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Clinical Orthopaedics and Related Research®

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01-12-2012 | Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Radiographic Features Associated With Differing Impinging Hip Morphologies With Special Attention to Coxa Profunda

Authors: Gregory Boone, BS, Michael R. Pagnotto, MD, Justin A. Walker, MD, Robert T. Trousdale, MD, Rafael J. Sierra, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2012

Abstract

Background

Combined with clinical examination and MRI, radiographs have been mainstays in the management femoroacetabular impingement (FAI). Because hip morphology often portends intraoperative damage, radiographic features should inform surgical management.

Questions/Purposes

We determined (1) the radiographic features of the various hip morphologies; (2) the prevalence of radiographic coxa profunda in each group; (3) the radiographic differences between hips with and without coxa profunda; and (4) its sensitivity and specificity as a measure of global acetabular overcoverage.

Methods

We reviewed preoperative radiographs and operative notes of 144 hips that underwent surgical dislocation and correction for FAI between August 2002 and February 2011. Hips were divided into four FAI subtypes by radiographic analysis (cam, global overcoverage, retroversion, and combined) and three subtypes (cam, pincer, or combined) by intraarticular pathology. Standard radiographic measurements were performed, and we introduce a novel measurement that assesses femoral head coverage.

Results

We found differences in median Angle of Sharp, femoral head-neck angle, and median roof length (and its subset) among the FAI morphologies. The prevalence of radiographic coxa profunda was 48% in cam hips, 85% in global overcoverage hips, 66% in retroverted hips, and 32% in combined hips. The sensitivity and specificity of radiographic coxa profunda as a measure of global overcoverage was 75% (95% CI, 0.62–0.85) and 62% (95% CI, 0.51–0.73), respectively.

Conclusions

We found major differences in radiographic measurements between FAI morphologies. Radiographic coxa profunda was poorly specific for global overcoverage. Measurement of roof length and ratio should be used to determine the morphology of the impinging hip.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Armbuster TG, Guerra JJ, Resnick D, Goergen TG, Feingold ML, Niwayama G, Danzig LA. The adult hip: an anatomic study. Part I: the bony landmarks. Radiology. 1978;128:1–10.PubMed

Beck M, Kalhor M, Leunig M, Ganz R. 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. 2005;87:1012–1018.PubMedCrossRef

Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289–300.

Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, Leuiq M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47–66.PubMedCrossRef

Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P, Steger-May K, Schoenecker PL, Millis M. Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res. 2009;467:666–675.PubMedCrossRef

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

Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. 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. 2001;83:1119–1124.PubMedCrossRef

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

Hooper JC, Jones EW. Primary protrusion of the acetabulum. J Bone Joint Surg Br. 1971;53:23–29.PubMed

10.

Kutty S, Schneider P, Faris P, Kiefer G, Frizzell B, Park R, Powell JN. Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Int Orthop. 2011 Jul 1 [Epub ahead of print].

11.

Leunig M, Nho SJ, Turchetto L, Ganz R. Protrusio acetabuli: new insights and experience with joint preservation. Clin Orthop Relat Res. 2009;467:2241–2250.PubMedCrossRef

12.

Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;15:561–570.PubMed

13.

R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2008. Available at: www.R-project.org. Accessed June 13, 2012.

14.

Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.PubMedCrossRef

15.

Ruelle M, Dubois JL. [The protrusive malformation and its arthroscopic complication. I. Radiological and clinical symptoms. Etiopathogenesis] [in French]. Rev Rhum Mal Osteoartic. 1962;29:476–489.PubMed

16.

Schoenecker PL, Clohisy JC, Millis MB, Wenger DR. Surgical management of the problematic hip in adolescent and young adult patients. J Am Acad Orthop Surg. 2011;19:275–286.PubMed

17.

Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic inclination on determination of acetabular retroversion: a study on cadaver pelves. Clin Orthop Relat Res. 2003;407:241–248.PubMedCrossRef

18.

Sierra RJ, Trousdale RT, Ganz R, Leunig M. Hip disease in the young, active patient: evaluation and nonarthroplasty surgical options. J Am Acad Orthop Surg. 2008;16:689–703.PubMed

19.

Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays: a comparison of six parameters. Skeletal Radiol. 2006;35:149–155.PubMedCrossRef

Title: Radiographic Features Associated With Differing Impinging Hip Morphologies With Special Attention to Coxa Profunda
Authors: Gregory Boone, BS
Michael R. Pagnotto, MD
Justin A. Walker, MD
Robert T. Trousdale, MD
Rafael J. Sierra, MD
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 12/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2539-5

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Radiographic Features Associated With Differing Impinging Hip Morphologies With Special Attention to Coxa Profunda

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Level of Evidence

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