Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Orthopaedics
Published in: International Orthopaedics 1/2014

01-01-2014 | Original Paper

The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement

Authors: Matthias Lahner, Nadine-Lucie Jahnke, Sonja Zirke, Wolfram Teske, Gregor Vetter, Christoph von Schulze Pellengahr, Kiriakos Daniilidis, Marco Hagen, Lars Victor von Engelhardt

Published in: International Orthopaedics | Issue 1/2014

Login to get access

Abstract

Purpose

This study was designed to evaluate whether the mechanical axis deviation (MAD) of the leg correlates with an increased hip alpha angle as described by Nötzli, which is associated with femoroacetabular impingement (FAI).

Methods

In a retrospective analysis, standing full-length anteroposterior radiographs were analysed in patients who suffered from symptomatic leg alignment. The study included 85 radiographs of 80 patients with an average age of 43.11 years (range 18–60 years). Five patients underwent a bilateral long-leg X-ray examination. All radiographs were transferred as Digital Imaging and Communications in Medicine data files from the Picture Archiving and Communications System into the OrthoPlanner software version 2.3.2. The radiographs were measured by one orthopaedic surgeon and one independent radiologist.

Results

The mean value of the alpha angle of Nötzli was 61.43° (49.07–74.04°). A total of 57 (67 %) radiographs showed a varus deviation, 25 (29.5 %) had a valgus malalignment and three (3.5 %) a straight leg axis. Of 82 radiographs, 40 (48.8 %) had a moderate axis deviation with a MAD <15 or > − 15 mm and a mean alpha angle of 57.81°, and 42 (51.2 %) with extended axis deviation of a MAD > 15 or < − 15 mm had a mean alpha angle of 62.93°; 40 (95.2 %) of these 42 showed an alpha angle > 55°. The alpha angle was significantly increased in extended axis deviation compared to moderate axis deviation (P = 0.001).

Conclusions

This study confirmed that increased alpha angles were found significantly at higher degrees of axis deviation on the full-length radiograph. In cases of a MAD >15 or < − 15 mm and symptomatic coxalgia, diagnostic tests must be pursued for FAI.
Literature
1.
2.
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(7):1012–1018PubMedCrossRef
3.
Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272PubMedCrossRef
4.
Leunig M, Ganz R (2005) Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis. Unfallchirurg 108(1):9–10, 12–17PubMedCrossRef
5.
6.
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120PubMed
7.
Kim WY, Hutchinson CE, Andrew JG, Allen PD (2006) The relationship between acetabular retroversion and osteoarthritis of the hip. J Bone Joint Surg Br 88(6):727–729PubMedCrossRef
8.
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
9.
Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560PubMedCrossRef
10.
Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R (2004) Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 418:54–60PubMedCrossRef
11.
Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, Ganz R (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71:370–375PubMedCrossRef
12.
Snow SW, Keret D, Scarangella S, Bowen JR (1993) Anterior impingement of the femoral head: a late phenomenon of Legg-Calvé-Perthes’ disease. J Pediatr Orthop 13:286–289PubMedCrossRef
13.
Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL (2007) The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res 462:115–121PubMedCrossRef
14.
Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2005) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236(2):588–592PubMedCrossRef
15.
Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M (2013) Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clin Orthop Relat Res Mar 6 [Epub ahead of print]
16.
Brown G, Amendola A (2000) Radiographic evaluation and preoperative planning for high tibial osteotomies. Oper Tech Sports Med 8:2–14CrossRef
17.
Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E (2007) A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg Br 89(10):1309–1316PubMedCrossRef
18.
Hack K, Di Primio G, Rakhra K, Beaulé PE (2010) Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92(14):2436–2344PubMedCrossRef
19.
Pollard TC, Villar RN, Norton MR, Fern ED, Williams MR, Murray DW, Carr AJ (2010) Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. J Bone Joint Surg Br 92(2):209–216PubMedCrossRef
20.
Reichenbach S, Jüni P, Werlen S, Nüesch E, Pfirmann CW, Trelle S, Odermatt A, Hofstetter W, Ganz R, Leunig M (2010) Prevalence of cam-type deformity on hip magnetic resonance imaging in young males: a cross-sectional study. Arthritis Care Res (Hoboken) 62(9):1319–1327CrossRef
21.
Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V (2012) Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop 36(5):903–914PubMedCentralPubMedCrossRef
22.
Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140PubMed
23.
Pape D, Seil R, Adam F, Rupp S, Kohn D, Lobenhoffer P (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33(2):122–134PubMedCrossRef
24.
Barton C, Salineros MJ, Rakhra KS, Beaulé PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469PubMedCrossRef
25.
Lerch S, Kasperczyk A, Warnecke J, Berndt T, Rühmann O (2013) Evaluation of Cam-type femoroacetabular impingement by ultrasound. Int Orthop 37(5):783–788PubMedCrossRef
26.
Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23(6):1286–1292PubMed
27.
Dudda M, Albers C, Mamisch TC, Werlen S, Beck M (2009) Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin Orthop Relat Res 467(3):651–659PubMedCrossRef
28.
Rakhra KS, Sheikh AM, Allen D, Beaulé PE (2009) Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res 467(3):660–665PubMedCrossRef
Metadata
Title
The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement
Authors
Matthias Lahner
Nadine-Lucie Jahnke
Sonja Zirke
Wolfram Teske
Gregor Vetter
Christoph von Schulze Pellengahr
Kiriakos Daniilidis
Marco Hagen
Lars Victor von Engelhardt
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 1/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2085-0

Other articles of this Issue 1/2014

International Orthopaedics 1/2014 Go to the issue

Original Paper

Human osteoblast damage after antiseptic treatment

Original Paper

Early follow-up of a custom non-fluted diaphyseal press-fit tumour prosthesis

Original Paper

Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study

Letter to the Editor

Letter regarding article by Ni et al.: press-fit cementless acetabular fixation with and without screws

Original Paper

The natural history of unexplained early poor function following total hip replacement

Original Paper

Mechanical behaviour of low-cost dynamic compression plates correlates with manufacturing quality standards