Top

International Orthopaedics

Published in:

01-03-2012 | Original Paper

Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement

Authors: Satish Kutty, Prism Schneider, Peter Faris, Gerhard Kiefer, Bevan Frizzell, Roy Park, James N. Powell

Published in: International Orthopaedics | Issue 3/2012

Abstract

Purpose

The aim of the study was to assess the use of the centre-edge (CE) angle in the assessment of pincer femoro-acetabular impingement (FAI) for reliability and predictability in the diagnosis.

Methods

Between 2004 and 2008, 55 patients underwent surgical treatment for FAI. A control group of 30 was identified among patients attending the emergency department with normal radiographs. Radiographs were assessed by two independent observers both before and after the operation. Nine patients with trauma were excluded. The magnetic resonance arthrogram reports of the remaining 46 patients were assessed for pincer FAI. Nineteen patients were identified and underwent repeat radiographic assessment. All underwent surgical dislocation of hip (SDH), acetabular, with/without femoral osteochondroplasty. Acetabular depth and version were also assessed. The intraclass correlation (ICC) was used to assess reliability of the CE angle. The paired t test and independent groups t test were used to assess the difference between the pincer FAI group, both pre-op and post-op and against controls.

Results

The control and pincer groups were similar in demographics (p=0.1769). Coxa profunda was present in 14 patients with eight also having retroverted acetabuli. Of the rest two had retroverted acetabuli and one protrusio. The mean CE angle in the control group was 31.4°, in the pre-op pincer group 46.2° and in the post-op pincer group 38.3°. The ICC for intra-observer correlation was 0.977 and 0.992 pre-op and 0.986 and 0.974 post-op. The ICC for inter-observer correlation was 0.960 and 0.957 pre-op and 0.979 and 0.967 post-op.The p value was <0.001 between the controls, the pre-op and post-op pincer groups. The test characteristics using the CE angle ≥ 40 is a reasonably good predictor of FAI, with a sensitivity of 84.2% and a specificity of 100%.

Conclusions

The pincer FAI can be reliably assessed with the CE angle and can be predicted in patients presenting with FAI.

Ganz R, Parvizi J, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop 417:112–120PubMed

Beall DP, Sweet CF, Martin HD, Lastine CL, Grayson DE, Ly JQ, Fish JR (2005) Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol 34:691–701PubMedCrossRef

Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018PubMedCrossRef

Allen D, Beaulé PE, Ramadan O, Doucette S (2009) Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. J Bone Joint Surg Br 91:589–594PubMedCrossRef

Takeyama A, Naito M, Shiramizu K, Kiyama T (2009) Prevalence of femoroacetabular impingement in Asian patients with osteoarthritis of the hip. Int Orthop 33(5):1229–1232PubMedCrossRef

Ito K, Minka MA 2nd, Leunig S, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176PubMedCrossRef

Beaulé PE, Zaragoza EJ, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23:1286–1292PubMed

Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73PubMedCrossRef

Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, Siebenrock KA (2003) Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage 11(7):508–518PubMedCrossRef

10.

Clohisy JC, Carlisle JC, Trousdale RT et al (2009) Radiographic evaluation of the hip has limited reliability. Clin Orthop 467:666–675PubMedCrossRef

11.

Wiberg G (1953) Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Joint Surg Am 35-A:65–80PubMed

12.

Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and débridement in young adults. J Bone Joint Surg Am 88:1735–1741PubMedCrossRef

13.

Beaulé PE, Le Duff MJ, Zaragoza EJ (2007) Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am 89:773–779PubMedCrossRef

14.

Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 188:1540–1552PubMedCrossRef

15.

Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770PubMed

16.

Lequesne M, Malghem J, Dion E (2004) The normal hip joint space: variations in width, shape, and architecture on 223 pelvic radiographs. Ann Rheum Dis 63:1145–1151PubMedCrossRef

17.

Tan T, Aktas C, Copuroglu C, Ozcan M, Ture M (2001) Reliability of radiological parameters measured on anteroposterior pelvis radiographs of patients with developmental dysplasia of the hip. Acta Orthop Belg 67(4):374–379PubMed

18.

Omeroglu H, Biçimoglu A, Aguş H, Tümer Y (2002) Measurement of center-edge angle in developmental dysplasia of the hip: a comparison of two methods in patients under 20 years of age. Skeletal Radiol 31(1):25–29PubMedCrossRef

19.

Tannast M, Zheng G, Anderegg C et al (2005) Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop 438:182–190PubMed

20.

Eijer H, Leunig M, Mahomed MN, Ganz R (2001) Cross-table lateral radiograph for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int 11:37–41

21.

Locher S, Werlen S, Leunig M, Ganz R (2002) MR-arthrography with radial sequences for visualization of early hip pathology not visible on plain radiographs (in German). Z Orthop Ihre Grenzgeb 140:52–57PubMedCrossRef

22.

Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240(3):778–785PubMedCrossRef

23.

Jamali AA, Mladenov K, Meyer DC et al (2007) Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 25:758–765PubMedCrossRef

24.

Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip. A technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 83:1119–1124PubMedCrossRef

25.

Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428PubMedCrossRef

26.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedCrossRef

27.

R Development Core Team (2008) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL http://www.R-project.org

28.

Umer M, Thambyah A, Tan WT, Das De S (2006) Acetabular morphometry for determining hip dysplasia in the Singaporean population. J Orthop Surg (Hong Kong) 14(1):27–31

29.

Crockarell JR, Trousdale RT, Guyton JL (2000) The anterior centre-edge angle. A cadaver study. J Bone Joint Surg Br 82(4):532–534PubMedCrossRef

30.

Loder RT, Mehbod AA, Meyer C, Meisterling M (2003) Acetabular depth and race in young adults: a potential explanation of the differences in the prevalence of slipped capital femoral epiphysis between different racial groups? J Pediatr Orthop 23(6):699–702PubMedCrossRef

Title: Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement
Authors: Satish Kutty
Prism Schneider
Peter Faris
Gerhard Kiefer
Bevan Frizzell
Roy Park
James N. Powell
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 3/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-011-1302-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2012

Could the use of bone morphogenetic proteins in fracture healing do more harm than good to our patients?

Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint

Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review

Less wear with aluminium-oxide heads than cobalt-chrome heads with ultra high molecular weight cemented polyethylene cups: A ten-year follow-up with radiostereometry

Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips

Wide resection of sacral chordoma via a posterior approach