Roentgenographic Changes in Proximal Femoral Dimensions Due to Hip Rotation

Bell, Alexander L.; Brand, Richard A.

doi:10.1097/00003086-198903000-00024

Cited by 21 publications

(23 citation statements)

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“…Standard imaging workup for these patients begins with AP biplanar radiography of the pelvis (using either conventional radiography or EOS 1 imaging). However, biplanar radiography with either technique may be limited by some variation in pelvic tilt, magnification, and femoral rotation [2,19,26,28,30,34], which must be identified and accounted for when interpreting these biplanar radiographs. We therefore used a dry cadaveric pelvis with increasing interval sizes of modeled morphologic features of the pincer to answer the following study questions: (1) What is the reliability of EOS 1 and conventional radiography at increasing sizes of morphologic features of the pincer with varying degrees of tilt and rotation?…”

Section: Discussionmentioning

confidence: 99%

“…We therefore used a dry cadaveric pelvis with increasing interval sizes of modeled morphologic features of the pincer to answer the following study questions: (1) What is the reliability of EOS 1 and conventional radiography at increasing sizes of morphologic features of the pincer with varying degrees of tilt and rotation? (2) What is the effect of tilt and rotation on acetabular overcoverage measurements?…”

Section: Discussionmentioning

confidence: 99%

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Reliability of Overcoverage Parameters With Varying Morphologic Pincer Features: Comparison of EOS® and Radiography

Monazzam¹,

Agashe²,

Hosalkar³

2013

Clinical Orthopaedics &Amp; Related Research

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Background Multiple radiographic parameters used for diagnosis and quantification of morphologic pincer features have emerged, but the degree to which pelvic tilt or rotation affects conventional radiography and EOS 1 is unknown. Question/purposes We asked: (1) What is the reliability of EOS 1 and conventional radiography at increasing sizes of morphologic pincer features with varying degrees of tilt and rotation? (2) What is the effect of tilt and rotation on acetabular overcoverage measurements? Methods Using a dry cadaveric pelvis, AP conventional radiographs and EOS 1 images were taken at intervals of increasing modeled pincer size with 0°to 15°varying tilt and rotation. Lateral center-edge angle, Sharp angle, Tönnis angle, crossover sign, and retroversion index were measured on all images. Statistical analysis was conducted. Results The intermodality intraclass correlation coefficients for conventional radiography and EOS 1 radiography across all pincer sizes, rotations, and tilts were excellent (0.93-0.98). Crossover sign was in perfect agreement in conventional radiography and EOS 1 . Rotation of the hip away from the beam source and/or increased anterior tilt falsely increased all overcoverage parameters except for Tönnis angle. Rotation away from the beam of 10°or greater or anterior tilt of 5°or greater produced a false-positive crossover sign. Conclusions EOS 1 radiography maintained excellent reliability in comparison to conventional radiography but both were equally vulnerable to the effects of tilt and rotation for quantification of hip parameters used in acetabular overcoverage assessment. A standardized pelvic radiograph ensuring that the pelvis is not excessively tilted or rotated should be used for assessing acetabular overcoverage parameters.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reliability of Overcoverage Parameters With Varying Morphologic Pincer Features: Comparison of EOS® and Radiography

Monazzam¹,

Agashe²,

Hosalkar³

2013

Clinical Orthopaedics &Amp; Related Research

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“…In many institutions, especially in the community where resources for advanced imaging are limited, standard imaging work-up for nonspecific groin and hip pain often begins with an AP radiograph of the pelvis. One should be aware of the associated variability in pelvic tilt, magnification, and femoral rotation [3,20,32,36,38], which may alter the radiographic appearance of the pelvis and/or proximal femur, while assessing and interpreting these biplanar radiographs. We therefore evaluated and characterized the potential effect of femoral rotation on (1) AP alpha angle, (2) LCEA, and (3) MPFA on AP hip radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…The emerging use of AP radiography (a convenient, low-cost, and widely available modality) for wider FAI evaluation inevitably invites concern of the welldocumented variability in pelvic tilt, magnification, and femoral rotation associated with AP radiographs [3,20,32,36,38]. Femoral rotation reportedly affects the neck-shaft angle [17], femoral offset [40], Southwick slip angle [21], preoperative hip arthroplasty templating [20], and femoral canal measurements [6].…”

Section: Introductionmentioning

confidence: 99%

Does Femoral Rotation Influence Anteroposterior Alpha Angle, Lateral Center-edge Angle, and Medial Proximal Femoral Angle? A Pilot Study

Monazzam

Bomar

Agashe

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Femoral rotation on AP radiographs affects several parameters used to assess morphologic features of the proximal femur but its effect on femoroacetabular impingement parameters remains unknown. Question/purposes We therefore evaluated and characterized the potential effect of femoral rotation on (1) AP alpha angle, (2) lateral-center edge angle (LCEA), and (3) medial proximal femoral angle (MPFA) on AP hip radiographs. Methods We took seven AP hip radiographs at intervals of successive femoral rotation on a single dry, cadaveric specimen: 60°, 40°, and 20°internal rotation; 0°neutral/ anatomic rotation; and 20°, 40°, and 50°external rotation. The AP alpha angle, LCEA, and MPFA were measured on all radiographs by two independent evaluators.Results Within the range of femoral rotation studied, the AP alpha angle ranged from 39°to 62°, the LCEA from 25°to 35°, and the MPFA from 70°to 115°. MPFA and AP alpha angle showed a linear relationship with femoral rotation. Each additional degree of internal rotation produced a reciprocal reduction of the MPFA by 0.36°and the AP alpha angle by 0.18°and vice versa in external rotation. The LCEA, especially within the internal rotation range, showed minimal variation. Conclusions These changes in radiographic parameters emphasize the importance of femoral rotation and patient positioning. We recommend radiographs be evaluated for excessive femoral rotation or nonstandardized positioning before interpretation for diagnostic and treatment implications. It may be prudent to repeat radiographs in these circumstances or, when standardized positioning is not feasible, proceed toward advance imaging.

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“…In comparison to the RSA values for the displacements along the transverse (X) axis, the MLD values were on an average underestimated by 1.2 mm and displayed a high variability, especially in relation to the usually small translations occurring along the transverse axis during fracture healing (Ragnarsson 1991). This inaccuracy might be explained by the sensitivity of the MLD to intemal/extemal hip rotation and by the oval shape of the femoral shaft (Bell and Brand 1989).…”

Section: Discussionmentioning

confidence: 91%