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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 6/2013

01-06-2013 | Clinical Research

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Authors: Simon D. Steppacher, MD, Christoph E. Albers, MD, Klaus A. Siebenrock, MD, Moritz Tannast, MD, Reinhold Ganz, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2013

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Abstract

Background

Traumatic posterior hip dislocation in adults is generally understood to be the result of a high-energy trauma. Aside from reduced femoral antetorsion, morphologic risk factors for dislocation are unknown. We previously noticed that some hips with traumatic posterior dislocations had evidence of morphologic features of femoroacetabular impingement (FAI), therefore, we sought to evaluate that possibility more formally.

Questions/purposes

We asked whether hips with a traumatic posterior hip dislocation present with (1) a cam-type deformity and/or (2) a retroverted acetabulum.

Methods

We retrospectively compared the morphologic features of 53 consecutive hips (53 patients) after traumatic posterior hip dislocation with 85 normal hips (44 patients) based on AP pelvic and crosstable axial radiographs. We measured the axial and the lateral alpha angle for detection of a cam deformity and the crossover sign, ischial spine sign, posterior wall sign, retroversion index, and ratio of anterior to posterior acetabular coverage to describe the acetabular orientation.

Results

Hips with traumatic posterior traumatic dislocation were more likely to have cam deformities than were normal hips, in that the hips with dislocation had increased axial and lateral alpha angles. Hips with posterior dislocation also were more likely to be retroverted; dislocated hips had a higher prevalence of a positive crossover sign, ischial spine sign, and posterior wall sign, and they had a higher retroversion index and increased ratio of anterior to posterior acetabular coverage.

Conclusions

Hips with posterior traumatic dislocation typically present with morphologic features of anterior FAI, including a cam-type deformity and retroverted acetabulum. An explanation for these findings could be that the early interaction between the aspherical femoral head and the prominent acetabular rim acts as a fulcrum, perhaps making these hips more susceptible to traumatic dislocation.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation
Authors
Simon D. Steppacher, MD
Christoph E. Albers, MD
Klaus A. Siebenrock, MD
Moritz Tannast, MD
Reinhold Ganz, MD
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2863-4

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