Top

Clinical Orthopaedics and Related Research®

Published in:

01-04-2015 | Symposium: 2014 Bernese Hip Symposium

Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?

Authors: Heinse W. Bouma, MD, Tom Hogervorst, MD, PhD, Emmanuel Audenaert, MD, PhD, Peter Krekel, PhD, Paulien M. van Kampen, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 4/2015

Abstract

Background

Femoroacetabular impingement (FAI) presupposes a dynamic interaction of the proximal femur and acetabulum producing clinical symptoms and chondrolabral damage. Currently, FAI classification is based on alpha angle and center-edge angle measurements in a single plane. However, acetabular and femoral version and neck-shaft angle also influence FAI. Furthermore, each of these parameters has a reciprocal interaction with the others; for example, a shallow acetabulum delays impingement of the femoral head with the acetabular rim.

Questions/purposes

We introduce the new parameter “omega zone,” which combines five parameters into one: the alpha and center-edge angles, acetabular and femoral version, and neck-shaft angle. We sought to determine whether the omega zone could differentiate patients with FAI from (1) normal control subjects (alpha < 55°), but also from (2) control subjects with elevated alpha angles (≥ 55°).

Methods

We evaluated CT data of 20 hips of male patients with symptomatic cam-type FAI and of 35 male hips extracted from 110 anonymized CT scans for vascular diagnosis. We excluded hips with osteoarthritis, developmental dysplasia, or coxa profunda (center-edge angle 20°–45° on AP pelvic view or corresponding coronal CT views). With dedicated software, femoral and pelvic orientation was standardized; we tested the omega zone in four hip positions in three distinct groups: patients with cam-type FAI (alpha > 60°) and control subjects with normal (< 55°) and high alpha angles (≥ 55°).

Results

The omega zone was smaller in patients with cam-type FAI than normal control subjects (alpha angle < 55°) at 60° and 90° of flexion (mean, 12%; 95% confidence interval [CI], 7–17; p = 0.008; Cohen’s d = 9%; 95% CI, 4–13; p = 0.003). Furthermore, the omega zone was smaller in all positions in patients with cam-type FAI than control subjects with high alpha angles (0° p = 0.017, 30° p = 0.004, 60° p = 0.004, 90° p = 0.007). In contrast, the omega zone did not differ between control subjects with normal or high alpha angles. In all hips, the omega zone decreased with flexion, corresponding to a decrease in remaining impingement-free motion with flexion.

Conclusions

The omega zone visualizes and quantifies the interaction of the proximal femur and acetabulum. The omega zone differed between patients with cam-type FAI and control subjects with high alpha angles (≥ 55°), who could not be distinguished based on alpha angle alone. For hip-preserving surgery, it can help surgeons decide whether to address the femur, the acetabulum, or both.

Level of Evidence

Level III, diagnostic study.

Agricola R, Reijman M, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. Total hip replacement but not clinical osteoarthritis can be predicted by the shape of the hip: a prospective cohort study (CHECK). Osteoarthritis Cartilage. 2013;21:559–564.CrossRefPubMed

Arbabi E, Chegini S, Boulic R, Tannast M, Ferguson SJ, Thalmann D. Penetration depth method—novel real-time strategy for evaluating femoroacetabular impingement. J Orthop Res. 2010;28:880–886.PubMed

Audenaert EA, Peeters I, Vigneron L, Baelde N, Pattyn C. Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. Am J Sports Med. 2012;40:1329–1336.CrossRefPubMed

Bardakos NV, Villar RN. Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br. 2009;91:162–169.CrossRefPubMed

Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br. 2008;90:1428–1434.CrossRefPubMed

DiGioia AM, Hafez MA, Jaramaz B, Levison TJ, Moody JE. Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res. 2006;453:272–276.CrossRefPubMed

Eilander W, Harris S, Henkus H, Cobb J, Hogervorst T. Functional acetabular component position with supine total hip replacement. Bone Joint J. 2013;95:1326–1331.CrossRefPubMed

Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.CrossRefPubMedCentralPubMed

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed

10.

Hartofilakidis G, Bardakos NV, Babis GC, Georgiades G. An examination of the association between different morphotypes of femoroacetabular impingement in asymptomatic subjects and the development of osteoarthritis of the hip. J Bone Joint Surg.Br. 2011;93:580–586.CrossRefPubMed

11.

Hogervorst T, Eilander W, Fikkers JT, Meulenbelt I. Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype. Clin Orthop Relat Res. 2012;470:3284–3296.CrossRefPubMedCentralPubMed

12.

Jacobsen S, Sonne-Holm S, Soballe K, Gebuhr P, Lund B. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Acta Orthop. 2005;76:149–158.CrossRefPubMed

13.

Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.PubMed

14.

Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458:117–124.PubMed

15.

Ng KG, Lamontagne M, Adamczyk AP, Rahkra KS, Beaulé PE. Patient-specific anatomical and functional parameters provide new insights into the pathomechanism of cam FAI. Clin Orthop Relat Res. 2014 Jul 22 [Epub ahead of print].

16.

Nicholls AS, Kiran A, Pollard TC, Hart DJ, Arden CP, Spector T, Gill HS, Murray DW, Carr AJ, Arden NK. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum. 2011;63:3392–3400.CrossRefPubMedCentralPubMed

17.

Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.CrossRefPubMed

18.

Puls M, Ecker TM, Tannast M, Steppacher SD, Siebenrock KA, Kowal JH. The Equidistant Method–a novel hip joint simulation algorithm for detection of femoroacetabular impingement. Computer Aided Surgery. 2010;15:75–82.CrossRefPubMed

19.

Röling M, Visser M, Bloem R, Oei E, Kleinrensink GJ, Pilot P. Non-invasive dynamic identification of femoroacetabular impingement: a cadaveric validation study. Arthroscopy. 2013;29:e193-e194.CrossRef

20.

Terjesen T. Residual hip dysplasia as a risk factor for osteoarthritis in 45 years follow-up of late-detected hip dislocation. J Child Orthop. 2011;5:425–431.CrossRefPubMedCentralPubMed

21.

Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. Vol 101. Berlin, Germany: Springer; 1984.

22.

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002;35:543–548.

23.

Wyss TF, Clark JM, Weishaupt D, Notzli HP. Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res. 2007;460:152–158.PubMed

Title: Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?
Authors: Heinse W. Bouma, MD
Tom Hogervorst, MD, PhD
Emmanuel Audenaert, MD, PhD
Peter Krekel, PhD
Paulien M. van Kampen, PhD
Publication date: 01-04-2015
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 4/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-4037-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 4/2015

Eighty Percent of Patients With Surgical Hip Dislocation for Femoroacetabular Impingement Have a Good Clinical Result Without Osteoarthritis Progression at 10 Years

Clinical Faceoff: Anterior Total Hip Versus Mini-Posterior: Which One is Better?

Can Femoral Rotation Be Localized and Quantified Using Standard CT Measures?

CORR Insights®: Patient-specific Anatomical and Functional Parameters Provide New Insights into the Pathomechanism of Cam FAI

Does the Nature of Chondrolabral Injury Affect the Results of Open Surgery for Femoroacetabular Impingement?

Does Surgical Hip Dislocation and Periacetabular Osteotomy Improve Pain in Patients With Perthes-like Deformities and Acetabular Dysplasia?