Femoroacetabular impingement caused by a femoral osseous head–neck bump deformity: clinical, radiological, and experimental results

Jäger, Markus; Wild, Alexander; Westhoff, Bettina; Krauspe, Rüdiger

doi:10.1007/s00776-004-0770-y

Cited by 145 publications

(87 citation statements)

References 18 publications

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“…Therefore we believe clinically and radiographically diagnosed FAI requires correction of the underlying bony abnormality and that is possible by surgery only. Open hip dislocation has become the primary approach to FAI, with good to excellent short-to mid-term results around 70% to 80% [1,4,13,28,41,49]. With an improved appreciation of FAI-causing morphologies, less invasive approaches such as arthroscopy have emerged [44].…”

Section: Treatment Of Faimentioning

confidence: 99%

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Leunig

Beaulé

Ganz³

2009

Clinical Orthopaedics &Amp; Related Research

389

269

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Femoroacetabular impingement (FAI) is a recently proposed mechanism causing abnormal contact stresses and potential joint damage around the hip. In the majority of cases, a bony deformity or spatial malorientation of the femoral head or head/neck junction, acetabulum, or both cause FAI. Supraphysiologic motion or high impact might cause FAI even with very mild bony alterations. FAI became of interest to the medical field when (1) evidence began to emerge suggesting that FAI may initiate osteoarthritis of the hip and when (2) adolescents and active adults with groin pain and imaging evidence of FAI were successfully treated addressing the causes of FAI. With an increased recognition and acceptance of FAI as a damage mechanism of the hip, defined standards of assessment and treatment need to be developed and established to provide high accuracy and precision in diagnosis. Early recognition of FAI followed by subsequent behavioral modification (profession, sports, etc) or even surgery may reduce the rate of OA due to FAI.

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Section: Treatment Of Faimentioning

confidence: 99%

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Leunig

Beaulé

Ganz³

2009

Clinical Orthopaedics &Amp; Related Research

389

269

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“…It occurs as a result of morphological deformity of one or either structure, and has increasingly been recognized as a significant contributor to labral tear and premature osteoarthritis [1,2]. This is particularly the case in young, athletic individuals in whom repetitive exaggerated or actively stressed motion at the hip joint may accelerate secondary degeneration [3].…”

Section: Introductionmentioning

confidence: 99%

Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?

et al. 2009

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Introduction In our institutional experience, determination of the alpha (α) angle at MR arthrography as an indicator of the likelihood of cam-type femoroacetabular impingement (FAI) is fraught with inconsistency. The aims of this study were to quantify the degree of variability in and calculate the diagnostic accuracy of the α angle in suggesting a diagnosis of cam impingement, to determine the accuracy of a positive clinical impingement test, and to suggest alternative MR arthrographic measures of femoral head-neck overgrowth and determine their diagnostic utilities. Materials and methods We carried out a retrospective analysis of MR arthrographic studies performed during a 4-year period, combined with chart analysis, which allowed identification of 78 patients in whom surgical correlation was also available. The status of a preoperative clinical impingement test was also noted. Patients were designated as having cam-type FAI (Group A, n= 39) if intra-operative femoral head-neck junction bony osteochondroplasty/arthoscopic femoral debridement was performed. Group B (n=39) acted as controls. Three radiologists independently and blindly performed a series of measurements (α angle and two newly proposed measurements) in each patient on two separate occasions. An α angle of greater than 55°was considered indicative of the presence of cam-type FAI.Results Performance values for α angle measurement were poor for each observer. There was considerable (up to 30% of the mean value) intra-observer variability between the first and second α angle measurements for each subject. Binary logistic regression analysis confirmed that the α angle is of no value in predicting the presence or absence of cam-FAI. A statistically significant difference existed between Groups A and B with regard to the newly proposed anterior femoral distance (AFD; p=0.004). Using an AFD value of 3.60 mm or greater as being indicative of the presence of cam-FAI yields a 0.67 performance measure (95% confidence interval 0.55-0.79). The second proposed parameter (femoral neck ratio) was of no value in suggesting the presence or absence of this condition. The sensitivity, specificity, and positive and negative predictive values of the clinical impingement test were 76.9%, 87.2%, 85.7% and 79.1% respectively. Conclusions Femoral α angle measurement is associated with considerable variability. This index performed poorly in our patient population and was statistically of no value in suggesting the presence or absence of cam-FAI. One of our proposed measures, the AFD, outperformed the α angle, though to an insufficient degree to suggest its routine incorporation into clinical practice. Our experience suggests that the clinical impingement test remains the most reliable predictor of the presence of this condition.

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“…TIO can lead to overcoverage in many cases. Overcoverage beyond a certain point leads to pincer morphology and as such can evolve into symptomatic FAI with time, which is a prearthritic condition [6,11,18,29,30]. Thus, surgical containment with TIO has a risk-benefit ratio.…”

Section: Discussionmentioning

confidence: 99%

“…It is likely longer followup may cause further remodeling in the other cases. Finally, we cannot predict which of these patients with persistent radiographic pincer morphology will become symptomatic with time and develop symptomatic FAI, which is now considered a major cause of early osteoarthritis of the hip, especially in young and active patients [6,11,18,29,30]. It is characterized by an early pathologic contact between the acetabulum and the femur that limits the physiologic hip ROM, typically flexion and internal rotation.…”

Section: Discussionmentioning

confidence: 99%

Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

Hosalkar

Cunha

Baldwin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement. Questions/purposes We therefore asked (1) whether TIO contained the femoral head in Catterall Stages III and IV of LCPD; (2) whether the center-edge (CE) angle, acetabular roof arc angle (ARA), and Sharp's angle changed during the growing years; and (3) what percentage of patients had radiographic evidence of pincer impingement beyond a minimum followup of 3 years.

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Femoroacetabular impingement caused by a femoral osseous head–neck bump deformity: clinical, radiological, and experimental results

Cited by 145 publications

References 18 publications

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?

Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

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