Are Normal Hips Being Labeled as Pathologic? A CT-based Method for Defining Normal Acetabular Coverage

Larson, Christopher M.; Moreau–Gaudry, Alexandre; Kelly, Bryan T.; Byrd, J. W. Thomas; Tonetti, Jérôme; Lavallée, Stéphane; Chabanas, Laurence; Barrier, Guillaume; Bedi, Asheesh

doi:10.1007/s11999-014-4055-2

Cited by 141 publications

(146 citation statements)

References 31 publications

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“…Crossover is sensitive to pelvic tilt and cranial crossover is likely a normal variant. We agree with Zaltz et al [45] as well as Larson et al [25] and so graded crossover critically and only considered the caudal Grades II to IV as diagnostic for radiographic pincer FAI while excluding cranial crossover.…”

Section: Methodssupporting

confidence: 88%

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis

Anderson

Kapron

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background It is not known whether morphological abnormalities of the hip are compatible with lifelong hip function and avoidance of osteoarthritis (OA). Our purpose was to investigate the prevalence of radiographic findings consistent with femoroacetabular impingement (FAI) and dysplasia (DDH) in senior athletes with well-functioning hips. Questions/purposes (1) What is the prevalence of FAI and DDH in senior athletes with well-functioning hips? (2) Are radiographic findings of FAI and DDH associated with OA? (3) Is a history of longer duration or more intense activity associated with hip pathomorphology? (4) Were the modified Harris hip scores and the Hip Outcome Scores lower (legacy scales) in patients with evidence of hip pathomorphology than those without? Methods Five hundred forty-seven individuals (55% men, 45% women; 1081 hips, 534 bilateral and 13 unilateral), mean age 67 years (SD 8 years), gave consent and qualified for this institutional review board-approved crosssectional study of senior athletes. Hips were independently evaluated for radiographic signs of FAI, DDH, and OA. Additionally, a lifetime activities questionnaire and outcome instruments were used to assess pain and function. Hips that had previously undergone arthroplasty or fracture surgery were excluded. Results Eighty-three percent (898 of 1081) of hips had radiographic abnormalities consistent with FAI, of which 67% (599 of 898) were cam-type FAI. Ten percent (103 of 1081) of hips had radiographic evidence for dysplasia. Radiographic findings of FAI were not predictive of OA after controlling for age and sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.48-6.62; p = 0.390). Similarly, radiographic findings of DDH were not predictive of OA (OR, 1.48; 95% CI, 0.31-7.21; p = 0.62). Our data suggest an increased risk of FAItype morphologies in athletes who participated in competitive sporting events during early adult years (OR, 1.49; 95% CI, 1.04-2.11; p = 0.020). Additionally, participants who reported lifetime participation in competitive sports were at an increased risk of OA compared with those who did not (OR, 1.75; 95% CI, 1.14-2.69; p = 0.007). There were no differences in outcome scores between athletes with and without morphologic abnormalities. Conclusions Radiographic findings consistent with FAI in these senior athletes were common and were not associated with the presence of OA. These data suggest that the need to screen for asymptomatic young athletes for radiographic evidence of FAI and DDH may not be necessary. Level of Evidence Level III, prognostic study.

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Section: Methodssupporting

confidence: 88%

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis

Anderson

Kapron

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The PWI in control hips was greater than Introduction Acetabular overcoverage (pincer-type impingement), undercoverage (dysplasia), and retroversion have been recognized as common pathomorphologies that may result in degenerative changes of the hip [2,6,7,12,18]. However, recent reports suggest that some of these common pathomorphologies may actually be normal variants as opposed to sources of pathology [1,10]. Acetabular coverage has historically been evaluated with plain radiographs and more recently with advanced three-dimensional imaging techniques and computerized measurements off plain films [8,17,19,20].…”

Section: Introductionmentioning

confidence: 99%

“…In this costconscious era, the ability to use plain film radiographs to assess acetabular morphology is warranted. It may be challenging to properly diagnose those hip pathomorphologies associated with anterior and posterior coverage with plain film radiography [10,14,15]. To better evaluate anterior and posterior coverage, Siebenrock et al [15] developed measurements on plain films that take into consideration femoral head size and relative anterior and posterior walls to better quantify wall coverage relative to the femoral head diameter.…”

Section: Introductionmentioning

confidence: 99%

Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies

Anderson

Erickson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy. Questions (1) What are the ranges for AWI and PWI from measurements obtained on AP pelvic radiographs of asymptomatic senior athletes with well-functioning hips? (2) Is there a difference between the AWI and PWI in asymptomatic athletes with acetabular morphology consistent with acetabular dysplasia, overcoverage, and retroversion when compared with asymptomatic hips that do not meet the radiographic definitions for those morphologies (controls)? Methods Five hundred five athletes (998 asymptomatic native hips) were independently evaluated by two readers on AP pelvic radiographs for AWI and the PWI after excluding hips with prior surgery, inadequate radiographs, or poor function (modified Harris hip score \ 80). Hips with a lateral center-edge angle (LCEA) C 20°and B 38°a nd without acetabular retroversion, based on a positive crossover sign, were used as controls. Hips were categorized as developmental dysplasia of the hip (DDH; undercoverage) if the LCEA was \ 20°. Finally, overcoverage was defined as an LCEA [ 38°. The mean age of the athletes was 67 years (range, 50-91 years) and 55% were men. Linear generalized estimating equation regression was used to compare each individual diagnosis (DDH, retroversion, overcoverage) with the controls for both AWI and PWI adjusting for age and sex. Results The mean AWI in the study population was 0.36 (range, À0.02 to 0.91). The mean PWI was 1.13 (range, 0.12-1.74). The mean AWI and PWI in controls (n = 740) was 0.35 (range, À0.02 to 0.91) and 1.13 (range, 0.64-1.70), respectively. There were 25 (3%) with DDH in whom the mean AWI was 0.26 (range, 0.05-0.5) and the mean PWI was 1.03 (range, 0.71-1.3). There were 112 (11%) retroverted hips in whom the mean AWI was 0.42 (range, 0.1-0.89) and PWI was 1.02 (range, 0.61-1.5). There were 121 (12%) overcovered hips in whom the mean AWI was 0.43 (range, À0.18 to 0.85) and PWI was 1.22 (0.12-1.74). The AWI in the control hips was no different than that of DDH hips (b À0.06; 95% confidence interval [CI], À0.12 to 0.002; p = 0.059) but was found to be lower than retroverted hips (b 0.08; 95% CI, 0.04-0.11; p \ 0.001) and overcovered hips (b 0.05; 95% CI, 0.03-0.08; p \ 0.001). The PWI in control hips was greater than Funding was provided by a grant from the LS Peery Foundation (LAA, CLP). One of the authors certifies that he (CLP), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Zimmer Biomet, Inc (Warsaw, IN, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file wit...

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“…Although acetabular morphology can be quantified accurately with the aid of CT scans or specialized computer software [1,2,5,8,9], an affordable and intraoperative reproducible method is a valuable resource. More-recently introduced radiographic parameters like AWI and PWI may help overcome the limitations of current parameters.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

“…In addition to normal reference values, we need reference-range values both for acetabular overcoverage and undercoverage. However, abnormal acetabular morphology is common among asymptomatic subjects [3,4,7,8], so we will depend on future studies to compare differences in acetabular morphology between asymptomatic and symptomatic hips. Only after ascertaining normal ranges, normal variants, and pathologic variations, would both the AWI and PWI be incorporated as a diagnosis and intraoperative aid tool.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

CORR Insights®: Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults with Varying Morphologies

Piuzzi

2017

Clinical Orthopaedics &Amp; Related Research

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Are Normal Hips Being Labeled as Pathologic? A CT-based Method for Defining Normal Acetabular Coverage

Cited by 141 publications

References 31 publications

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis

Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies

CORR Insights®: Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults with Varying Morphologies

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