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Chadayammuri V, Garabekyan T, Jesse MK, Pascual-Garrido C, Strickland C, Milligan K, Mei-Dan O. Measurement of lateral acetabular coverage: a comparison between CT and plain radiography. J Hip Preserv Surg 2015; 2:392-400. [PMID: 27011864 PMCID: PMC4732381 DOI: 10.1093/jhps/hnv063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/19/2015] [Accepted: 09/10/2015] [Indexed: 02/02/2023] Open
Abstract
We prospectively evaluated the degree of absolute agreement between measurements of lateral center-edge angle (LCEA) on plain radiography (XR) and computed tomography (CT) in a consecutive cohort of 205 patients (410 hips) undergoing hip arthroscopy. Preoperative measurements of the LCEA were performed bilaterally utilizing standardized anteroposterior radiographs and coronal reformatted CT scans. Demographic variables including age, gender, height, weight, BMI and clinical diagnosis were recorded for all patients. Overall, measured values of the LCEA were 2.1° larger on CT compared with XR (32.9° versus 30.8°, P < 0.001). Subgroup analysis revealed the highest mean difference in hips with acetabular dysplasia and concomitant cam-type femoroacetabular impingement (FAI) [mean difference (CT–XR) 5.5°, 95% confidence interval (CI) 3.7°–7.3°, P = 0.011], followed by hips with isolated acetabular dysplasia (mean difference [CT–XR] 4.9°, 95% CI 2.7°–7.0°, P < 0.001). In contrast, 119 (29.0%) of the hips demonstrated larger measurements of the LCEA on 25 XR relative to CT. Of these hips, 20 (16.8%) had pincer-FAI and 25 had cam-FAI (21.0%), representing a significantly higher proportion compared with all other clinical subgroups (P = 0.045 and 0.036, respectively). Our study demonstrates measured values of the LCEA are consistently inflated on CT relative to XR for a wide variety of hip pathologies, highlighting the need for standardization and validation of CT-based measurements to improve the quality of clinical decision making. Level of Evidence: Diagnostic Level II.
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Affiliation(s)
- Vivek Chadayammuri
- 1. Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tigran Garabekyan
- 2. Department of Orthopaedic Surgery, Division of Sports Medicine and Hip Preservation
| | - Mary-Kristen Jesse
- 3. Department of Radiology, Division of Musculoskeletal Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Colin Strickland
- 3. Department of Radiology, Division of Musculoskeletal Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth Milligan
- 1. Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Omer Mei-Dan
- 2. Department of Orthopaedic Surgery, Division of Sports Medicine and Hip Preservation
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Bouma H, Hogervorst T, Audenaert E, van Kampen P. Combining femoral and acetabular parameters in femoroacetabular impingement: the omega surface. Med Biol Eng Comput 2015; 53:1239-46. [PMID: 26446831 DOI: 10.1007/s11517-015-1392-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
The concept of femoroacetabular impingement (FAI) proposes the development of hip osteoarthritis through motion-induced damage to the acetabular cartilage and labrum. Thus, dynamic interaction of the proximal femur and acetabulum is the crux of FAI. Several types of FAI can be distinguished, but FAI classification is mostly done with separate parameters for acetabular and femoral morphology on planar images, without direct representation of the femoroacetabular interaction. Five main parameters influence impingement between the proximal femur and the acetabular rim: alpha and center edge angles, acetabular and femoral version, and neck-shaft angle. We attempted to integrate these five parameters in order to reflect their interaction and derive a signal comprehensive parameter, the omega surface, to characterize the severity of FAI. The omega surface is a CT-based delineation of the femoral head surface that represents the area for impingement-free motion. The omega surface is determined with dedicated software (Articulis™) and can be determined for various positions of the hip joint. We determined the omega surface in a pilot study for five different hip morphotypes and found the omega surface was smaller in FAI morphotypes than in a normal hip. Furthermore, the omega surface was smaller in symptomatic versus control subjects with FAI morphotypes. The omega surface may therefore help in improved differentiation between symptomatic and asymptomatic FAI hips.
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Affiliation(s)
- Heinse Bouma
- Departments of Orthopaedic Surgery, Haga Hospital, The Hague, The Netherlands.
| | - Tom Hogervorst
- Departments of Orthopaedic Surgery, Haga Hospital, The Hague, The Netherlands
| | - Emanuel Audenaert
- Departments of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Paulien van Kampen
- Departments of Orthopaedic Surgery, Haga Hospital, The Hague, The Netherlands
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Mlynarek RA, Weber AE, Ross JR, Bedi A. Advances in Hip Imaging: 3-Dimensional Computed Tomography, Magnetic Resonance Imaging, and Dynamic Imaging. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Crawford EA, Welton KL, Kweon C, Kelly BT, Larson CM, Bedi A. Arthroscopic Treatment of Pincer-Type Impingement of the Hip. JBJS Rev 2015; 3:01874474-201508000-00004. [DOI: 10.2106/jbjs.rvw.n.00096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chhabra A, Nordeck S, Wadhwa V, Madhavapeddi S, Robertson WJ. Femoroacetabular impingement with chronic acetabular rim fracture - 3D computed tomography, 3D magnetic resonance imaging and arthroscopic correlation. World J Orthop 2015; 6:498-504. [PMID: 26191497 PMCID: PMC4501936 DOI: 10.5312/wjo.v6.i6.498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/13/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement (FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI.
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Mlynarek RA, Cowan JB, Larson CM, Kelly BT, Bedi A. Arthroscopic Approach to Femoroacetabular Impingement. J Arthroplasty 2015; 30:1096-104. [PMID: 25922123 DOI: 10.1016/j.arth.2015.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/23/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ryan A Mlynarek
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - James B Cowan
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota
| | | | - Asheesh Bedi
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Ross JR, Bedi A, Stone RM, Sibilsky Enselman E, Kelly BT, Larson CM. Characterization of symptomatic hip impingement in butterfly ice hockey goalies. Arthroscopy 2015; 31:635-42. [PMID: 25498869 DOI: 10.1016/j.arthro.2014.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 10/06/2014] [Accepted: 10/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to characterize the radiographic deformity observed in a consecutive series of butterfly goalies with symptomatic mechanical hip pain and to use computer-based software analysis to identify the location of impingement and terminal range of motion. We also compared these analyses to a matched group of positional hockey players with symptomatic femoroacetabular impingement (FAI). METHODS A consecutive series of 68 hips in 44 butterfly-style hockey goalies and a matched group of 34 hips in 26 positional hockey players who underwent arthroscopic correction for symptomatic FAI were retrospectively analyzed. Each patient underwent preoperative anteroposterior (AP) and modified Dunn lateral radiographs and computed tomography (CT) of the affected hips. Common FAI measurements were assessed on plain radiographs. Patient-specific, CT-based 3-dimensional (3D) models of the hip joint were developed, and the femoral version, alpha angles at each radial clock face position, and femoral head coverage were calculated. Maximum hip flexion, abduction, internal rotation in 90° flexion (IRF), flexion/adduction/internal rotation (FADIR), and butterfly position were determined, and the areas of bony collision were defined. RESULTS Butterfly goalies had an elevated mean alpha angle on both AP (61.3°) and lateral radiographs (63.4°) and a diminished beta angle (26.0°). The mean lateral center-edge angle (LCEA) measured 27.3° and acetabular inclination was 6.1°. A crossover sign was present in 59% of the hips. The maximum alpha angle on the radial reformatted computed tomographic scan was significantly higher among the butterfly goalies (80.9° v 68.6°; P < .0001) and was located in a more lateral position (1:00 o'clock v. 1:45 o'clock; P < .0001) compared with positional players. CONCLUSIONS Symptomatic butterfly hockey goalies have a high prevalence of FAI, characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- James R Ross
- Sports Medicine and Shoulder Service, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Asheesh Bedi
- Sports Medicine and Shoulder Service, University of Michigan, Ann Arbor, Michigan, U.S.A..
| | - Rebecca M Stone
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A
| | | | - Bryan T Kelly
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A
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Ross JR, Larson CM, Adeoyo O, Kelly BT, Bedi A, Bedi A. Residual deformity is the most common reason for revision hip arthroscopy: a three-dimensional CT study. Clin Orthop Relat Res 2015; 473:1388-95. [PMID: 25475714 PMCID: PMC4353554 DOI: 10.1007/s11999-014-4069-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. An awareness of the most frequent locations of the residual deformities may be critical to minimize these failures. QUESTIONS/PURPOSES The purposes of this study were to (1) define the three-dimensional (3-D) morphology of hips with residual symptoms before revision femoroacetabular impingement (FAI) surgery; (2) determine the limitation in range of motion (ROM) in these patients using dynamic, computer-assisted, 3-D analysis; and (3) compare these measures with a cohort of patients who underwent successful arthroscopic surgery for FAI by a high-volume hip arthroscopist. METHODS Between 2008 and 2013, one senior surgeon (BTK) performed revision arthroscopic FAI procedures on patients with residual FAI deformity and symptoms after prior unsuccessful arthroscopic surgery; all of these 47 patients (50 hips) had preoperative CT scans. Mean patient age was 29 ± 9 years (range, 16-52 years). Three-dimensional models of the hips were created to allow measurements of femoral and acetabular morphology and ROM to bony impingement using a validated, computer-based dynamic imaging software. During the same time period, 65 patients with successful primary arthroscopic treatment of FAI by the same surgeon underwent preoperative CT scans for the symptomatic contralateral hip; this group of 65 patients thus fortuitously provided postoperative evaluation of the originally operated hip and served as a control group. A comparison of the virtual correction with the actual correction in the primary successful FAI treatment cohort was performed. Correspondingly, a comparison of the recommended virtual correction with the correction evident at the time of presentation after failed primary surgery in the revision cohort was performed. Analysis was performed by two independent observers (JRR, OA) and a paired t-test was used for comparison of continuous variables, whereas chi-square testing was used for categorical variables with p < 0.05 defined as significant. RESULTS Ninety percent (45 of 50) of patients undergoing revision surgery for symptomatic FAI had residual deformities; the mean maximal alpha angle in revision hips was 68° ± 16° and was most often located at 1:15, considering the acetabulum as a clockface and 1 to 5 o'clock as anterior independent of side. Twenty-six percent (13 of 50) of hips had signs of overcoverage with a lateral center-edge angle greater than or equal to 40°. Dynamic analysis revealed mean direct hip flexion of 114° ± 11° to osseous impingement. Internal rotation in 90° of hip flexion and flexion, adduction, internal rotation to osseous contact were 28° ± 12° and 20° ± 10°, respectively, which were less than those in hips that had underwent hip arthroscopy by a high-volume hip arthroscopist (all p < 0.001). CONCLUSIONS We found marked radiographic evidence of incomplete correction of deformity in patients with residual symptoms compared with patients with successful results with residual deformity present in the large majority of patients (45 of 50 [90%]) undergoing residual FAI surgery. We recommend careful attention to full 3-D resection of impinging structures.
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Affiliation(s)
- James R. Ross
- Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 USA
| | - Christopher M. Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, MN USA
| | | | | | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106 USA
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Functional acetabular orientation varies between supine and standing radiographs: implications for treatment of femoroacetabular impingement. Clin Orthop Relat Res 2015; 473:1267-73. [PMID: 25560956 PMCID: PMC4353556 DOI: 10.1007/s11999-014-4104-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Often, anteroposterior (AP) pelvic radiographs are performed with the patient positioned supine. However, this may not represent the functional position of the pelvis and the acetabulum, and so when assessing patients for conditions like femoroacetabular impingement (FAI), it is possible that standing radiographs better incorporate the dynamic influences of periarticular musculature and sagittal balance. However, this thesis remains largely untested. QUESTIONS/PURPOSES The purpose of this study was to determine the effect of supine and standing pelvic orientation on (1) measurements of acetabular version and common radiographic signs of FAI as assessed on two- and three-dimensional (3-D) imaging; and (2) on terminal hip range of motion (ROM). METHODS Preoperative pelvic CT scans of 50 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI between July 2013 and October 2014 were analyzed. The mean age of the study population was 29 ± 10 years (range, 15-50 years) and 70% were male. All patients had a standing AP pelvis radiograph, a reconstructed supine radiograph from the CT data, and a 3-D model created to allow manipulation of pelvic tilt and simulate ROM to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign were recorded on simulated plain radiographs. Measurements of ROM to bony impingement were made during (1) simulated hip flexion; (2) simulated internal rotation in 90° of flexion (IRF); and (3) simulated internal rotation in 90° of flexion and 15° adduction (FADIR), and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for supine and standing pelvic orientations. A paired Student's t-test was used for comparison of continuous variables, whereas chi square testing was used for categorical variables. A p value of < 0.05 was considered significant. RESULTS When changing from supine to the standing radiographs, both mean cranial and central version increased by 2° ± 4° (95% confidence interval [CI], 1°-3°) and 2° ± 3° (95% CI, 1°-3°), respectively (both p < 0.001). However, with the numbers available, there were no changes in the proportion of positive crossover, posterior wall, and prominent ischial spine signs. Standing pelvic position tilt resulted in an increased hip flexion of 3° (95% CI, 2°-4°) as well as an increase in IRF of 2° (95% CI, 1°-3°) and FADIR of 3° (95% CI, 2°-4°) (all p < 0.001). CONCLUSIONS The functional orientation of the acetabulum varies between supine and standing radiographs and must be considered when diagnosing and treating patients with symptomatic FAI. Standing pelvic orientation results in posterior pelvic tilt and later occurrence of FAI in the arc of motion. Although we cannot recommend standing radiographs on the current study alone, we do recommend larger studies to determine whether any significant differences truly exist.
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Tramer JS, Deneweth JM, Whiteside D, Ross JR, Bedi A, Goulet GC. On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement. Sports Health 2015; 7:542-7. [PMID: 26502449 PMCID: PMC4622373 DOI: 10.1177/1941738115576481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown. HYPOTHESIS The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. STUDY DESIGN Clinical research. LEVEL OF EVIDENCE Level 5. METHODS An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements. RESULTS Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°). CONCLUSION On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is needed to determine the costs and benefits of such an approach. CLINICAL RELEVANCE Surgical treatment of symptomatic FAI can achieve pain relief and improved kinematics of the hip joint with athletic activities. Additional studies are necessary to determine whether improved kinematics enhance the longevity of the native hip and alter the progression of osteoarthritic changes in those with asymptomatic FAI deformity.
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Affiliation(s)
- Joseph S Tramer
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Jessica M Deneweth
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - David Whiteside
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - James R Ross
- Broward Orthopedic Specialists, Fort Lauderdale, Florida
| | - Asheesh Bedi
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Grant C Goulet
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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Massey PA, Nho SJ, Larson CM, Harris JD. Letter to the Editor re: "Cam impingement: defining the presence of a cam deformity by the alpha angle data from the CHECK cohort and Chingford cohort". Osteoarthritis Cartilage 2014; 22:2093-4. [PMID: 25300575 DOI: 10.1016/j.joca.2014.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/24/2014] [Accepted: 09/01/2014] [Indexed: 02/02/2023]
Affiliation(s)
- P A Massey
- Houston Methodist Hospital, Department of Orthopaedics and Sports Medicine, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX 77030, USA.
| | - S J Nho
- Midwest Orthopaedics at Rush, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612, USA.
| | - C M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN 55435, USA.
| | - J D Harris
- Houston Methodist Hospital, Department of Orthopaedics and Sports Medicine, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX 77030, USA.
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Pros, Cons, and Future Possibilities for Use of Computer Navigation in Hip Arthroscopy. Sports Med Arthrosc Rev 2014; 22:e33-41. [DOI: 10.1097/jsa.0000000000000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Needell SD, Borzykowski RM, Carreira DS, Kozy J. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data. Skeletal Radiol 2014; 43:1605-11. [PMID: 25001873 DOI: 10.1007/s00256-014-1949-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/12/2014] [Accepted: 06/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. MATERIALS AND METHODS Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115° through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. RESULTS The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. CONCLUSIONS The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography.
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Affiliation(s)
- Steven D Needell
- Boca Radiology Group, 951 NW 13th St, Suite 1C, Boca Raton, FL, 33486, USA,
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Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. Am J Sports Med 2014; 42:2402-9. [PMID: 25060073 DOI: 10.1177/0363546514541229] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current understanding of the effect of dynamic changes in pelvic tilt on the functional acetabular orientation and occurrence of femoroacetabular impingement (FAI) is limited. PURPOSE To determine the effect of changes in pelvic tilt on (1) terminal hip range of motion and (2) measurements of acetabular version as assessed on 2- and 3-dimensional imaging. STUDY DESIGN Controlled laboratory study. METHODS Preoperative pelvic computed tomographic scans of 48 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI were analyzed. The mean age of the study population was 25.7 years (range, 14-56 years), and 56% were male. Three-dimensional models of the hips were created, allowing manipulation of the pelvic tilt and simulation of hip range of motion to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign was recorded on simulated plain radiographs. Measurements of range of motion to bony impingement during (1) hip flexion, (2) internal rotation in 90° of flexion, and (3) internal rotation in 90° of flexion and 15° adduction were performed, and the location of bony contact between the proximal femur and acetabular rim was defined. These measurements were calculated for -10° (posterior), 0° (native), and +10° (anterior) pelvic orientations. RESULTS In native tilt, mean cranial acetabular version was 3.3°, while central version averaged 16.2°. Anterior pelvic tilt (10° change) resulted in significant retroversion, with mean decreases in cranial and central version of 5.9° and 5.8°, respectively (P < .0001 for both). Additionally, this resulted in a significantly increased proportion of positive crossover, posterior wall, and prominent ischial spine signs (P < .001 for all). Anterior pelvic tilt (10° change) resulted in a decrease in internal rotation in 90° of flexion of 5.9° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 8.5° (P < .0001), with a shift in the location of osseous impingement more anteriorly. Posterior pelvic tilt (10° change) resulted in an increase in internal rotation in 90° of flexion of 5.1° (P < .0001) and internal rotation in 90° of flexion and 15° adduction of 7.4° (P < .0001), with a superolateral shift in the location of osseous impingement. CONCLUSION/CLINICAL RELEVANCE Dynamic changes in pelvic tilt significantly influence the functional orientation of the acetabulum and must be considered. Dynamic anterior pelvic tilt is predicted to result in earlier occurrence of FAI in the arc of motion, whereas dynamic posterior pelvic tilt results in later occurrence of FAI, which may have implications regarding nonsurgical treatments for FAI.
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Affiliation(s)
- James R Ross
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA Broward Orthopedic Specialists, Fort Lauderdale, Florida, USA
| | - Jeffrey J Nepple
- Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Philippon
- Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Bryan T Kelly
- Hospital for Special Surgery, New York, New York, USA
| | - Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Asheesh Bedi
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA Hospital for Special Surgery, New York, New York, USA
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Schottel PC, Park C, Chang A, Knutson Z, Ranawat AS. The role of experience level in radiographic evaluation of femoroacetabular impingement and acetabular dysplasia. J Hip Preserv Surg 2014; 1:21-6. [PMID: 27011798 PMCID: PMC4765259 DOI: 10.1093/jhps/hnu005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/27/2014] [Accepted: 07/13/2014] [Indexed: 12/02/2022] Open
Abstract
Accurate radiographic interpretation is essential for properly diagnosing the etiology of pre-arthritic hip pain such as femoroacetabular impingement (FAI) and acetabular dysplasia (AD); however, radiographic interpretation can be significantly influenced by the observer’s experience level. This study assesses the accuracy and inter- and intraobserver reliability in the radiographic evaluation of FAI and AD based on experience level. Fifty-five patients diagnosed with FAI, AD or normal hip morphology were identified from the principal investigator’s institutional database. Four observers performed an independent and blinded radiographic review, assessing 14 radiographic parameters and an interpretation of a final diagnosis. A second radiographic evaluation of 20 preselected cases was completed 6 weeks after the initial reading to assess intraobserver reliability. Inter- and intraobserver reliability was determined using Cohen’s Kappa Coefficient (κ) and intraclass correlation coefficient (ICC) for continuous parameters in a four-rater design. Interobserver reliability was highest across experience levels for lateral centre edge angle (ICC = 0.92) and alpha angle (ICC = 0.90) and lowest (κ < 0.3, ICC < 0.3) for joint congruency and detection of herniation pits. Intraobserver reliability was highest for acetabular depth (κ = 0.89) and alpha angle (ICC = 0.80) and lowest for head–neck offset ratio and Tönnis grade. Final diagnosis was consistent with the original blinded clinical diagnosis 75–84% of the time across four experience levels. The attending orthopaedic hip surgeon demonstrated greatest diagnostic sensitivity but lowest specificity for making an accurate radiographic diagnosis. Subjective parameters must be redefined, and objective parameters must be further developed to improve the reliability of accurately diagnosing FAI or AD.
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Affiliation(s)
- Patrick C Schottel
- 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 St, New York, NY 10021, USA
| | - Caroline Park
- 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 St, New York, NY 10021, USA
| | - Anthony Chang
- 2. Department of Radiology, Sharp Rees-Stealy Medical Center, San Diego, CA, USA
| | - Zakary Knutson
- 3. Department of Orthopaedic Surgery, Bone and Joint Hospital at St. Anthony, Norman, OK 73072, USA
| | - Anil S Ranawat
- 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70 St, New York, NY 10021, USA
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Henak CR, Abraham CL, Peters CL, Sanders RK, Weiss JA, Anderson AE. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum. Clin Radiol 2014; 69:e381-91. [PMID: 25070373 DOI: 10.1016/j.crad.2014.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/20/2014] [Accepted: 06/03/2014] [Indexed: 11/16/2022]
Abstract
AIM To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. MATERIALS AND METHODS Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. RESULTS Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98-6.7 mm (2.46 ± 1.16 mm). CONCLUSIONS When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required.
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Affiliation(s)
- C R Henak
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - C L Abraham
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - C L Peters
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - R K Sanders
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - J A Weiss
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - A E Anderson
- Department of Bioengineering, and Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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67
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Ruder JA, Magennis E, Ranawat AS, Kelly BT. Clinical and morphologic factors associated with suture anchor refixation of labral tears in the hip. HSS J 2014; 10:18-24. [PMID: 24482617 PMCID: PMC3903958 DOI: 10.1007/s11420-013-9372-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The acetabular labrum is critical to hip function. Surgical options for treatment of a damaged labrum include removal, debridement, and refixation using suture anchors. QUESTIONS/PURPOSES The purpose of this study is to determine if certain patient demographic and osseous morphological factors result in increased labral damage requiring refixation. METHODS Data was collected prospectively from a consecutive series of 334 procedures performed from August 2010 to June 2011 for femoroacetabular impingement. Demographic data, including age, sex, and race, was collected from patient charts. Three-dimensional (3D) CT scans were reviewed to retrieve alpha angles, acetabular version, femoral version, and lateral center edge angle on the symptomatic hip. RESULTS In 238 (71.3%) of the procedures, the labrum required refixation using suture anchors with a mean of 2.74 anchors being used. Of males, 78.8% required suture anchors and 62.3% of females required suture anchors. Among procedures requiring suture anchors, significantly more suture anchors were used in males (2.92) than females (2.47). Regression analysis showed a positive association between alpha angle, acetabular retroversion at 1 and 2 o'clock, and the number of suture anchors used. The mean alpha angle in the cohort that required suture anchors (63.1°) was significantly greater than the cohort that did not (59.4°). CONCLUSION This study found femoral deformities to contribute more to labral damage than acetabular deformities and highlighted the importance of preoperative 3D CT scans. This study provides demographic and morphologic factors to review preoperatively to evaluate if extensive labral damage is present and if suture anchor refixation will be required.
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Affiliation(s)
- John A. Ruder
- />University of Central Florida College of Medicine, 2048 Shroud St. Apt 306, Orlando, FL 239-537-1580 USA
| | - Erin Magennis
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Anil S. Ranawat
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Bryan T. Kelly
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Abstract
Hip arthroscopy is one of the fastest growing surgical procedures performed by orthopaedic surgeons, with the number of hip arthroscopies expected to double in 2013. The increase in surgical prevalence is at least in part due to an increased awareness of prearthritic hip pathology. The diagnoses of prearthritic hip conditions are made through a comprehensive history, physical examination, and selection of appropriate diagnostic imaging modalities. The purpose of this review article is to provide the practicing orthopaedic surgeon with an overview of the imaging modalities available for the diagnosis of prearthritic hip pathology, with a focus on literature supporting advancements in imaging techniques and new applications of existing modalities.
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Affiliation(s)
- Alexander E. Weber
- />Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | - Jon A. Jacobson
- />Department of Radiology, University of Michigan, 2910G Taubman Center, SPC 5326, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Asheesh Bedi
- />Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
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Larson CM, Stone RM. Current concepts and trends for operative treatment of FAI: hip arthroscopy. Curr Rev Musculoskelet Med 2013; 6:242-9. [PMID: 23728614 DOI: 10.1007/s12178-013-9170-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and meta-analysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischio-femoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.
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Affiliation(s)
- Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, 4010 West 65th St, Edina, MN, 55435, USA,
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Safran MR. Symposium: Advanced hip arthroscopy: editorial comment. Clin Orthop Relat Res 2013; 471:2461-2. [PMID: 23728888 PMCID: PMC3705031 DOI: 10.1007/s11999-013-3090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Marc R. Safran
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA 94305 USA
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