum-diaphyseal, center-edge (CE), three alpha angles, head-neck offset (HNO), and HNO ratio along with the acetabular depth, inclination, and anteversion were derived. Quantitative validation was provided by comparison with average manual assessments of radiologists in a cross-validation format. Paired-sample t tests with a Bonferroni-corrected significance level of .005 were employed alongside mean differences and 10th/90th percentiles, median absolute deviations (MADs), and intraclass correlation coefficients (ICCs). Results High agreement in mean Dice similarity coefficients was achieved (average of 97.52% ± 0.46 [standard deviation]). The subsequent morphometric analysis produced results with low mean MAD values, with the highest values of 3.34° (alpha 03:00 o'clock position) and 0.87 mm (HNO) and ICC values ranging between 0.288 (HNO ratio) and 0.858 (CE) compared with manual assessments. These values were in line with interreader agreements, which at most had MAD values of 4.02° (alpha 12:00 o'clock position) and 1.07 mm (HNO) and ICC values ranging between 0.218 (HNO ratio) and 0.777 (CE). Conclusion Automatic extraction of geometric hip parameters from MRI is feasible using a morphometric analysis approach with deep learning.Keywords: Computer-Aided Diagnosis (CAD), Interventional-MSK, MR-Imaging, Neural Networks, Skeletal-Appendicular, Hip, Anatomy, Computer Applications-3D, Segmentation, Vision, Application Domain, Quantification Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Marc Fischer
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Sven S Walter
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Tobias Hepp
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Manuela Zimmer
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Mike Notohamiprodjo
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Fritz Schick
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
| | - Bin Yang
- Institute of Signal Processing and Systems Theory, University of Stuttgart, Pfaffenwaldring 47, 70550 Stuttgart, Germany (M.F., M.Z., B.Y.); Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, University Hospital Tübingen, Tübingen, Germany (S.S.W., T.H., M.N., F.S.); and Empirical Inference Department, Max Planck Institute for Intelligent Systems, Tübingen, Germany (T.H.)
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Catelli DS, Kowalski E, Beaulé PE, Lamontagne M. Muscle and Hip Contact Forces in Asymptomatic Men With Cam Morphology During Deep Squat. Front Sports Act Living 2021; 3:716626. [PMID: 34568821 PMCID: PMC8458768 DOI: 10.3389/fspor.2021.716626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/06/2021] [Indexed: 01/01/2023] Open
Abstract
Cam morphology is defined as an aspherical femoral head-neck junction that causes abnormal contact of the acetabular rim with the anterior hip. Imaging confirmation of the cam morphology, associated with clinical signs and pain in the hip or groin, is characterized as femoroacetabular impingement (FAI) syndrome. Although some individuals with cam morphology do not experience any symptoms, sparse studies have been done on these individuals. Understanding the way asymptomatic individuals generate muscle forces may help us to better explain the progression of the degenerative FAI process and discover better ways in preventing the onset or worsening of symptoms. The purpose of this study was to compare the muscle and hip contact forces of asymptomatic cam morphology (ACM) and FAI syndrome men compared to cam-free healthy controls during a deep squat task. This prospective study compared 39 participants, with 13 in each group (ACM, FAI, and control). Five deep squatting trials were performed at a self-selected pace while joint trajectories and ground reaction forces were recorded. A generic model was scaled for each participant, and inverse kinematics and inverse dynamics calculated joint angles and moments, respectively. Muscle and hip contact forces were estimated using static optimization. All variables were time normalized in percentage by the total squat cycle and both muscle forces and hip contact forces were normalized by body weight. Statistical non-parametric mapping analyses were used to compare the groups. The ACM group showed increased pelvic tilt and hip flexion angles compared to the FAI group during the descent and ascent phases of the squat cycle. Muscle forces were greater in the ACM and control groups, compared to the FAI group for the psoas and semimembranosus muscles. Biceps femoris muscle force was lower in the ACM group compared to the FAI group. The FAI group had lower posterior hip contact force compared to both the control and ACM groups. Muscle contraction strategy was different in the FAI group compared to the ACM and control groups, which caused different muscle force applications during hip extension. These results rebut the concept that mobility restrictions are solely caused by the presence of the cam morphology and propose evidence that symptoms and muscle contraction strategy can be the origin of the mobility restriction in male patients with FAI.
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Affiliation(s)
- Danilo S Catelli
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Erik Kowalski
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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48
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Gao G, Fu Q, Wu R, Liu R, Ao Y, Xu Y. The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients. J Orthop Surg Res 2021; 16:567. [PMID: 34544472 PMCID: PMC8454115 DOI: 10.1186/s13018-021-02719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some studies have proved that labrum size is associated with symptoms in patients with hip labral tear. The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients is still uncertain. METHODS The volunteers with no history of pain, injury, or surgery were recruited from the community. Patients who were diagnosed with labral tear and underwent hip arthroscopic surgery in this period in our hospital were also included. The length and height of the acetabular hip labrum were measured at three separate anatomic sites through magnetic resonance imaging (MRI) along the acetabular rim: lateral, anterior, and anteroinferior. RESULTS A total of 70 volunteers (125 hips) and 70 patients (70 hips) were included in this study. Sixty-six (52.8%) hips had labral tears in all 125 hips of volunteers. The lateral labral length of volunteers with labral tears was significantly larger than those without labral tears (P < .05). In 14 volunteers with unilateral labral tears, length of lateral, anterior, and anteroinferior labrum in the side with tear were significantly larger than normal on the other side. The anterior labral height of volunteers was significantly larger than that of patients (P < .05). CONCLUSIONS In conclusion, asymptomatic volunteers with larger length of lateral, anterior, and anteroinferior labrum are more prone to present with labral tears. Symptomatic patients with labral tears exhibited thinner anterior labrum. Further studies are warranted to explore the mechanisms of labral tears in asymptomatic people and validate the use of labral size as a guide to differential diagnosis and treatment.
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Affiliation(s)
- Guanying Gao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Qiang Fu
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ruiqi Wu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Rongge Liu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Ricciardi BF. CORR Insights®: Is Cam Morphology Found in Ancient and Medieval Populations in Addition to Modern Populations? Clin Orthop Relat Res 2021; 479:1839-1841. [PMID: 33950878 PMCID: PMC8277271 DOI: 10.1097/corr.0000000000001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin F Ricciardi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, University of Rochester School of Medicine, Rochester, NY, USA
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Knapik DM, Clapp IM, Wichman D, Nho SJ. Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement-Related Hip Pain. Am J Sports Med 2021; 49:2110-2116. [PMID: 34081563 DOI: 10.1177/03635465211015431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with symptomatic femoroacetabular impingement syndrome, bilateral hip pain has been reported to occur in high frequency. However, not all patients require bilateral hip arthroscopy. PURPOSE To determine the incidence, patient-specific variables, and postoperative outcomes in patients who presented with bilateral hip pain at the time of index hip arthroscopy and underwent subsequent contralateral arthroscopic hip surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who presented with bilateral hip pain, underwent primary hip arthroscopy between January 2012 and June 2018 for indication of femoroacetabular impingement syndrome, and had minimum 2-year follow-up were retrospectively analyzed. Baseline descriptive data, preoperative hip range of motion, and radiographic measurements were recorded with pre- and postoperative patient-reported outcomes (PROs). Independent samples t test was used to compare continuous variables, and chi-square test was used to compare categorical variables between patients undergoing unilateral and bilateral surgery. Bivariate correlations and a multivariable binary logistic regression were performed to determine factors predictive of the need for future contralateral hip arthroscopy. RESULTS In total, 108 patients were identified who reported bilateral hip pain during the index evaluation, underwent primary hip arthroscopy, and had 2-year follow-up. Among these, 42% (n = 45) elected to undergo hip arthroscopy on the contralateral hip at a mean of 6.0 months (range, 1-17 months) after the index surgery. Patients requiring bilateral surgery were significantly younger (P = .004) and had a larger preoperative anterior center-edge angle (ACEA; P = .038) when compared with patients who had unilateral surgery. There were no significant differences in alpha angle measurements between patients who had unilateral and bilateral surgery. On bivariate analysis, younger age at the time of the index surgery (r = -0.272; P = .005) and preoperative ACEA (r = 0.249; P = .016) were significantly correlated with the need for bilateral surgery. On multivariate analysis, younger age remained a significant predictor for bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). Patients who underwent bilateral hip arthroscopy reported significant improvement in all PROs (P < .001), with a significantly greater mean Hip Outcome Score- Sports Specific Subscale score when compared with patients undergoing unilateral surgery (P = .037). CONCLUSION Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. Younger age at the time of the index surgery and greater ACEA were predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significantly improvement in PROs at minimum 2-year follow-up.
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Affiliation(s)
- Derrick M Knapik
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ian M Clapp
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Wichman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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