Reliability in the diagnosis of femoroacetabular impingement and dysplasia among hip surgeons: role of surgeon volume and experience

Accuracy of Clinical and Imaging Tests for the Diagnosis of Hip Dysplasia and Instability: A Systematic Review

BACKGROUND

Evidence concerning the accurate clinical or imaging methods to diagnose hip instability or hip dysplasia is currently scarce.

OBJECTIVE

To summarize the diagnostic accuracy of clinical and imaging tests for the diagnosis of hip dysplasia and instability.

METHODS

A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases, using key words related to diagnostic accuracy of the hip joint, was conducted on March 6, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the searching and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Diagnostic accuracy, including sensitivity, specificity, likelihood ratio, and 95% confidence interval, was summarized.

RESULTS

Out of 3109 citations, 7 articles were included. Two studies reported on 5 clinical tests for hip instability and 5 studies reported on 5 radiographic measures for hip dysplasia. Only 1 study was not of low methodological quality. The prone instability test moderately improved positive posttest probability by 38% to diagnose hip instability. The Shenton line moderately to highly improved posttest probability by 41% to 60% to diagnose hip dysplasia.

CONCLUSION

This systematic review summarizes the diagnostic accuracy of various clinical tests and radiographic measures for hip instability and hip dysplasia. Further high-quality studies are necessary to examine the diagnostic accuracy of the clinical examination and radiography to assist in ruling in or ruling out the diagnoses of hip dysplasia and instability. Consensus is required to standardize the definitions of these diagnoses and their reference standards. The study was registered with the International Prospective Register of Systematic Reviews (CRD42018089019).

LEVEL OF EVIDENCE

Diagnosis, level 3b. J Orthop Sports Phys Ther 2019;49(2):87-97. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8476.

Bony Morphology of Femoroacetabular Impingement in Young Female Dancers and Single-Sport Athletes

BACKGROUND

Femoroacetabular impingement (FAI) is a painful and limiting condition of the hip that is often seen in young athletes. Previous studies have reported a higher prevalence of this disorder in male athletes, but data on the structural morphology of adolescent and young adult female athletes, specifically those involved in dance, are lacking.

PURPOSE

(1) To investigate the radiographic morphology of FAI deformities in adolescent and young adult female single-sport dance and nondance athletes and (2) to examine the differences in the radiographic findings between these 2 groups.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A retrospective chart review of 56 female single-sport athletes 10 to 21 years of age with a diagnosis of FAI within a single-sports medicine division of a pediatric academic medical center was performed. Acetabular index (AI), lateral center-edge angle (LCEA), crossover sign, and ischial spine sign were measured bilaterally on anteroposterior radiographs; alpha angle (AA) was measured on lateral films, and anterior center-edge angle (ACEA) was measured on false-profile films. Independent t tests and Mann-Whitney U tests were used to compare mean angle measurements between dance and nondance athletes. Dichotomized categorical variables and crossover and ischial spine signs were analyzed between dance and nondance athletes by applying a chi-square test. Statistical significance was set as P < .05 a priori.

RESULTS

Significant differences in angle measurements were noted. AA was significantly lower in the dancers compared with the nondance athlete group (49.5° ± 6.0° vs 53.9° ± 7.3°, P = .001). The LCEA and ACEA of dance athletes were significantly greater compared with nondance athletes (33.8° ± 6.7° vs 30.9° ± 5.8° [P = .016] and 36.0° ± 8.1° vs 32.3° ± 7.0° [P = .035], respectively). No significant difference in AI was seen between the 2 cohorts (5.0° ± 4.0° for dancers vs 5.9° ± 3.4° for nondancers, P = .195).

CONCLUSION

Significant differences existed in the radiographic bony morphology of young female single-sport dance athletes compared with nondance athletes with FAI. In dance athletes, symptoms were seen in the setting of normal bony morphology.