Radiographic Signs of Femoroacetabular Impingement Are Associated With Decreased Pelvic Incidence

Weinberg, Douglas S.; Gebhart, Jeremy J.; Liu, Raymond W.; Salata, Michael J.

doi:10.1016/j.arthro.2015.11.047

Cited by 48 publications

(58 citation statements)

References 37 publications

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“…Such pelvic position leads to increased femoral head coverage anteriorly, further increasing impingement risk. Our findings are contrary to those of Weinberg et al and Hellman et al both of which showed lower PI was associated with cam morphology. However, Weinberg et al re‐assembled the studied skeletons and included cases of isolated pincer‐FAI, whereas Hellman et al looking at various types of FAI (cam, pincer, acetabular retroversion) used only two‐dimensional imaging analysis with their associated limitations.…”

Section: Discussioncontrasting

confidence: 99%

“…Exclusion criteria included neurological disorders, previous lower limb surgery or severe injury, and body mass index greater than 40 kg/m 2 . A power analysis was performed; the effect size was calculated by comparing Control and FAI subtended (83° vs. 79°) and PI (55° vs. 49°) angles from previous studies . A cohort of 56 patients would be sufficient for adequate power (80%, α = 0.05) to study both parameters.…”

Section: Methodsmentioning

confidence: 99%

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Acetabular and spino‐pelvic morphologies are different in subjects with symptomatic cam femoro‐acetabular impingement

Grammatopoulos

Speirs

et al. 2018

Journal Orthopaedic Research

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Acetabular and spino-pelvic (SP) morphological parameters are important determinants of hip joint dynamics. This prospective study aimed to determine whether acetabular and SP morphological differences exist between hips with and without cam morphology and between symptomatic and asymptomatic hips with cam morphology. A cohort of 67 patients/hips was studied. Hips were either asymptomatic with no cam (Controls, n = 18), symptomatic with cam (n = 26) or asymptomatic with cam (n = 23). CT-based quantitative assessments of femoral, acetabular, pelvic, and spino-pelvic parameters were performed. Measurements were compared between controls and those with a cam deformity, as well as between the three groups. Morphological parameters that were independent predictors of a symptomatic cam were determined using a regression analysis. Hips with cam deformity had slightly smaller subtended angles superior-anteriorly (87° vs. 84°, p = 0.04) and greater pelvic incidence (53° vs. 48°, p = 0.003) compared to controls. Symptomatic cams had greater acetabular version (p < 0.01), greater subtended angles superiorly and superior-posteriorly (p = 0.01), higher pelvic incidence (p = 0.02), greater alpha angles and lower femoral neck-shaft angles compared to asymptomatic cams (p < 0.01) and controls (p < 0.01). The four predictors of symptomatic cam included antero-superior alpha angle, femoral neck-shaft angle, acetabular depth, and pelvic incidence. In conclusion, this study illustrates that symptomatic hips had a greater amount of supero-posterior coverage; which would be the contact area between a radial cam and the acetabulum, when the hip is flexed to 90°. Furthermore, individuals with symptomatic cam morphology had greater PI. Acetabular- and SP parameters should be part of the radiological assessment of femoro-acetabular impingement. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1840-1848, 2018.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Acetabular and spino‐pelvic morphologies are different in subjects with symptomatic cam femoro‐acetabular impingement

Grammatopoulos

Speirs

et al. 2018

Journal Orthopaedic Research

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“…8 A decreased pelvic incidence has been related to radiographic signs of FAI, as well. [9][10][11][12] These results suggest that limited range of motion in the spine can alter spinopelvic parameters and subsequently change the joint mechanics of the hip. The article published by Chandrasekaran, Darwish, Suarez-Ahedo, Lodhia, and Domb, 13 "Outcomes of Hip Arthroscopy in Patients With Previous Lumbar Spine Surgery: A Matched-Pair Controlled Cohort Study With Minimum Two-Year Follow Up," brings a good topic of discussion suggesting that patients with a history of lumbar spine surgery undergoing hip arthroscopy should expect improvement in symptoms following surgery.…”

Section: See Related Article On Page 443mentioning

confidence: 86%

Editorial Commentary: The Hip-Spine Connection in Patients Undergoing Hip Arthroscopy: Should We Learn From Total Hip Replacement and Counsel Patients Differently If They Have Had Previous Back Surgery?

Pascual‐Garrido¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Disorders of the adult hip and spine are common, and there is evidence that there is a hip-spine connection in patients with hip femoroacetabular impingement (FAI). Many reports have shown that patients undergoing lumbar fusion and subsequent total hip arthroplasty have a higher risk of complications and worse outcomes following total hip arthroplasty. However, there has been a paucity of research on the effect of a history of lumbar spine surgery in patients undergoing hip arthroscopy for the treatment of FAI. Variations in lumbar lordosis, pelvic incidence, tilt, and sacral slope may modify the degree of FAI, symptoms, and patient-reported outcomes following hip arthroscopy. In the future, we should continue our efforts to better understand the impact that limited range of motion in the spine has in joint mechanics of the hip and the possibility of affecting patient-reported outcomes after hip arthroscopy. Future studies incorporating novel imaging technology, such as EOS, may be an objective way of assessing the effect of abnormal spine-pelvic function in patients with hip FAI.

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“…Assessment of tissue abnormalities can be challenging, even in the case of radiographs for the analysis of bone, where the projected outline of the structures is relatively clear. Measurements from 2‐dimensional (2D) radiographs are commonly used in the diagnosis of FAI . In particular, alpha angles were first described by Nötzli et al to assess the size of cam deformities (excess bone on the femoral neck), whilst centre edge (CE) and anteversion (AV) angles are used to identify acetabular abnormalities such as pincer impingement (acetabular overcoverage) and dysplasia (undercoverage) .…”

Section: Introductionmentioning

confidence: 99%

“…Measurements from 2-dimensional (2D) radiographs are commonly used in the diagnosis of FAI. [3][4][5] In particular, alpha angles were first described by Nötzli et al 6 to assess the size of cam deformities (excess bone on the femoral neck), whilst centre edge (CE) and anteversion (AV) angles are used to identify acetabular abnormalities such as pincer impingement (acetabular overcoverage) and dysplasia (undercoverage). 7 However, such 2D measurements do not capture the full 3-dimensional (3D) geometry of the hip.…”

mentioning

confidence: 99%

Three‐dimensional assessment of impingement risk in geometrically parameterised hips compared with clinical measures

Cooper

Mengoni

Groves

et al. 2017

Numer Methods Biomed Eng

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Abnormal bony morphology is a factor implicated in hip joint soft tissue damage and an increased lifetime risk of osteoarthritis. Standard 2‐dimensional radiographic measurements for diagnosis of hip deformities, such as cam deformities on the femoral neck, do not capture the full joint geometry and are not indicative of symptomatic damage.In this study, a 3‐dimensional geometric parameterisation system was developed to capture key variations in the femur and acetabulum of subjects with clinically diagnosed cam deformity. The parameterisation was performed for computed tomography scans of 20 patients (10 female and 10 male). Novel quantitative measures of cam deformity were taken and used to assess differences in morphological deformities between males and females.The parametric surfaces matched the more detailed, segmented hip bone geometry with low fitting error. The quantitative severity measures captured both the size and the position of cams and distinguished between cam and control femurs. The precision of the measures was sufficient to identify differences between subjects that could not be seen with the sole use of 2‐dimensional imaging. In particular, cams were found to be more superiorly located in males than in females.As well as providing a means to distinguish between subjects more clearly, the new geometric hip parameterisation facilitates the flexible and rapid generation of a range of realistic hip geometries including cams. When combined with material property models, these stratified cam shapes can be used for further assessment of the effect of the geometric variation under impingement conditions.

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Radiographic Signs of Femoroacetabular Impingement Are Associated With Decreased Pelvic Incidence

Cited by 48 publications

References 37 publications

Acetabular and spino‐pelvic morphologies are different in subjects with symptomatic cam femoro‐acetabular impingement

Acetabular and spino‐pelvic morphologies are different in subjects with symptomatic cam femoro‐acetabular impingement

Editorial Commentary: The Hip-Spine Connection in Patients Undergoing Hip Arthroscopy: Should We Learn From Total Hip Replacement and Counsel Patients Differently If They Have Had Previous Back Surgery?

Three‐dimensional assessment of impingement risk in geometrically parameterised hips compared with clinical measures

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