Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

Nitschke, Ashley; Lambert, Jeffery R.; Glueck, Deborah H.; Jesse, Mary K.; Mei-Dan, Omer; Strickland, C.; Petersen, Brian

doi:10.1007/s00256-015-2225-2

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…These variables, however, fail to capture what happens in the axial plane, and additional measurements are needed to provide a more complete description, including the posterior wall sign, crossover sign, anterior wall index, posterior wall index, neck axis distance, and transverse axis distance. 3,4 These axial-plane acetabular indices aim to approximate acetabular version, further informing surgical decision making. It is important to note that no such radiograph-based analog exists for assessing femoral version, whichduntil recentlydhas largely been excluded from the decision-making algorithm for the evaluation and treatment of hip impingement.…”

Section: See Related Article On Page 1864mentioning

confidence: 99%

Editorial Commentary: Treating Hip Impingement Without a Computed Tomography Scan? You Might as Well Operate With a Blindfold

Garabekyan¹,

Mei-Dan

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip impingement is defined as a bony conflict between the femur and acetabulum occurring throughout normal or supraphysiological range of motion. Traditionally, the cause was attributed to reduced femoral head-neck offset and/or excessive acetabular coverage, giving rise to cam, pincer, and mixed impingement. However, recent outcome studies showing less favorable results of hip arthroscopy in patients with femoral and acetabular version abnormalities have sparked renewed interest in the pathomechanics of hip impingement. We now have a greater appreciation for the 3dimensional scope of the problem through specialized computed tomography sequencing allowing assessment of the entire limb and pelvis. Consequently, we have learned that rotational hip range of motion is more strongly correlated with combined femoral and acetabular version than with the sphericity of the femoral head, allowing us to counsel patients accordingly. We also recognize that impingement can occur with little to no femoral asphericity if the combined femoral and acetabular version does not permit adequate clearance for unimpeded motion. This improved understanding can be applied to diagnose subtle and uncommon cases of impingement and will ultimately enable a more complete bony resection.

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Section: See Related Article On Page 1864mentioning

confidence: 99%

Editorial Commentary: Treating Hip Impingement Without a Computed Tomography Scan? You Might as Well Operate With a Blindfold

Garabekyan¹,

Mei-Dan

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Conversely, femoral antetorsion can exacerbate posterior impingement by decreasing the amount of external rotation before the femoral neck comes into contact intra-and extra-articular structures [2]. This relationship and stress on the anterior structures is especially magnified when there is anterior undercoverage with hip instability or dysplasia [3,4]. Thus, accurate measurement of femoral torsion is important for diagnosing different hip conditions and can help guide treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Analysis Versus Two-Dimensional Slice-Based Analysis of CT for Measuring Femoral Torsion and Its Correlation to Passive Hip Range of Motion

Ratner¹,

Kolaczko²,

Jeffers³

et al. 2022

Cureus

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IntroductionFemoral torsion is an important anatomical consideration of the hip that has major implications on the natural motion of the hip joint. Similarly, it affects pathologic conditions of the hip, including femoroacetabular impingement, dysplasia, and/or microinstability. Femoral torsion is typically measured on two-dimensional (2D) axial CT cuts by creating the angle between the femoral neck and the posterior aspect of the ipsilateral femoral condyles. Position of the leg during imaging may affect 2D measurements. Threedimensional (3D) analysis of a hip CT with inclusion of femoral alignment may portray the anatomy of the hip more accurately as compared to a 2D slice-based analysis of a hip CT scan. It is thought that femoral torsion measured using this system could be a more accurate and reliable means of measurement. The primary purpose of this study is to assess the differences in measuring femoral torsion with 3D modeling and analysis compared to the standard 2D slice-based approach on a CT scan. Secondarily, we attempt to determine how the passive range of motion of the hip correlates with femoral torsion measured using the 3D model versus the 2D model. MethodsIn a prospective cohort study of 20 patients, femoral torsion was assessed using both 2D analysis and 3D analysis. The differences between these measurements on each of the imaging modalities were compared. Additionally, each patient had the passive range of motion of their hip measured with a goniometer. The amount of internal and external rotation was measured with the hip in a neutral position and with the hip flexed to 90°. Acetabular version, combined version, and alpha angle were added to multivariate regression analysis to evaluate their effect versus femoral torsion alone. ResultsFemoral antetorsion measured using the standard 2D slice-based approach on CT scan was 22.1° (SD: 11.1°), which was higher (p<0.001) than that using 3D analysis (8.25°; SD: 10.5°). There was a strong correlation between femoral torsion measurements using 3D analysis and 2D analysis (R=0.91). Based on 3D analysis, there was a moderate correlation between femoral torsion and passive hip external rotation measured with the hip flexed to 90° (R=0.65, p<0.002) and with the hip in a neutral position (R=0.58, p<0.007). ConclusionThere was a significant difference between femoral torsion measurements using the 3D analysis, which showed approximately 14° of less antetorsion on average. Additionally, rotation of the hip and femoral torsion was correlated to higher levels of antetorsion associated with more internal rotation of the hip.

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MR Imaging Evaluation of Hip Dysplasia in the Young Adult

Beltran

2025

Magnetic Resonance Imaging Clinics of North America

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Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

Abstract: TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain.

Cited by 5 publications

References 23 publications

Editorial Commentary: Treating Hip Impingement Without a Computed Tomography Scan? You Might as Well Operate With a Blindfold

Editorial Commentary: Treating Hip Impingement Without a Computed Tomography Scan? You Might as Well Operate With a Blindfold

Three-Dimensional Analysis Versus Two-Dimensional Slice-Based Analysis of CT for Measuring Femoral Torsion and Its Correlation to Passive Hip Range of Motion

MR Imaging Evaluation of Hip Dysplasia in the Young Adult

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