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Buldo-Licciardi M, Shankar DS, Akpinar B, Montgomery SR, Vasavada KD, Savage-Elliott I, Youm T. A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy. Arthroscopy 2024; 40:810-817. [PMID: 37579955 DOI: 10.1016/j.arthro.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up. METHODS We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up. RESULTS Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P = .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P = .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P = .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P = .65). CONCLUSIONS A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Michael Buldo-Licciardi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Samuel R Montgomery
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kinjal D Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Ian Savage-Elliott
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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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 2024:101932. [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] [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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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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Murphy NJ, Diamond LE, Bennell KL, Burns A, Dickenson E, Eyles J, Fary C, Grieve SM, Griffin DR, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O'Connell RL, O'Donnell J, Randhawa S, J Singh P, Spiers L, Tran P, Wrigley T, Hunter DJ. Which hip morphology measures and patient factors are associated with age of onset and symptom severity in femoroacetabular impingement syndrome? Hip Int 2023; 33:102-111. [PMID: 34424780 DOI: 10.1177/11207000211038550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. METHODS 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were recorded. Backward stepwise regression assessed morphological parameters and patient factors (age, sex, BMI, symptom duration, annual income, private/public healthcare system accessed) to determine variables independently associated with onset age and iHOT-33 score. RESULTS Earlier symptom onset was associated with larger superoanterior alpha angle (p = 0.007), smaller AV (p = 0.023), lower BMI (p = 0.010) and public healthcare system access (p = 0.041) (r2 = 0.320). Worse iHOT-33 score was associated with smaller ACEA (p = 0.034), female sex (p = 0.040), worse modified UCLA activity score (p = 0.010) and public healthcare system access (p < 0.001) (r2 = 0.340). CONCLUSIONS Age of symptom onset was chiefly predicted by femoral and acetabular bony morphology measures, whereas symptom severity predominantly by patient factors. Factors measured explained a small amount of variance in the data; additional unmeasured factors may be more influential.
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Affiliation(s)
- Nicholas J Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Orthopaedic Surgery, John Hunter Hospital, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | | | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, University of Sydney, Camperdown, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Rachel L O'Connell
- Department of Rheumatology, Royal North Shore Hospital, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia.,St Vincent's Private Hospital, East Melbourne, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Parminder J Singh
- Hip Arthroscopy Australia, Richmond, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
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Rogers MJ, Sato EH, LaBelle MW, Ou Z, Presson AP, Maak TG. Association of Cam Deformity on Anteroposterior Pelvic Radiographs and More Severe Chondral Damage in Femoroacetabular Impingement Syndrome. Am J Sports Med 2022; 50:2980-2988. [PMID: 35975987 DOI: 10.1177/03635465221111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal proximal femoral morphology in femoroacetabular impingement syndrome (FAIS) identifiable on the anteroposterior (AP) pelvic radiograph has been described as the "pistol grip" deformity. The effect of a superior cam deformity identified on this radiographic view remains unknown. PURPOSES To assess the relationship between AP cam deformity (AP alpha angle [AP AA] >55°) and cartilage injury; to assess the relationship between AP cam deformity and labral injury; and to determine if patient factors are correlated with cartilage and labral injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing osteochondroplasty and labral repair for FAIS with a single surgeon were identified retrospectively. Intraoperative size, location, and severity of cartilage and labral damage were prospectively collected. Chondrolabral and femoral/acetabular cartilage damage were graded with the Beck labral and cartilage injury criteria. Radiographic data included the AP AA, lateral center-edge angle (LCEA), and maximum femoral alpha angle (MF AA). Patients with hip dysplasia (LCEA <18°; LCEA 18°-25° with acetabular index >10°) were excluded. Outcomes were compared across cartilage and labral severity grades. We report odds ratios (ORs) with 95% confidence intervals and P values from multivariable logistic regressions. RESULTS Of the 158 included hips (154 patients), 69% were female and the mean (± standard deviation [SD]) age was 30.3 ± 9.7 years. Increase in age, increase in body mass index (BMI), and male sex were associated with increasing severity of cartilage and labral injury. More severe cartilage damage was associated with increasing AP AA (P < .001) and MF AA (P < .001). The odds of developing a higher category of cartilage injury severity (grade ≥3) were 119% higher (OR, 2.19 [95% CI, 1.36-3.64]; P = .002) for every SD increase (16.7°) in AP AA, adjusting for age, sex, and BMI. The odds of developing a severe labral injury (grade ≥3) were 118% higher (OR, 2.18 [95% CI 1.17-4.32]; P = .018) for every SD increase (10.5°) in MF AA, adjusting for age, sex, BMI, and AP AA. CONCLUSION Increasing age and BMI, and male sex are associated with increasing severity of cartilage and labral injury in FAIS. The odds of developing a cartilage injury are significantly higher with independent increases in AP AA and MF AA.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Eleanor H Sato
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Mark W LaBelle
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
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Ewertowski NP, Schleich C, Abrar DB, Hosalkar HS, Bittersohl B. Automated measurement of alpha angle on 3D-magnetic resonance imaging in femoroacetabular impingement hips: a pilot study. J Orthop Surg Res 2022; 17:370. [PMID: 35907886 PMCID: PMC9338591 DOI: 10.1186/s13018-022-03256-5] [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: 02/13/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) syndrome is an established pre-osteoarthritic condition. Diagnosis is based on both clinical and radiographic parameters. An abnormal manually calculated alpha angle in magnetic resonance imaging (MRI) is traditionally utilized to diagnose abnormal femoral head-neck offset. This pilot study aimed to assess the feasibility of automated alpha angle measurements in patients with FAI syndrome, and to compare automated with manual measurements data with regard to the time and effort needed in each method. METHODS Alpha angles were measured with manual and automated techniques, using postprocessing software in nineteen hip MRIs of FAI syndrome patients. Two observers conducted manual measurements. Intra- and inter-observer reproducibility and correlation of manual and automated alpha angle measurements were calculated using intra-class correlation (ICC) analysis. Both techniques were compared regarding the time taken (in minutes) and effort required, measured as the amount of mouse button presses performed. RESULTS The first observer's intra-observer reproducibility was good (ICC 0.77; p < 0.001) while the second observer's was good-to-excellent (ICC 0.93; p < 0.001). Inter-observer reproducibility between both observers in the first (ICC 0.45; p < 0.001) and second (ICC 0.56; p < 0.001) manual alpha angle assessment was moderate. The intra-class correlation coefficients between manual and automated alpha angle measurements were ICC = 0.24 (p = 0.052; observer 1, 1st measurement), ICC = 0.32 (p = 0.015; observer 1, 2nd measurement), ICC = 0.50 (p < 0.001; observer 2, 1st measurement), and ICC = 0.45 (p < 0.001; observer 2, 2nd measurement). Average runtime for automatic processing of the image data for the automated assessment was 16.6 ± 1.9 min. Automatic alpha angle measurements took longer (time difference: 14.6 ± 3.9 min; p < 0.001) but required less effort (difference in button presses: 231 ± 23; p < 0.001). While the automatic processing is running, the user can perform other tasks. CONCLUSIONS This pilot study demonstrates that objective and reliable automated alpha angle measurement of MRIs in FAI syndrome hips is feasible. Trial registration The Ethics Committee of the University of Düsseldorf approved our study (Registry-ID: 2017084398).
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Affiliation(s)
- Nastassja Pamela Ewertowski
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Harish S Hosalkar
- Paradise Valley Hospital, San Diego, CA, USA.,Tri-City Medical Center, Oceanside, CA, USA.,Sharp Grossmont Hospital, La Mesa, CA, USA.,Scripps Hospital, San Diego, CA, USA
| | - Bernd Bittersohl
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
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Alter TD, Knapik DM, Lambers F, Guidetti M, Chahla J, Malloy P, Nho SJ. Sex-Based Differences in Femoroacetabular Impingement Syndrome and the Effect of Cam Deformity Location on the Extent of Labral Tearing: A 3-Dimensional Computed Tomography Study. Orthop J Sports Med 2022; 10:23259671221095174. [PMID: 38115855 PMCID: PMC10728605 DOI: 10.1177/23259671221095174] [Citation(s) in RCA: 1] [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: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 12/21/2023] Open
Abstract
Background Sex-specific quantification of cam morphology in patients with femoroacetabular impingement syndrome may improve diagnostics, surgical planning, and outcomes. Purpose To (1) examine differences between men and women with symptomatic cam deformities based on deformity location, magnitude, and extent; (2) assess the association between cam deformity and labral pathology; and (3) evaluate the relationship between cam deformity and patient-reported outcome measures after hip arthroscopy. Study Design Cohort study; Level of evidence, 3. Methods Computed tomography (CT) scans were acquired in 98 consecutive patients before hip arthroscopy for femoroacetabular impingement syndrome. Custom software was used to generate 3-dimensional bone models and align them to a standard coordinate system. The alpha angle was measured at the 12-, 1-, 2-, and 3-o'clock positions, with 12 and 3 o'clock corresponding to the superior and anterior aspects of the femur, respectively. These alpha angle measurements were used to define the cam midpoint and extent. The labral tear midpoint and extent were evaluated intraoperatively. Bivariate correlation analysis was used to evaluate the association between the cam and labral tear midpoints and between the extent of the cam morphology and labral tearing. Results The 3-dimensional models were analyzed in a cohort of 69 female and 29 male patients. Male patients were older (mean ± SD, 38.9 ± 12.6 vs 30.7 ± 12.2 years, P = .006) and had a greater body mass index (27.8 ± 4.4 vs 25.3 ± 5.6 kg/m2, P = .005). Male patients had greater alpha angle measures at 12, 1, and 3 o'clock (P < .05) and a greater maximum alpha angle (69.0° ± 18.8° vs 62.1° ± 21.0°, P = .031); the location of their maximum cam impingement was also significantly different (P < .05) when compared with female patients. Cam impingement (2:06 ± 1:09 vs 1:33 ± 1:16 clockfaces, P = .032) and labral tearing (3:02 ± 0:35 vs 2:34 ± 0:53 clockfaces, P = .003) in men extended over a greater region of the femoral clockface when compared with women. Significant correlations were demonstrated between the cam and labral tear midpoint locations (r = 0.190, P = .032) and the extent of the cam deformity and labral tearing (r = 0.203, P = .024). There were no sex-based differences in patient-reported outcome measures at baseline or 2-year follow-up. Conclusion Male patients possessed greater cam deformity magnitude and extent when compared with female patients. Cam pathomorphology was associated with the location and extent of labral tearing.
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Affiliation(s)
- Thomas D. Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M. Knapik
- Division of Sports Medicine, Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | - Floor Lambers
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Martina Guidetti
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Malloy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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Felsing C, Schröder J. Update Bildgebung beim Femoroazetabulären Impingement-Syndrom. DER ORTHOPADE 2022; 51:176-186. [DOI: 10.1007/s00132-022-04223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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Bodendorfer BM, Alter TD, Carreira DS, Wolff AB, Kivlan BR, Christoforetti JJ, Salvo JP, Matsuda DK, Nho SJ. Multicenter Outcomes After Primary Hip Arthroscopy: A Comparative Analysis of Two-Year Outcomes After Labral Repair, Segmental Labral Reconstruction, or Circumferential Labral Reconstruction. Arthroscopy 2022; 38:352-361. [PMID: 34052367 DOI: 10.1016/j.arthro.2021.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To report minimum 2-year follow-up patient-reported outcome measures in patients undergoing labral repair (LR), segmental labral reconstruction (SLR), or circumferential labral reconstruction (CLR) in the primary setting; and (2) to compare minimum 2-year follow-up patient-reported outcome measures among these groups. METHODS A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. Inclusion criteria were patients undergoing hip arthroscopy for treatment of labral tear and femoroacetabular impingement syndrome between January 2014 and October 2017, and completion of minimum 2-year postoperative outcome scores. Exclusion criteria were patients undergoing revision hip surgery, labral treatment limited to debridement, lateral center-edge angle <20°, osteoarthritis (Tönnis grade > 1), slipped capital femoral epiphysis, workers compensation status, and patients undergoing concomitant gluteus medius and/or minimus repair. Labral reconstruction patients were matched (1:3) with labral repair patients on age, sex, and body mass index. The labral reconstruction group was further stratified into SLR, and CLR groups. Patient demographic characteristics and clinical outcomes including Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool, and visual analog scale for pain were analyzed, as well as achievement of the minimal clinical improvement difference (MCID). A P-value less than .05 indicated statistical significance. RESULTS A total of 416 patients were included (LR, n = 312; SLR, n = 53; CLR, n = 51). The age, body mass index, and sex of the matched cohort were 42.3 ± 11.2 years, 24.7 ± 3.7, and 55.0% female. At a minimum of 2-year after hip arthroscopic surgery, no differences were found in preoperative, postoperative, or the delta visual analog scale for pain, modified Harris Hip Score, Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, or international Hip Outcome Tool. Subsequently, the proportion of patients achieving the MCID and the PASS at latest follow-up were analyzed. This analysis revealed that no significant differences in the rate of MCID or PASS achievement for any outcome measure existed based on labral treatment. CONCLUSIONS In this multicenter study on labral treatment in the primary setting, patients undergoing LR, SLR, and CLR demonstrated no difference in preoperative or postoperative scores, nor the proportion of patients achieving clinically significant outcome improvement. LEVEL OF EVIDENCE III; therapeutic outcome study with controls.
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Affiliation(s)
- Blake M Bodendorfer
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, U.S.A
| | - Benjamin R Kivlan
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, U.S.A
| | - John J Christoforetti
- Center for Athletic Hip Injury, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Drexel University College of Medicine, Pittsburgh, Pennsylvania, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A
| | - John P Salvo
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.; Hip Arthroscopy Program, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Dean K Matsuda
- DISC Sports and Spine Center, Marina del Rey, California, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A..
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10
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Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs. Arthroscopy 2021; 37:3371-3382. [PMID: 33957216 DOI: 10.1016/j.arthro.2021.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in the arthroscopic treatment of femoroacetabular impingement syndrome and compare those results with traditional unguided resections. METHODS Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between July 2019 and October 2019 were evaluated. Cases with CVI were identified along with controls, consisting of patients from the same study period who underwent surgery without the CVI and were balanced for age, sex, laterality, and preoperative alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs, as well as intraoperatively for the CVI group. Cam resections were quantified by measuring pre- and postresection alpha angles and compared between groups. The correlation between CVI views and office-based radiographs was assessed, and the 3 CVI views that best correlated with each of the 3 standard clinic radiographs were evaluated for accuracy and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based films as the reference. RESULTS A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control group. There were no significant differences between groups with respect to age, sex, laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45 with the anteroposterior (ρ = 0.588, P = .0025), 12:30 with the Dunn lateral (ρ = 0.632, P = .0009), and 1:45 with the false-profile (ρ = 0.575, P = .0033). Greater reliability was observed with 12:30/Dunn (accuracy = 83.33%, P < .0001; sensitivity = 77.14%; specificity = 87.76%) and 1:45/false-profile (accuracy = 82.35%, P = .0051; sensitivity = 81.82%; specificity = 82.61%) than with 11:45/anteroposterior (accuracy = 69.15%, P = .0077; sensitivity = 56.10%; specificity = 79.25%). CONCLUSIONS CVI-guided cam resection results in successful resection of proximal femur cam lesions and represents a femoroplasty templating method that does not require preoperative computed tomography imaging or additional invasive intraoperative referencing modules. The accuracy and adequacy of this resection was validated by comparison with routine clinic radiographs. LEVEL OF EVIDENCE Therapeutic Level III: retrospective comparative analysis.
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11
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Abstract
Computed tomography (CT) is most commonly used to produce three-dimensional (3D) models for evaluating bone and joint morphology in clinical practice. However, 3D models created from magnetic resonance imaging (MRI) data can be equally effective for comprehensive and accurate assessment of osseous and soft tissue structure morphology and pathology. The quality of 3D MRI models has steadily increased over time, with growing potential to replace 3D CT models in various musculoskeletal (MSK) applications. In practice, a single MRI examination for two-dimensional and 3D assessments can increase the value of MRI and simplify the pre- and postoperative imaging work-up. Multiple studies have shown excellent performance of 3D MRI models in shoulder injuries, in the hip in the setting of femoroacetabular impingement, and in the knee for the creation of bone surface models. Therefore, the utility of 3D MRI postprocessed models is expected to continue to rise and broaden in applications. Computer-based and artificial intelligence-assisted postprocessing techniques have tremendous potential to improve the efficiency of 3D model creation, opening many research avenues to validate the applicability of 3D MRI and establish 3D-specific quantitative assessment criteria. We provide a practice-focused overview of 3D MRI acquisition strategies, postprocessing techniques for 3D model creation, MSK applications of 3D MRI models, and an illustration of cases from our daily clinical practice.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, NYU Langone Medical Center, New York, New York
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12
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Derin Cicek E, Cevik H. Analysis of morphological parameters in pelvic radiography and hip MRI : a practical reporting recommendation. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although numerous criteria have been proposed to define abnormal hip morphology, mostly used in the diagnosis of femoroacetabular impingement, it is not a practical approach to measure all of these parameters in all cases without clinical suspicion.
In this study, our aim was to develop an evaluating and reporting standardization for routine hip examinations to define both hip morphology and impingement.
A total of 108 patients with routine hip magnetic resonance imaging (MRI) and antero-posterior pelvic radiograph (PR) were included in this retrospective study. Alpha angle (AA), acetabular depth (AD), acetabular protrusion, acetabular anteversion, collo- diaphyseal angle (CDA), lateral center-edge angle (LCEA) and Tönnis angle (TA) were measured. The differences and associations between these parameters were evaluated according to imaging modality or plane, and sex.
Although a significant difference has been found between the axial AA and the coronal AA mean values measured on MRI, there was also a strong correlation. Coronal measurements were significantly higher. AA values measured in PR and coronal MRI were comparable. Males had higher AA in both planes as compared to females. There were no significant differences between CDA values in MRI and PR. There was a significant difference and a moderate correlation between AD values in MRI and PR. We suggest that routine reports should include a measurement of AA in two planes, and measurement of CDA in PR or MRI. Due to the difference in AD between MRI and radiography, LCEA or TA may represent better alternatives. Checking for a negative Tönnis sign would represent a practical approach.
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13
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Ina J, Raji Y, Strony JT, Su C, Nho S, Salata MJ. The Role of Imaging in Femoroacetabular Impingement: History, Current Practices, and Future Applications. JBJS Rev 2021; 9:01874474-202108000-00008. [PMID: 34415885 DOI: 10.2106/jbjs.rvw.21.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Femoroacetabular impingement (FAI) is one of the most common causes of early hip articular cartilage wear and labral damage, and subsequently leads to the onset of hip osteoarthritis. » Cam-type FAI impingement lesions can be best identified with a 90° Dunn lateral radiograph and a cross-table lateral radiograph with 15° of internal rotation; the alpha angle and the femoral head-neck offset are the most used predictive radiographic markers. » FAI lesions with pincer impingement are associated with acetabular retroversion and are more difficult to identify on traditional radiographic imaging; however, the presence of a crossover sign, an ischial spine sign, and/or a posterior wall sign can be useful radiographic markers. » Advanced imaging modalities such as magnetic resonance imaging (MRI) and/or magnetic resonance arthrography (MRA) can also be beneficial in the evaluation of FAI and labral pathology; MRA is more sensitive than MRI in detecting intra-articular pathology. » Computer-assisted navigation for preoperative planning and intraoperative surgical assistance are promising technologies; however, additional studies are needed before they can be utilized safely and effectively.
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Affiliation(s)
- Jason Ina
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yazdan Raji
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John T Strony
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles Su
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shane Nho
- Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Michael J Salata
- Department of Orthopaedic Surgery and Sports Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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14
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Dijkstra HP, Ardern CL, Serner A, Mosler AB, Weir A, Roberts NW, Mc Auliffe S, Oke JL, Khan KM, Clarke M, Glyn-Jones S. Primary cam morphology; bump, burden or bog-standard? A concept analysis. Br J Sports Med 2021; 55:1212-1221. [PMID: 34281962 PMCID: PMC8551977 DOI: 10.1136/bjsports-2020-103308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. DESIGN We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. RESULTS We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. CONCLUSION We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
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Affiliation(s)
- H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, UK .,Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Clare L Ardern
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia.,Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Andreas Serner
- Research & Scientific Support, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Nia Wyn Roberts
- Bodleain Health Care Libraries, University of Oxford Bodleian Libraries, Oxford, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, Qatar University, Doha, Qatar
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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15
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Abstract
Preoperative evaluation of the pathomorphology is crucial for surgical planning, including radiographs as the basic modality and magnetic resonance imaging (MRI) and case-based additional imaging (e.g. 3D-CT, abduction views). Hip arthroscopy (HAS) has undergone tremendous technical advances, an immense increase in use and the indications are getting wider. The most common indications for revision arthroscopy are labral tears and residual femoroacetabular impingement (FAI). Treatment of borderline developmental dysplastic hip is currently a subject of controversy. It is paramount to understand the underlining problem of the individual hip and distinguish instability (dysplasia) from FAI, as the appropriate treatment for unstable hips is periacetabular osteotomy (PAO) and for FAI arthroscopic impingement surgery. PAO with a concomitant cam resection is associated with a higher survival rate compared to PAO alone for the treatment of hip dysplasia. Further, the challenge for the surgeon is the balance between over- and undercorrection. Femoral torsion abnormalities should be evaluated and evaluation of femoral rotational osteotomy for these patients should be incorporated to the treatment plan.
Cite this article: EFORT Open Rev 2021;6:472-486. DOI: 10.1302/2058-5241.6.210019
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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16
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Morattel B, Bonin N. Unusual apical femoral head deformity treated by hip arthroscopy and tunnel drilling through femoral head: a case report. J Hip Preserv Surg 2021; 8:i25-i33. [PMID: 34178368 PMCID: PMC8221387 DOI: 10.1093/jhps/hnab026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Femoro-acetabular impingement (FAI), is the result of an abnormal morphology of the hip joint. On the femoral side, asphericity of the head can be highlighted by an alpha angle measurement >50° on computed tomography or MRI. However, some particular cephalic asphericities can make it difficult to measure the alpha angle, leading to a diagnostic pitfall. While in the classic cam effect, the deformity is peripheral and can be treated by arthroscopic femoroplasty, an apical head deformity remains a therapeutic challenge. We present the case of a 17-year-old male patient with a femoral head deformity, corresponding to an ISHA zone 6 overhang, significantly improved in everyday and sports life by arthroscopic trapdoor technique to resect the focal central deformity while enabling concomitant treatment of central compartment pathology, in this case, a hypertrophic ligamentum teres and femoral head chondral flap. Etiology of this femoral head deformity remains uncertain but could be a particular cam deformity, sequelae to pediatric disease or instability with repeated traction of the ligament teres on the femoral head apical insertion during cephalic growth.
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Affiliation(s)
- Boris Morattel
- Orthopaedic Surgeon, Lyon Ortho Clinic, 29B Avenue des sources, Lyon 69009, France
| | - Nicolas Bonin
- Orthopaedic Surgeon, Lyon Ortho Clinic, 29B Avenue des sources, Lyon 69009, France
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17
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Hanke MS, Schmaranzer F, Steppacher SD, Reichenbach S, Werlen SF, Siebenrock KA. A Cam Morphology Develops in the Early Phase of the Final Growth Spurt in Adolescent Ice Hockey Players: Results of a Prospective MRI-based Study. Clin Orthop Relat Res 2021; 479:906-918. [PMID: 33417423 PMCID: PMC8052031 DOI: 10.1097/corr.0000000000001603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cam morphologies seem to develop with an increased prevalence in adolescent boys performing high-impact sports. The crucial question is at what age the cam morphology actually develops and whether there is an association with an aberration of the shape of the growth plate at the cam morphology site. QUESTIONS/PURPOSES (1) What is the frequency of cam morphologies in adolescent ice hockey players, and when do they appear? (2) Is there an association between an extension of the physeal growth plate and the development of a cam morphology? (3) How often do these players demonstrate clinical findings like pain and lack of internal rotation? METHODS A prospective, longitudinal MRI study was done to monitor the proximal femoral development and to define the appearance of cam morphologies in adolescent ice hockey players during the final growth spurt. Young ice hockey players from the local boys' league up to the age of 13 years (mean age 12 ± 0.5 years) were invited to participate. From 35 players performing on the highest national level, 25 boys and their parents consented to participate. None of these 25 players had to be excluded for known disease or previous surgery or hip trauma. At baseline examination as well as 1.5 and 3 years later, we performed a prospective noncontrast MRI scan and a clinical examination. The three-dimensional morphology of the proximal femur was assessed by one of the authors using radial images of the hip in a clockwise manner. The two validated parameters were: (1) the alpha angle for head asphericity (abnormal > 60°) and (2) the epiphyseal extension for detecting an abnormality in the shape of the capital physis and a potential correlation at the site of the cam morphology. The clinical examination was performed by one of the authors evaluating (1) internal rotation in 90° of hip and knee flexion and (2) hip pain during the anterior impingement test. RESULTS Cam morphologies were most apparent at the 1.5-year follow-up interval (10 of 25; baseline versus 1.5-year follow-up: p = 0.007) and a few more occurred between 1.5 and 3 years (12 of 23; 1.5-year versus 3-year follow-up: p = 0.14). At 3-year follow-up, there was a positive correlation between increased epiphyseal extension and a high alpha angle at the anterosuperior quadrant (1 o'clock to 3 o'clock) (Spearman correlation coefficient = 0.341; p < 0.003). The prevalence of pain on the impingement test and/or restricted internal rotation less than 20° increased most between 1.5-year (1 of 25) and the 3-year follow-up (6 of 22; 1.5-year versus 3-year follow-up: p = 0.02). CONCLUSION Our data suggest that a cam morphology develops early during the final growth spurt of the femoral head in adolescent ice hockey players predominantly between 13 to 16 years of age. A correlation between an increased extension of the growth plate and an increased alpha angle at the site of the cam morphology suggests a potential underlying growth disturbance. This should be further followed by high-resolution or biochemical MRI methods. Considering the high number of cam morphologies that correlated with abnormal clinical findings, we propose that adolescents performing high-impact sports should be screened for signs of cam impingement, such as by asking about hip pain and/or examining the patient for limited internal hip rotation. LEVEL OF EVIDENCE Level I, prognostic study.
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Affiliation(s)
- Markus S. Hanke
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Florian Schmaranzer
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Simon D. Steppacher
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stephan Reichenbach
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stefan F. Werlen
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Klaus A. Siebenrock
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
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18
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Abstract
OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.
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19
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Hanzlik S, Riff AJ, Wuerz TH, Abdulian M, Gurin D, Nho SJ, Salata MJ. The Prevalence of Cam Morphology: A Cross-Sectional Evaluation of 3,558 Cadaveric Femora. Front Surg 2021; 7:588535. [PMID: 33553238 PMCID: PMC7859647 DOI: 10.3389/fsurg.2020.588535] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: We sought to determine (1) the prevalence of cam deformity in the population and that of bilateral cam deformity, (2) the typical location of a cam lesion, and (3) the typical size of a cam lesion by direct visualization in cadaveric femora. Methods: Two observers inspected 3,558 human cadaveric femora from the Hamann-Todd Osteological Collection from the Cleveland Museum of Natural History. Any asphericity >2 mm from the anterior femoral neck line was classified as a cam lesion. Once lesions had been inspected, the prevalence in the population, prevalence by gender, and prevalence of bilateral deformity were determined. Additionally, each lesion was measured and localized to a specific quadrant on the femoral neck based upon location of maximal deformity. Results: Cam lesions were noted in 33% of males and 20% of females. Eighty percent of patients with a cam lesion had bilateral lesions. When stratified by location of maximal deformity, 90.9% of lesions were in the anterosuperior quadrant and 9.1% were in the anteroinferior quadrants. The average lesion measured 17 mm long × 24 mm wide × 6 mm thick in men and 14 mm × 22 mm × 4 mm in women (p < 0.05). Conclusions: The population prevalence of cam deformity determined by direct visualization in cadavers may be higher than has been suggested in studies utilizing imaging modalities. Level of Evidence : Level II, diagnostic study.
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Affiliation(s)
- Shane Hanzlik
- Department of Orthopaedics, UH Case Medical Center, Cleveland, OH, United States
| | - Andrew J Riff
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, IL, United States
| | - Thomas H Wuerz
- Sports and Orthopaedic Specialists, Edina, MN, United States
| | | | - Danielle Gurin
- Cleveland Clinic South Pointe, Warrensville Heights, OH, United States
| | - Shane J Nho
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, IL, United States
| | - Michael J Salata
- Department of Orthopaedics, UH Case Medical Center, Cleveland, OH, United States
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20
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Castro MO, Mascarenhas VV, Afonso PD, Rego P, Schmaranzer F, Sutter R, Kassarjian A, Sconfienza L, Dienst M, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 3: imaging techniques. Eur Radiol 2021; 31:4652-4668. [PMID: 33411053 DOI: 10.1007/s00330-020-07501-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided. METHODS The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements. CONCLUSION The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications. KEY POINTS • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
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Affiliation(s)
- Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Sítio do Poço Seco, Portimão, 8500-338, Portugal.
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Luca Sconfienza
- RCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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21
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Mascarenhas VV, Castro MO, Afonso PD, Rego P, Dienst M, Sutter R, Schmaranzer F, Sconfienza L, Kassarjian A, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting. Eur Radiol 2021; 31:4634-4651. [PMID: 33411052 DOI: 10.1007/s00330-020-07432-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building. METHODS The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0-10). This is the second part of a three-part consensus series and focuses on 'General issues' and 'Parameters and reporting'. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to 'General issues' (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and 'Parameters and reporting' (16 addressing femoral/acetabular parameters) were produced. CONCLUSIONS The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the 'gold standard' imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning. KEY POINTS • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the 'gold standard' modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg's angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head-neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | | | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Luca Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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22
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Zeng G, Schmaranzer F, Degonda C, Gerber N, Gerber K, Tannast M, Burger J, Siebenrock KA, Zheng G, Lerch TD. MRI-based 3D models of the hip joint enables radiation-free computer-assisted planning of periacetabular osteotomy for treatment of hip dysplasia using deep learning for automatic segmentation. Eur J Radiol Open 2020; 8:100303. [PMID: 33364259 PMCID: PMC7753932 DOI: 10.1016/j.ejro.2020.100303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/02/2022] Open
Abstract
Introduction Both Hip Dysplasia(DDH) and Femoro-acetabular-Impingement(FAI) are complex three-dimensional hip pathologies causing hip pain and osteoarthritis in young patients. 3D-MRI-based models were used for radiation-free computer-assisted surgical planning. Automatic segmentation of MRI-based 3D-models are preferred because manual segmentation is time-consuming.To investigate(1) the difference and(2) the correlation for femoral head coverage(FHC) between automatic MR-based and manual CT-based 3D-models and (3) feasibility of preoperative planning in symptomatic patients with hip diseases. Methods We performed an IRB-approved comparative, retrospective study of 31 hips(26 symptomatic patients with hip dysplasia or FAI). 3D MRI sequences and CT scans of the hip were acquired. Preoperative MRI included axial-oblique T1 VIBE sequence(0.8 mm3 isovoxel) of the hip joint. Manual segmentation of MRI and CT scans were performed. Automatic segmentation of MRI-based 3D-models was performed using deep learning. Results (1)The difference between automatic and manual segmentation of MRI-based 3D hip joint models was below 1 mm(proximal femur 0.2 ± 0.1 mm and acetabulum 0.3 ± 0.5 mm). Dice coefficients of the proximal femur and the acetabulum were 98 % and 97 %, respectively. (2)The correlation for total FHC was excellent and significant(r = 0.975, p < 0.001) between automatic MRI-based and manual CT-based 3D-models. Correlation for total FHC (r = 0.979, p < 0.001) between automatic and manual MR-based 3D models was excellent.(3)Preoperative planning and simulation of periacetabular osteotomy was feasible in all patients(100 %) with hip dysplasia or acetabular retroversion. Conclusions Automatic segmentation of MRI-based 3D-models using deep learning is as accurate as CT-based 3D-models for patients with hip diseases of childbearing age. This allows radiation-free and patient-specific preoperative simulation and surgical planning of periacetabular osteotomy for patients with DDH.
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Affiliation(s)
- Guodong Zeng
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Celia Degonda
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Kate Gerber
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital, University of Fribourg, Switzerland
| | - Jürgen Burger
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Till D Lerch
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
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23
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Abstract
Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described:
(1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’).
Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results.
Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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24
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Balci S, Karanfil Y, Oguz B, Aydingoz U. Validity of US measurements of cam-type femoroacetabular impingement parameters: a preliminary study in an asymptomatic adult population. Jpn J Radiol 2020; 38:1082-1089. [DOI: 10.1007/s11604-020-01005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
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25
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Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 2020; 30:5281-5297. [PMID: 32405754 DOI: 10.1007/s00330-020-06822-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS • FAI imaging literature is extensive although often of low level of evidence. • Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. • MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Paulo A Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK.,NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Apostolos H Karantanas
- Medical School, University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Filip M Vanhoenacker
- Department of Radiology, Ghent University Hospital, Gent, Belgium.,Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
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Lee HS, Lee YH, Jung I, Song OK, Kim S, Song HT, Suh JS. Optimization of MRI Protocol for the Musculoskeletal System. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:21-40. [PMID: 36238123 PMCID: PMC9432082 DOI: 10.3348/jksr.2020.81.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/05/2022]
Abstract
자기공명영상(magnetic resonance imaging; 이하 MRI)은 다른 영상 기법에 비해 연부 조직 대조도와 해상력이 높아 근골격계 영역에서 중요한 진단 기기로 이용되고 있다. 최근 MRI 관련 기술이 발달함에 따라 빠른 영상 촬영 및 다양한 영상면 재구성이 가능해짐으로써 입체적인 근골격계 해부학적 구조와 병변을 더욱 잘 평가할 수 있게 되었다. 또한, MRI는 최적화 정도에 따라 영상의 질, 진단 정확도 및 촬영 시간 등이 달라지며, MRI 장치의 효율적 인 운용과도 관련이 있어, 이를 관리하는 것은 영상의학과 의사의 중요한 역할이다. 본 종설에서는 6개 주요 관절에 따른 환자 자세, radiofrequency 코일 선택, 권장 펄스열, 영상면 구성 및 스캔 파라미터에 대한 지침을 제시함으로써 근골격계 MRI의 최적화에 도움이 되고자 한다.
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Affiliation(s)
- Hong Seon Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Inha Jung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Ok Kyu Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
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Murphy MM, Atkins PR, Kobayashi EF, Anderson AE, Maak TG, Nechyporenko AV, Aoki SK. Assessment of Acetabular Morphology Using the Acetabular Anterior Center-Edge Angle on Modified False-Profile Radiographs. Arthroscopy 2019; 35:3060-3066. [PMID: 31699257 DOI: 10.1016/j.arthro.2019.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiographic parameters of acetabular morphology between standard and modified false-profile (FP) radiographs. METHODS Standard and modified FP radiographs were obtained in 225 hips in 200 consecutive patients evaluated for hip pain and suspected femoroacetabular impingement. Radiographs were retrospectively reviewed by 2 readers to determine the anterior center-edge angle (ACEA), as assessed to the sourcil and to the bone edge. Inter-rater reliability of radiographic measurements was assessed using the intraclass correlation coefficient. Measurements were evaluated for normality with the Shapiro-Wilk test, averaged between the 2 readers, and compared between views using the paired Wilcoxon test. RESULTS The intraclass correlation coefficient values for standard and modified FP views were 0.923 and 0.932, respectively, measuring to the sourcil and 0.867 and 0.896, respectively, measuring to the lateral bone edge. The median difference in ACEA measurements to the sourcil was 1° between the standard and modified FP view (45° vs 44°, P < .001). The median difference in ACEA measurements to the bone edge was 2° (34° vs 32°, P < .001). CONCLUSIONS Thirty-five degrees of femoral internal rotation for a modified FP hip radiographic view provides similar clinical information regarding acetabular morphology to that of the standard FP view. Given that the modified FP view also provides better visualization of the anterosuperior head-neck junction cam lesion, the modified FP view may be preferred over the standard FP view in evaluation of hip pain in the young patient. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Michael M Murphy
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Physical Therapy, University of Utah, Salt Lake City, Utah, U.S.A.; Scientific Computing and Imaging Institute, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Anatoliy V Nechyporenko
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
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Isolated focal cartilage and labral defects in patients with femoroacetabular impingement syndrome may represent new, unique injury patterns. Knee Surg Sports Traumatol Arthrosc 2019; 27:3057-3065. [PMID: 29441427 DOI: 10.1007/s00167-018-4861-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/06/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Develop a framework to quantify the size, location and severity of femoral and acetabular-sided cartilage and labral damage observed in patients undergoing hip arthroscopy, and generate a database of individual defect parameters to facilitate future research and treatment efforts. METHODS The size, location, and severity of cartilage and labral damage were prospectively collected using a custom, standardized post-operative template for 100 consecutive patients with femoroacetabular impingement syndrome. Chondrolabral junction damage, isolated intrasubstance labral damage, isolated acetabular cartilage damage and femoral cartilage damage were quantified and recorded using a combination of Beck and ICRS criteria. Radiographic measurements including alpha angle, head-neck offset, lateral centre edge angle and acetabular index were calculated and compared to the aforementioned chondral data using a multivariable logistic regression model and adjusted odd's ratio. Reliability among measurements were assessed using the kappa statistic and intraclass coefficients were used to evaluate continuous variables. RESULTS Damage to the acetabular cartilage originating at the chondrolabral junction was the most common finding in 97 hips (97%) and was usually accompanied by labral damage in 65 hips (65%). The width (p = 0.003) and clock-face length (p = 0.016) of the damaged region both increased alpha angle on anteroposterior films. 10% of hips had femoral cartilage damage while only 2 (2%) of hips had isolated defects to either the acetabular cartilage or labrum. The adjusted odds of severe cartilage (p = 0.022) and labral damage (p = 0.046) increased with radiographic cam deformity but was not related to radiographic measures of acetabular coverage. CONCLUSIONS Damage at the chondrolabral junction was very common in this hip arthroscopy cohort, while isolated defects to the acetabular cartilage or labrum were rare. These data demonstrate that the severity of cam morphology, quantified through radiographic measurements, is a primary predictor of location and severity of chondral and labral damage and focal chondral defects may represent a unique subset of patients that deserve further study. LEVEL OF EVIDENCE IV.
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Lerch TD, Degonda C, Schmaranzer F, Todorski I, Cullmann-Bastian J, Zheng G, Siebenrock KA, Tannast M. Patient-Specific 3-D Magnetic Resonance Imaging-Based Dynamic Simulation of Hip Impingement and Range of Motion Can Replace 3-D Computed Tomography-Based Simulation for Patients With Femoroacetabular Impingement: Implications for Planning Open Hip Preservation Surgery and Hip Arthroscopy. Am J Sports Med 2019; 47:2966-2977. [PMID: 31486679 DOI: 10.1177/0363546519869681] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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 a complex 3-dimensional (3D) hip abnormality that can cause hip pain and osteoarthritis in young and active patients of childbearing age. Imaging is static and based on 2-dimensional radiographs or computed tomography (CT) scans. Recently, CT-based 3D impingement simulation was introduced for patient-specific assessments of hip deformities, whereas magnetic resonance imaging (MRI) offers a radiation-free alternative for surgical planning before hip arthroscopic surgery. PURPOSE To (1) investigate the difference between 3D models of the hip, (2) correlate the location of hip impingement and range of motion (ROM), and (3) correlate diagnostic parameters while comparing CT- and MRI-based osseous 3D models of the hip in symptomatic patients with FAI. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS The authors performed an institutional review board-approved comparative and retrospective study of 31 hips in 26 symptomatic patients with FAI. We compared CT- and MRI-based osseous 3D models of the hip in the same patients. 3D CT scans (slice thickness, 1 mm) of the entire pelvis and the distal femoral condyles were obtained. Preoperative MRI of the hip was performed including an axial-oblique T1 VIBE sequence (slice thickness, 1 mm) and 2 axial anisotropic (1.2 × 1.2 × 1 mm) T1 VIBE Dixon sequences of the entire pelvis and the distal femoral condyles. Threshold-based semiautomatic reconstruction of 3D models was performed using commercial software. CT- and MRI-based 3D models were compared with specifically developed software. RESULTS (1) The difference between MRI- and CT-based 3D models was less than 1 mm for the proximal femur and the acetabulum (median surface distance, 0.4 ± 0.1 mm and 0.4 ± 0.2 mm, respectively). (2) The correlation for ROM values was excellent (r = 0.99, P < .001) between CT and MRI. The mean absolute difference for flexion and extension was 1.9°± 1.5° and 2.6°± 1.9°, respectively. The location of impingement did not differ between CT- and MRI-based 3D ROM analysis in all 12 of 12 acetabular and 11 of 12 femoral clock-face positions. (3) The correlation for 6 diagnostic parameters was excellent (r = 0.98, P < .001) between CT and MRI. The mean absolute difference for inclination and anteversion was 2.0°± 1.8° and 1.0°± 0.8°, respectively. CONCLUSION Patient-specific and radiation-free MRI-based dynamic 3D simulation of hip impingement and ROM can replace CT-based 3D simulation for patients with FAI of childbearing age. On the basis of these excellent results, we intend to change our clinical practice, and we will use MRI-based 3D models for future clinical practice instead of CT-based 3D models. This allows radiation-free and patient-specific preoperative 3D impingement simulation for surgical planning and simulation of open hip preservation surgery and hip arthroscopic surgery.
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Affiliation(s)
- Till D Lerch
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Celia Degonda
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Inga Todorski
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | | | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Knapik DM, Gaudiani MA, Camilleri BE, Nho SJ, Voos JE, Salata MJ. Reported Prevalence of Radiographic Cam Deformity Based on Sport: A Systematic Review of the Current Literature. Orthop J Sports Med 2019; 7:2325967119830873. [PMID: 30915376 PMCID: PMC6429661 DOI: 10.1177/2325967119830873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Repetitive loading and shear stress across the proximal femur account for the high prevalence of cam deformity in athletes. Purpose To systematically review the literature to identify the reported number, age, mean alpha angle measurements, and differences between male and female athletes with radiographic cam deformity based on sport. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was conducted of studies in the literature between January 1990 and March 2018 that reported on athletes with radiographic cam deformity based on sport. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases were used. Inclusion criteria included studies documenting radiographic cam deformity based on alpha angle measurements categorized according to the athlete's primary sport and according to sex. Exclusion criteria were (1) studies not documenting primary sport, (2) studies not reporting total number of athletes with radiographic cam deformity, and (3) studies not separating cam deformity based on sex or using alpha angle measurements. Statistical analysis was used to compare mean reported age and alpha angle measurements between males and females. Results A total of 28 studies consisting of 1160 male and 53 female athletes with radiographic cam deformity were identified. Cam lesions were most commonly reported in soccer athletes among both males and females, followed by hockey and American football. Male athletes had significantly higher mean alpha angle measurements (59.9° ± 5.5°) compared with female athletes (48.3° ± 6.9°) (P = .001). No significant difference in age was appreciated between males (21.1 ± 4.0 years) and females (21.7 ± 3.0 years) (P = .62). Conclusion Radiographic cam deformity is most commonly reported in athletes participating in soccer and hockey. Males possessed significantly greater mean alpha angle measurements compared with females, whereas no significant difference in mean age at the time of diagnosis was appreciated between sexes.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Michael A Gaudiani
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | | | - Shane J Nho
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
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Which Two-dimensional Radiographic Measurements of Cam Femoroacetabular Impingement Best Describe the Three-dimensional Shape of the Proximal Femur? Clin Orthop Relat Res 2019; 477:242-253. [PMID: 30179924 PMCID: PMC6345307 DOI: 10.1097/corr.0000000000000462] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many two-dimensional (2-D) radiographic views are used to help diagnose cam femoroacetabular impingement (FAI), but there is little consensus as to which view or combination of views is most effective at visualizing the magnitude and extent of the cam lesion (ie, severity). Previous studies have used a single image from a sequence of CT or MR images to serve as a reference standard with which to evaluate the ability of 2-D radiographic views and associated measurements to describe the severity of the cam lesion. However, single images from CT or MRI data may fail to capture the apex of the cam lesion. Thus, it may be more appropriate to use measurements of three-dimensional (3-D) surface reconstructions from CT or MRI data to serve as an anatomic reference standard when evaluating radiographic views and associated measurements used in the diagnosis of cam FAI. QUESTIONS/PURPOSES The purpose of this study was to use digitally reconstructed radiographs and 3-D statistical shape modeling to (1) determine the correlation between 2-D radiographic measurements of cam FAI and 3-D metrics of proximal femoral shape; and 2) identify the combination of radiographic measurements from plain film projections that were most effective at predicting the 3-D shape of the proximal femur. METHODS This study leveraged previously acquired CT images of the femur from a convenience sample of 37 patients (34 males; mean age, 27 years, range, 16-47 years; mean body mass index [BMI], 24.6 kg/m, range, 19.0-30.2 kg/m) diagnosed with cam FAI imaged between February 2005 and January 2016. Patients were diagnosed with cam FAI based on a culmination of clinical examinations, history of hip pain, and imaging findings. The control group consisted of 59 morphologically normal control participants (36 males; mean age, 29 years, range, 15-55 years; mean BMI, 24.4 kg/m, range, 16.3-38.6 kg/m) imaged between April 2008 and September 2014. Of these controls, 30 were cadaveric femurs and 29 were living participants. All controls were screened for evidence of femoral deformities using radiographs. In addition, living control participants had no history of hip pain or previous surgery to the hip or lower limbs. CT images were acquired for each participant and the surface of the proximal femur was segmented and reconstructed. Surfaces were input to our statistical shape modeling pipeline, which objectively calculated 3-D shape scores that described the overall shape of the entire proximal femur and of the region of the femur where the cam lesion is typically located. Digital reconstructions for eight plain film views (AP, Meyer lateral, 45° Dunn, modified 45° Dunn, frog-leg lateral, Espié frog-leg, 90° Dunn, and cross-table lateral) were generated from CT data. For each view, measurements of the α angle and head-neck offset were obtained by two researchers (intraobserver correlation coefficients of 0.80-0.94 for the α angle and 0.42-0.80 for the head-neck offset measurements). The relationships between radiographic measurements from each view and the 3-D shape scores (for the entire proximal femur and for the region specific to the cam lesion) were assessed with linear correlation. Additionally, partial least squares regression was used to determine which combination of views and measurements was the most effective at predicting 3-D shape scores. RESULTS Three-dimensional shape scores were most strongly correlated with α angle on the cross-table view when considering the entire proximal femur (r = -0.568; p < 0.001) and on the Meyer lateral view when considering the region of the cam lesion (r = -0.669; p < 0.001). Partial least squares regression demonstrated that measurements from the Meyer lateral and 90° Dunn radiographs produced the optimized regression model for predicting shape scores for the proximal femur (R = 0.405, root mean squared error of prediction [RMSEP] = 1.549) and the region of the cam lesion (R = 0.525, RMSEP = 1.150). Interestingly, views with larger differences in the α angle and head-neck offset between control and cam FAI groups did not have the strongest correlations with 3-D shape. CONCLUSIONS Considered together, radiographic measurements from the Meyer lateral and 90° Dunn views provided the most effective predictions of 3-D shape of the proximal femur and the region of the cam lesion as determined using shape modeling metrics. CLINICAL RELEVANCE Our results suggest that clinicians should consider using the Meyer lateral and 90° Dunn views to evaluate patients in whom cam FAI is suspected. However, the α angle and head-neck offset measurements from these and other plain film views could describe no more than half of the overall variation in the shape of the proximal femur and cam lesion. Thus, caution should be exercised when evaluating femoral head anatomy using the α angle and head-neck offset measurements from plain film radiographs. Given these findings, we believe there is merit in pursuing research that aims to develop the framework necessary to integrate statistical shape modeling into clinical evaluation, because this could aid in the diagnosis of cam FAI.
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Hip arthroscopy-MRI correlation and differences for hip anatomy and pathology: What radiologists need to know. Clin Imaging 2018; 52:315-327. [DOI: 10.1016/j.clinimag.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/18/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022]
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Ross JR, Khan M, Noonan BC, Larson CM, Kelly BT, Bedi A. Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen. HSS J 2018; 14:128-133. [PMID: 29983653 PMCID: PMC6031539 DOI: 10.1007/s11420-018-9605-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) morphology can lead to range-of-motion deficits in football players. It is therefore important for physicians treating these players to be aware of the location and implications of FAI morphology. PURPOSE/QUESTIONS We sought to characterize the radiographic deformity and dynamic impingement observed in a consecutive series of American football linemen with symptomatic, mechanical hip pain who underwent surgical treatment for FAI and to use software analysis to identify the location of impingement and terminal range of motion and the effects of simulated correction. METHODS A retrospective analysis was conducted of 17 hips in 13 football linemen who underwent arthroscopic correction for symptomatic FAI. Computed tomography (CT) scans were used to generate preoperative three-dimensional models of the hips. Femoral and acetabular measurements, maximum hip flexion, abduction, internal rotation at 90° flexion (IR90), and flexion/adduction/internal rotation (FADIR) were determined, and areas of bony collision were defined. Simulated femoral correction was performed and motion analysis was repeated. RESULTS Mean femoral version was 13.1° (range, 0 to 26°), while mean femoral neck-shaft angle was 132.1° (range, 123 to 145°). Mean maximum alpha angle on the radial reformatted CT was 69.2° (range, 48 to 95°) and was located at the 12:45 clock-face position (range, 11:30 to 2:15). Mean acetabular version values at 1:30 and 3:00 were 1.1° (range, - 11 to 11°) and 12.7° (range, 2 to 20°), respectively. Fifty-three percent of hips showed a "crossover" sign. Mean lateral center-edge angle was 31.7° (range, 25 to 44°). CT-derived motion analysis demonstrated a mean preoperative flexion of 108.2° (range, 73 to 127°), IR90 of 20.5° (range, 0 to 52°), and FADIR of 12.3° (range, 0 to 39°). Simulated correction resulted in significant improvements in flexion (6.6°), IR90 (11.3°), and FADIR (10.6°). CONCLUSIONS While cephalad retroversion was observed in approximately half of the hips, a significant cam deformity was seen maximally at 12:45, a more posterior cam location than that of the general population. Managing this pathology required obtaining preoperative and intraoperative images to characterize lesions and allow for their complete correction. With complete correction of the deformity, simulated range of motion demonstrated significant improvement in flexion, IR90, and FADIR maneuvers.
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Affiliation(s)
- James R. Ross
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | - Moin Khan
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | | | - Christopher M. Larson
- grid.477554.0Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, MN USA
| | - Bryan T. Kelly
- 0000 0001 2285 8823grid.239915.5Sports Medicine Service, Hospital for Special Surgery, New York, NY USA
| | - Asheesh Bedi
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA ,0000 0001 2285 8823grid.239915.5Sports Medicine Service, Hospital for Special Surgery, New York, NY USA
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Abstract
PURPOSE To determine if a significant difference existed among alpha angle measurements between 4 imaging techniques, axial oblique CT and MRI, Dunn 45° and Dunn 90° plain radiographs, in patients with symptomatic cam femoroacetabular impingement (FAI) and labral tear. METHODS A single-surgeon prospective radiographic analysis of consecutive non-arthritic and non-dysplastic -patients with symptomatic FAI and labral tears who underwent surgery was performed. Alpha angle was measured using standard techniques as described by Nötzli. Cam morphology was defined via alpha angle measurement of >50.5 degrees. Group comparisons were made using ANOVA and chi-squared test. Sample size calculation was performed prior to study enrollment. RESULTS 31 subjects (16 female; 33.5 ± 10.5 years mean age) were included. There was a significant difference in alpha angle measurements between all 4 imaging techniques (F [3,120] = 8.144; p<0.001), with the Dunn 45° view (66.3 ± 11.4°) significantly greater than all 3 other techniques (Dunn 90° [57.5 ± 10.7°; p = 0.015], MRI [53.3 ± 11.5°; p<0.001], and CT (54.9 ± 11.6°; p = 0.001). There was no significant difference in alpha angle between Dunn 90°, MRI, and CT. There was a significant difference in the observed number of hips with cam morphology between imaging techniques (χ2 9.4; p = 0.025). CONCLUSIONS The Dunn 45° radiograph yielded a significantly higher alpha angle than Dunn 90°, axial oblique MRI, and CT imaging modalities. Use of the Dunn 90° or axial oblique MRI or CT as the threshold for cam osteoplasty may result in untreated symptomatic cam FAI. The authors recommend the Dunn 45° radiograph as the most sensitive evaluation of cam morphology.
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Gollwitzer H, Suren C, Strüwind C, Gottschling H, Schröder M, Gerdesmeyer L, Prodinger PM, Burgkart R. The natural alpha angle of the femoral head-neck junction. Bone Joint J 2018; 100-B:570-578. [DOI: 10.1302/0301-620x.100b5.bjj-2017-0249.r3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims Asphericity of the femoral head-neck junction is common in cam-type femoroacetabular impingement (FAI) and usually quantified using the alpha angle on radiographs or MRI. The aim of this study was to determine the natural alpha angle in a large cohort of patients by continuous circumferential analysis with CT. Methods CT scans of 1312 femurs of 656 patients were analyzed in this cross-sectional study. There were 362 men and 294 women. Their mean age was 61.2 years (18 to 93). All scans had been performed for reasons other than hip disease. Digital circumferential analysis allowed continuous determination of the alpha angle around the entire head-neck junction. All statistical tests were conducted two-sided; a p-value < 0.05 was considered statistically significant. Results The mean maximum alpha angle for the cohort was 59.0° (sd 9.4). The maximum was located anterosuperiorly at 01:36 on the clock face, with two additional maxima of asphericity at the posterior and inferior head-neck junction. The mean alpha angle was significantly larger in men (59.4°, sd 8.0) compared with women (53.5°, sd 7.4°; p = 0.0005), and in Caucasians (60.7°, sd 9.0°) compared with Africans (56.3°, sd 8.0; p = 0.007) and Asians (50.8°, sd 7.2; p = 0.0005). The alpha angle showed a weak positive correlation with age (p < 0.05). If measured at commonly used planes of the radially reconstructed CT or MRI, the alpha angle was largely underestimated; measurement at the 01:30 and 02:00 positions showed a mean underestimation of 4° and 6°, respectively. Conclusion This study provides important data on the normal alpha angle dependent on age, gender, and ethnic origin. The normal alpha angle in men is > 55°, and this should be borne in mind when making a diagnosis of cam-type morphology. Cite this article: Bone Joint J 2018;100-B:570–8.
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Affiliation(s)
- H. Gollwitzer
- ECOM – Excellent Center of Medicine and
ATOS - Clinic, Munich, Germany
| | - C. Suren
- Clinic and Polyclinic for Orthopaedics
and Sports Orthopaedics, Rechts der Isar Hospital, The Technical
University of Munich
| | | | - H. Gottschling
- Clinic and Polyclinic for Orthopaedics
and Sports Orthopaedics, Rechts der Isar Hospital, The Technical
University of Munich
| | - M. Schröder
- Clinic and Polyclinic for Orthopaedics
and Sports Orthopaedics, Rechts der Isar Hospital, The Technical
University of Munich
| | - L. Gerdesmeyer
- Department of Orthopaedics and Traumatology,
Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - P. M. Prodinger
- Clinic and Polyclinic for Orthopaedics
and Sports Orthopaedics, Rechts der Isar Hospital, The Technical
University of Munich
| | - R. Burgkart
- Clinic and Polyclinic for Orthopaedics
and Sports Orthopaedics, Rechts der Isar Hospital, The Technical
University of Munich
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Hip malformation is a very common finding in young patients scheduled for total hip arthroplasty. Arch Orthop Trauma Surg 2018; 138:581-589. [PMID: 29429067 DOI: 10.1007/s00402-018-2900-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In Denmark, 20% of all registered total hip arthroplasties (THA) from 1995 to 2014 has been patients younger than 60 years with primary idiopathic osteoarthritis (OA). It is speculated that hip malformations may be a major contributor to early OA development. It has been shown that hip malformation may compromise implant position and, therefore, identifying and knowing the incidence of malformations is important. Our aim was to assess the prevalence and type of hip malformations in a cohort of younger patients undergoing THA. MATERIALS AND METHODS In this prospective two center cohort study, 95 consecutive patients (106 hips) met the inclusion criteria. One observer performed radiographic measurements for malformations and radiographic OA. Inter- and intraobserver variability was assessed. RESULTS From 95 patients (male n = 52 and female n = 43) age ranged from 35 to 59 years and prevalences of hip malformations were; CAM-deformity 50.9 and 25.5%, coxa profunda 33 and 27.4%, acetabular retroversion 33 and 29.2%, and acetabular dysplasia 10.4 and 3.8%. All patients showed minimum of one malformation. Prevalences of Tönnis grade 0-1 were 22.6% and 2-3 were 77.4%. CONCLUSION All patients showed malformations, especially high prevalences were found for CAM-deformity, coxa profunda and acetabular retroversion. Identifying these malformations is fairly simple and recognizing the high prevalence may help surgeons avoid pitfalls during implant positioning in THA surgery. Further, focus on hip malformations may facilitate correct referral to joint-preserving surgery before OA develops.
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The Prevalence of Cam and Pincer Morphology and Its Association With Development of Hip Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:230-238. [PMID: 29548271 DOI: 10.2519/jospt.2018.7816] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Our understanding of femoroacetabular impingement syndrome is slowly improving. The number of studies on all aspects (etiology, prevalence, pathophysiology, natural history, treatment, and preventive measures) of femoroacetabular impingement syndrome has grown exponentially over the past few years. This commentary provides the latest updates on the prevalence of cam and pincer hip morphology and its relationship with development of hip osteoarthritis (OA). Cam and pincer morphology is highly prevalent in the general population and in this paper is presented for different subgroups based on age, sex, ethnicity, and athletic activity. Methodological issues in determining prevalence of abnormal hip morphology are also discussed. Cam morphology has been associated with development of hip OA, but the association between pincer morphology and hip OA is much less clear. Results from reviewed studies, as well as remaining gaps in literature on this topic, are critically discussed and put into perspective for the clinician. J Orthop Sports Phys Ther 2018;48(4):230-238. doi:10.2519/jospt.2018.7816.
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Modified False-Profile Radiograph of the Hip Provides Better Visualization of the Anterosuperior Femoral Head-Neck Junction. Arthroscopy 2018; 34:1236-1243. [PMID: 29289395 DOI: 10.1016/j.arthro.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantify the amount of internal femur rotation required to visualize the 12 to 3 o'clock positions of the femoral head-neck junction as seen on the false-profile radiograph. METHODS Computed tomography (CT) images of the femur were retrospectively reviewed from control subjects and cam femoroacetabular impingement (FAI) patients. Using an automatically determined clockface, the positions between 12 and 3 o'clock were determined. The optimal femoral rotation angle to visualize each clockface position on the femoral head-neck junction was calculated based on the CT surface data. RESULTS Fifty-nine control subjects and 38 cam FAI patients were evaluated for this study. The mean (95% confidence interval) internal femur rotation needed to optimally visualize the clockface positions of the femoral head-neck junction on the modified false-profile radiograph were 0.9° (0.8°-1.0°) for 3:00, 10.3° (10.0°-10.6°) for 2:30, 21.6° (21.0°-22.1°) for 2:00, 34.3° (33.6°-35.1°) for 1:30, 49.6° (48.6°-50.4°) for 1:00, 68.4° (67.7°-69.0°) for 12:30, and 90.1° (89.9°-90.4°) for 12:00. CONCLUSIONS Internal femur rotation of 35° during the false-profile radiograph may better visualize the femoral head-neck junction in the anterosuperior (1 to 2 o'clock) region commonly associated with the cam lesion. From this view, rotation angles between 0° and 90° can be used to visualize other regions of the anterosuperior femoral head-neck junction. CLINICAL RELEVANCE The internal rotation of the affected femur for a modified false-profile radiograph may provide a new radiographic view that can be used to quantify anterosuperior femoral head-neck morphology.
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Han J, Won SH, Kim JT, Hahn MH, Won YY. Prevalence of Cam Deformity with Associated Femoroacetabular Impingement Syndrome in Hip Joint Computed Tomography of Asymptomatic Adults. Hip Pelvis 2018; 30:5-11. [PMID: 29564291 PMCID: PMC5861026 DOI: 10.5371/hp.2018.30.1.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Femoroacetabular impingement (FAI) is considered an important cause of early degenerative arthritis development. Although three-dimensional (3D) imaging such as computed tomography (CT) and magnetic resonance imaging are considered precise imaging modalities for 3D morphology of FAI, they are associated with several limitations when used in out-patient clinics. The paucity of FAI morphologic data in Koreans makes it difficult to select the most effective radiographical method when screening for general orthopedic problems. We postulate that there might be an individual variation in the distribution of cam deformity in the asymptomatic Korean population. Materials and Methods From January 2011 to December 2015, CT images of the hips of 100 subjects without any history of hip joint ailments were evaluated. A computer program which generates 3D models from CT scans was used to provide sectional images which cross the central axis of the femoral head and neck. Alpha angles were measured in each sectional images. Alpha angles above 55° were regarded as cam deformity. Results The mean alpha angle was 43.5°, range 34.7–56.1°(3 o'clock); 51.24°, range 39.5–58.8°(2 o'clock); 52.45°, range 43.3–65.5°(1 o'clock); 44.09°, range 36.8–49.8°(12 o'clock); 40.71, range 33.5–45.8°(11 o'clock); and 39.21°, range 34.1–44.6°(10 o'clock). Alpha angle in 1 and 2 o'clock was significantly larger than other locations (P<0.01). The prevalence of cam deformity was 18.0% and 19.0% in 1 and 2 o'clock, respectively. Conclusion Cam deformity of FAI was observed in 31% of asymptomatic hips. The most common region of cam deformity was antero-superior area of femoral head-neck junction (1 and 2 o'clock).
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Affiliation(s)
- Jun Han
- Department of Orthopaedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Seok-Hyung Won
- Department of Orthopaedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Myung-Hoon Hahn
- Department of Orthopaedic, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Cheonan, Korea
| | - Ye-Yeon Won
- Department of Orthopaedic Surgery, Ajou University College of Medicine, Suwon, Korea
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Hipfl C, Titz M, Chiari C, Schöpf V, Kainberger F, Windhager R, Domayer S. Detecting cam-type deformities on plain radiographs: what is the optimal lateral view? Arch Orthop Trauma Surg 2017; 137:1699-1705. [PMID: 28918517 DOI: 10.1007/s00402-017-2793-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Radial magnetic resonance imaging (MRI) is the most accurate diagnostic tool in assessing cam-type femoroacetabular impingement. Plain radiographs, however, are useful for the initial diagnosis in the daily practice and there is still debate regarding the optimal lateral view. The purpose of this study was to investigate the reliability of detecting cam deformities using the frog-leg view or the 45° Dunn view by comparison with radial MRI. MATERIAL 66 consecutive hips with plain radiographs (36 with AP and frog-leg views, 30 with AP and 45° Dunn views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and for radial MRI reformats by two investigators. Statistics included frequency analysis, bivariate linear correlation analyses, and cross-table analyses testing the sensitivity and specificity of the radiographic projections for detecting an alpha angle larger than 55°. RESULTS The intra-class correlation revealed excellent agreement between the two raters [ICC = 0.959, CI (0.943; 0.972)]. 50% (33/66) had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 40/66 cases (61%) in radial MRI. Pearson correlation demonstrated that the 45° Dunn view was most accurate for the superior-anterior aspect (0.730, p < 0.05). The frog-leg view was best suited for the anterior aspect (0.703, p < 0.05). The sensitivity for detecting cam deformities in the 45° Dunn view was 84 vs 62% in the frog-leg view. CONCLUSION The frog-leg lateral radiograph does not provide reliable measurements of the alpha angle. This study highlights the importance of the 45° Dunn view for early detection of femoroacetabular cam-type impingement.
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Affiliation(s)
- Christian Hipfl
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Markus Titz
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Catharina Chiari
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Veronika Schöpf
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Domayer
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Atkins PR, Elhabian SY, Agrawal P, Harris MD, Whitaker RT, Weiss JA, Peters CL, Anderson AE. Quantitative comparison of cortical bone thickness using correspondence-based shape modeling in patients with cam femoroacetabular impingement. J Orthop Res 2017; 35:1743-1753. [PMID: 27787917 PMCID: PMC5407942 DOI: 10.1002/jor.23468] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/23/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED The proximal femur is abnormally shaped in patients with cam-type femoroacetabular impingement (FAI). Impingement may elicit bone remodeling at the proximal femur, causing increases in cortical bone thickness. We used correspondence-based shape modeling to quantify and compare cortical thickness between cam patients and controls for the location of the cam lesion and the proximal femur. Computed tomography images were segmented for 45 controls and 28 cam-type FAI patients. The segmentations were input to a correspondence-based shape model to identify the region of the cam lesion. Median cortical thickness data over the region of the cam lesion and the proximal femur were compared between mixed-gender and gender-specific groups. Median [interquartile range] thickness was significantly greater in FAI patients than controls in the cam lesion (1.47 [0.64] vs. 1.13 [0.22] mm, respectively; p < 0.001) and proximal femur (1.28 [0.30] vs. 0.97 [0.22] mm, respectively; p < 0.001). Maximum thickness in the region of the cam lesion was more anterior and less lateral (p < 0.001) in FAI patients. Male FAI patients had increased thickness compared to male controls in the cam lesion (1.47 [0.72] vs. 1.10 [0.19] mm, respectively; p < 0.001) and proximal femur (1.25 [0.29] vs. 0.94 [0.17] mm, respectively; p < 0.001). Thickness was not significantly different between male and female controls. CLINICAL SIGNIFICANCE Studies of non-pathologic cadavers have provided guidelines regarding safe surgical resection depth for FAI patients. However, our results suggest impingement induces cortical thickening in cam patients, which may strengthen the proximal femur. Thus, these previously established guidelines may be too conservative. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1743-1753, 2017.
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Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Michael D. Harris
- Program of Physical Therapy, Washington University School of Medicine, Saint Louis, Missouri 63110
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Ross T. Whitaker
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Jeffrey A. Weiss
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah 84108
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Yépez AK, Abreu M, Germani B, Galia CR. Prevalence of femoroacetabular impingement morphology in asymptomatic youth soccer players: magnetic resonance imaging study with clinical correlation. Rev Bras Ortop 2017; 52:14-20. [PMID: 28971081 PMCID: PMC5620002 DOI: 10.1016/j.rboe.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/26/2017] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine the prevalence of femoroacetabular impingement morphology (FAIM), cam- or pincer-type, by magnetic resonance imaging (MRI) in asymptomatic adolescent soccer players, and to evaluate the possible correlation between alterations on MRI and clinical examination findings. METHODS A cross-sectional study was conducted to determine the prevalence of FAIM in asymptomatic youth soccer players aged 13-18 years. A total of 112 hips in 56 players (mean age 15.3 years) were evaluated by MRI. Images were examined by two musculoskeletal radiologists for signs of FAIM. Cam-type (impingement) deformity was diagnosed by alpha angle ≥55° or head-neck offset <7 mm. Pincer-type (impingement) deformity was diagnosed by center-edge angle (CEA) ≥35° or acetabular index ≤0°. Other MRI changes, characteristic of FAIM, were observed. Clinical examination was performed to determine the range of motion (ROM) of the hips. In addition, specific tests for anterolateral and posteroinferior impingement were performed. RESULTS The prevalence of MRI findings consistent with FAIM among this young population was 84.8% (95/112). The alpha angle was ≥55° in 77.7% (87/112) of hips, while the CEA was altered in 10.7% (12/112) of hips. Qualitative MRI findings consistent with FAIM were highly prevalent, and included loss of sphericity of the femoral head (77%), osseous bump (44%), femoral neck edema (21%), and acetabular osteitis (9%). The anterior impingement test was positive in 15% of the hips evaluated. CONCLUSION Youth soccer players have a high prevalence of FAIM as diagnosed by MRI. There is no correlation between physical examination findings and MRI evidence of FAIM in this population.
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Affiliation(s)
- Anthony Kerbes Yépez
- Santa Casa de Porto Alegre, Departamento de Cirurgia Ortopédica, Porto Alegre, RS, Brazil
| | - Marcelo Abreu
- Hospital Mãe de Deus, Departamento de Radiologia, Porto Alegre, RS, Brazil
| | - Bruno Germani
- Santa Casa de Porto Alegre, Departamento de Cirurgia Ortopédica, Porto Alegre, RS, Brazil
| | - Carlos Roberto Galia
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Cirurgia Ortopédica, Porto Alegre, RS, Brazil
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Tudisco C, Bisicchia S, Tormenta S, Taglieri A, Fanucci E. Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities. JOINTS 2017; 5:21-26. [PMID: 29114626 PMCID: PMC5672861 DOI: 10.1055/s-0037-1601411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose
The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI).
Methods
A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up.
Results
The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain.
Conclusion
In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities.
Level of Evidence
Level IV, retrospective case series.
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Affiliation(s)
- Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Bisicchia
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Sandro Tormenta
- Department of Radiology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Amedeo Taglieri
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
| | - Ezio Fanucci
- Department of Radiology, San Pietro Fatebenefratelli Hospital, Rome, Italy
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Abstract
BACKGROUND Periacetabular osteotomy (PAO) is a reliable procedure to correct the deficient acetabular coverage in hips with developmental dysplasia. It is unclear how the presence of additional femoral cam-type deformity might influence the clinical and radiographic treatment results of PAO. QUESTIONS/PURPOSES (1) Are there differences in clinical scores (WOMAC, EQ-5D) and examination findings (impingement sign) or radiographic measures of acetabular orientation and head sphericity after PAO for isolated acetabular dysplasia when compared with the combined pathology of dysplasia and additional femoral cam deformity? (2) Are these clinical and radiographic findings after combined surgical therapy for additional cam deformity influenced by different pathology-adjusted surgical techniques? METHODS From July 2005 to December 2010, 86 patients (106 hips) underwent PAO for hip dysplasia. Surgical and outcome data were prospectively collected and retrospectively reviewed in a comparative observational study. Indications for surgery were a lateral center-edge angle less than 25° and hip pain for at least 6 months. The contraindications for surgery were advanced radiographic osteoarthritis (Kellgren-Lawrence Grade 3), incongruency of joint space, and patient age > 50 years. Depending on preoperative hip ROM, impingement test, and presence of a radiographically visible cam deformity, treatment allocation was performed: Group I: isolated PAO in patients without symptomatic asphericity, Group IIa: PAO with subsequent osteochondroplasty through arthrotomy for patients with symptomatic cam deformity and no labrochondral pathology, and Group IIb: arthroscopically assisted osteochondroplasty and additional labrochondral repair with subsequent PAO when patients had labrochondral lesions in addition to a symptomatic cam deformity. Clinical outcome (impingement test, EQ-5D, WOMAC) as well as radiographic parameters (lateral center-edge angle, crossover sign, alpha angle, osteoarthritis grade) were obtained after a mean followup of 63 ± 18 months (range, 31-102 months) and compared with the baseline data. Eleven patients (13%) were lost to followup. With the numbers available, our study had 80% power to detect a difference between Groups I and II of 10 points on the WOMAC scores. RESULTS There was no difference in the increase of WOMAC scores in patients with PAO alone (Group I; preoperative score 74 ± 17 versus postoperative 91 ± 15, p = 0.033) when compared with PAO and concurrent osteochondroplasty (Groups II A and B preoperative 73 ± 19 versus postoperative 90 ± 13 p < 0.001). The mean postoperative alpha angles in Group II (38° ± 6°) improved when compared with preoperative values (56° ± 15°; p < 0.001) and were even lower than native offset alpha angles in Group I (47° ± 11°). Clinical scores as well as postoperative radiographic parameters were not different between patients with conventional osteochondroplasty alone (Group IIA) and patients with arthroscopically assisted cam resection and intraarticular labrochondral repair (Group IIB). CONCLUSIONS With the numbers available, we detected no differences in outcome scores and radiographic results between patients who had been treated with PAO alone and patients who underwent combined PAO and offset correction for cam deformity. Although arthroscopically assisted treatment of advanced labrochondral lesions together with osteochondroplasty is possible during PAO and the results were not different in this small study when compared with patients with PAO and osteochondroplasty alone, the type and extent of damage that would indicate additional cartilage surgery over cam resection alone remain unclear. LEVEL OF EVIDENCE Level III, therapeutic study.
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Postoperative imaging in arthroscopic hip surgery. Musculoskelet Surg 2017; 101:43-49. [PMID: 28210944 DOI: 10.1007/s12306-017-0459-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/27/2022]
Abstract
Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.
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Henn LL, Hughes J, Iisakka E, Ellermann J, Mortazavi S, Ziegler C, Nissi MJ, Morgan P. Disease severity classification using quantitative magnetic resonance imaging data of cartilage in femoroacetabular impingement. Stat Med 2017; 36:1491-1505. [DOI: 10.1002/sim.7213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Lisa L. Henn
- Arbor Research Collaborative for Health; Ann Arbor MI USA
| | - John Hughes
- Department of Biostatistics and Informatics; University of Colorado; Denver Denver CO USA
| | | | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology; University of Minnesota; Minneapolis MN USA
| | - Shabnam Mortazavi
- Center for Magnetic Resonance Research, Department of Radiology; University of Minnesota; Minneapolis MN USA
| | - Connor Ziegler
- Department of Orthopedic Surgery; University of Connecticut Health Center; Farmington MN USA
| | - Mikko J. Nissi
- Department of Applied Physics; University of Eastern Finland; Kuopio Finland
| | - Patrick Morgan
- Department of Orthopaedic Surgery; University of Minnesota; Minneapolis MN USA
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Saito M, Tsukada S, Yoshida K, Okada Y, Tasaki A. Correlation of alpha angle between various radiographic projections and radial magnetic resonance imaging for cam deformity in femoral head-neck junction. Knee Surg Sports Traumatol Arthrosc 2017; 25:77-83. [PMID: 26878850 DOI: 10.1007/s00167-016-4046-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Radial magnetic resonance imaging (MRI) along the axis of the femoral head neck is the gold standard for detection of cam deformity of the proximal femur. This study was performed to identify which plain radiographic projection was best correlated with radial MRI. METHODS Five different plain radiographic projections and 18 slices of radial MRI were applied to 35 consecutive hips with groin pain and positive impingement sign. Alpha angles were measured to detect the asphericity of the femoral head-neck junction in all images. Radiographs were taken in anteroposterior pelvis, cross-table lateral, 90° Dunn, 45° Dunn and modified 45° Dunn views. Pearson's correlation coefficients were determined to assess the association between the alpha angle obtained from radial MRI and each radiographic technique. The sensitivity, specificity, positive and positive predictive values and accuracy of plain radiographic alpha angle measurements were assessed using a threshold alpha angle value of 50.5° for cam deformity. RESULTS Pearson's correlation coefficients in the alpha angle values between MRI and plain radiographic projections were 0.45, 0.70, 0.62, 0.81 and 0.69 for the anteroposterior pelvis, cross-table lateral, 90° Dunn, 45° Dunn and modified 45° Dunn views, respectively. In terms of sensitivity and accuracy, the 45° Dunn view had the greatest values. CONCLUSIONS Alpha angle of the 45° Dunn view was best correlated with that of radial MRI. The 45° Dunn view had better sensitivity and accuracy than other radiographic projections. The 45° Dunn view may be preferable for screening of cam deformity. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Kazuki Yoshida
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Yasuaki Okada
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
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Prevalência da morfologia de impacto femoroacetabular em jogadores de futebol juvenil assintomáticos: estudo de ressonância magnética com correlação clínica. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Albers CE, Wambeek N, Hanke MS, Schmaranzer F, Prosser GH, Yates PJ. Imaging of femoroacetabular impingement-current concepts. J Hip Preserv Surg 2016; 3:245-261. [PMID: 29632685 PMCID: PMC5883171 DOI: 10.1093/jhps/hnw035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
Following the recognition of femoroacetabular impingement (FAI) as a clinical entity, diagnostic tools have continuously evolved. While the diagnosis of FAI is primarily made based on the patients' history and clinical examination, imaging of FAI is indispensable. Routine diagnostic work-up consists of a set of plain radiographs, magnetic resonance imaging (MRI) and MR-arthrography. Recent advances in MRI technology include biochemically sensitive sequences bearing the potential to detect degenerative changes of the hip joint at an early stage prior to their appearance on conventional imaging modalities. Computed tomography may serve as an adjunct. Advantages of CT include superior bone to soft tissue contrast, making CT applicable for image-guiding software tools that allow evaluation of the underlying dynamic mechanisms causing FAI. This article provides a summary of current concepts of imaging in FAI and a review of the literature on recent advances, and their application to clinical practice.
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Affiliation(s)
- Christoph E. Albers
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicholas Wambeek
- Department of Radiology, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Markus S. Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gareth H. Prosser
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
| | - Piers J. Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
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