Advertisement

Cam-type femoroacetabular impingement—correlations between alpha angle versus volumetric measurements and surgical findings

  • Riham Dessouky
  • Avneesh Chhabra
  • Lihua Zhang
  • Adam Gleason
  • Rajiv Chopra
  • Yonatan Chatzinoff
  • Nicholas P. Fey
  • Yin Xi
  • Joel WellsEmail author
Musculoskeletal
  • 3 Downloads

Abstract

Aim

Determine correlations of 3DCT cam-type femoroacetabular impingement (FAI) measurements with surgical findings of labral tear and cartilage loss.

Methods

Digital search of symptomatic cam-type FAI from July 2013 to August 2016 yielded 43 patients. Two readers calculated volumes of femoral head, bump, and alpha angles on 3DCT images. Correlations between CT and surgical findings, inter-, and intra-reader reliabilities were assessed using Spearman rank correlation and intraclass correlation coefficients (ICC).

Results

Thirteen men and 14 women aged 37 ± 10 (mean ± SD) years were included. Most common clinical finding was positive flexion–adduction–internal rotation (70.4%). Twenty-seven labral tears and 20 cartilage defects were surgically detected. Significant correlations existed between femoral bump, head volumes, and extent of the labral tear (p = 0.008 and 0.003). No significant correlations were found between the alpha angles at 12 to 3 o’clock and the extent of labral tear (p = 0.2, 0.8, 0.9, and 0.09) or any measurement with the cartilage loss (p values for alpha 12 to 3, bump, and head volumes = 0.7, 0.3, 0.9, 0.9, 0.07, and 0.2). Inter- and intra-reader reliabilities were excellent to moderate for femoral head and bump volumes (ICC = 0.85, 0.52, and 0.8, 0.5) and moderate to poor for alpha angles (ICC = 0.48, 0.40, 0.05, 0.25 and 0.3, 0.24, 0.29, 0.49).

Conclusion

Three dimensional volumetric measurements of cam-type FAI significantly correlate with the extent of intraoperative labral tears. Superior inter- and intra-reader reliability to that of alpha angles renders it a more clinically relevant measurement for quantifying cam morphology.

Key Points

• The 3DCT bump volume and femoral head volume showed significant correlations with the extent of labral tear (p values = 0.008 and 0.003).

• No significant correlations were seen between alpha angles and the extent of labral tear (p values > 0.05).

• Inter- and intra-reader reliability was excellent to moderate (ICC = 0.85 and 0.52, 0.8, and 0.5) for femoral head and bump volumes while inter- and intra-reader reliability was fair to poor (ICC = 0.48, 0.40, 0.05, 0.25 and 0.3, 0.24, 0.29, 0.49) for alpha angles.

Keywords

Hip joint Femoroacetabular impingement Image processing Computer-assisted Tomography 

Abbreviations

3DCT

Three-dimensional computed tomography

FABER

Flexion-abduction-external rotation

FADIR

Flexion-adduction-internal rotation

FAI

Femoroacetabular impingement

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Avneesh Chhabra, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

RD, LZ, AG, RC, YC, NPF: no conflicts of interest.

AC: consultant ICON Medical, royalties: Jaypee, Wolters (not related).

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

Supplementary material

330_2018_5968_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)

References

  1. 1.
    Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85:278–286.  https://doi.org/10.2106/00004623-200302000-00015 CrossRefPubMedGoogle Scholar
  2. 2.
    Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 81:281–288.  https://doi.org/10.1302/0301-620X.81B2.8291 CrossRefPubMedGoogle Scholar
  3. 3.
    Eijer H, Leunig M, Mahomed MN, Ganz R (2001) Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int 11:37–41.  https://doi.org/10.1177/112070000101100104 CrossRefGoogle Scholar
  4. 4.
    Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176.  https://doi.org/10.1302/0301-620X.83B2.11092 CrossRefPubMedGoogle Scholar
  5. 5.
    Carter DR, Vasu R, Harris WH (1982) Stress distributions in the acetabular region-II. Effects of cement thickness and metal backing of the total hip acetabular component. J Biomech 15:165–170.  https://doi.org/10.1016/0021-9290(82)90248-2 CrossRefPubMedGoogle Scholar
  6. 6.
    Leunig M, Casillas MM, Hamlet M et al (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by prominent femoral metaphysis. Acta Orthop Scand 71:370–375CrossRefGoogle Scholar
  7. 7.
    Clohisy JC, Beaulé PE, O'Malley A, Safran MR, Schoenecker P (2008) AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am 90:2267–2281.  https://doi.org/10.2106/JBJS.G.01267 CrossRefPubMedGoogle Scholar
  8. 8.
    Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H (2009) Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res 467:638–644.  https://doi.org/10.1007/s11999-008-0680-y CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23:1286–1292.  https://doi.org/10.1016/j.orthres.2005.03.011.1100230608 CrossRefPubMedGoogle Scholar
  10. 10.
    Ross JR, Bedi A, Stone RM et al (2014) Intraoperative fluoroscopic imaging to treat cam deformities: correlation with 3-dimensional computed tomography. Am J Sports Med 42:1370–1376.  https://doi.org/10.1177/0363546514529515 CrossRefPubMedGoogle Scholar
  11. 11.
    Röling MA, Visser MI, Oei EH, Pilot P, Kleinrensink GJ, Bloem RM (2015) A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation — cadaveric validation study. BMC Musculoskelet Disord 16:50.  https://doi.org/10.1186/s12891-015-0504-7 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Speirs AD, Beaulé PE, Rakhra KS, Schweitzer ME, Frei H (2013) Bone density is higher in cam-type femoroacetabular impingement deformities compared to normal subchondral bone. Osteoarthritis Cartilage 21:1068–1073.  https://doi.org/10.1016/j.joca.2013.04.016 CrossRefPubMedGoogle Scholar
  13. 13.
    Nepple JJ, Prather H, Trousdale RT et al (2013) Diagnostic imaging of femoroacetabular impingement. J Am Acad Orthop Surg 21:S20–S26.  https://doi.org/10.5435/JAAOS-21-07-S20 CrossRefPubMedGoogle Scholar
  14. 14.
    Arezoomand S, Lee WS, Rakhra KS, Beaulé PE (2015) A 3D active model framework for segmentation of proximal femur in MR images. Int J Comput Assist Radiol Surg 10:55–66.  https://doi.org/10.1007/s11548-014-1125-6 CrossRefPubMedGoogle Scholar
  15. 15.
    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84–B:556–560Google Scholar
  16. 16.
    Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW (2012) How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers? Radiology 264:514–521.  https://doi.org/10.1148/radiol.12112479 CrossRefPubMedGoogle Scholar
  17. 17.
    Wyles CC, Norambuena GA, Howe BM et al (2017) Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: a prospective matched cohort study. Am J Sports Med 45:3036–3043.  https://doi.org/10.1177/0363546517719460 CrossRefPubMedGoogle Scholar
  18. 18.
    Audenaert EA, Peeters I, Vigneron L, Baelde N, Pattyn C (2012) Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. Am J Sports Med 40:1329–1336.  https://doi.org/10.1177/0363546512441328 CrossRefPubMedGoogle Scholar
  19. 19.
    Omoumi P, Thiery C, Michoux N, Malghem J, Lecouvet FE, Vande Berg BC (2014) Anatomic features associated with femoroacetabular impingement are equally common in hips of old and young asymptomatic individuals without CT signs of osteoarthritis. AJR Am J Roentgenol 202:1078–1086.  https://doi.org/10.2214/AJR.12.10083 CrossRefPubMedGoogle Scholar
  20. 20.
    Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770.  https://doi.org/10.2106/JBJS.L.00710 CrossRefPubMedGoogle Scholar
  21. 21.
    Wells J, Nepple JJ, Crook K et al (2017) Femoral morphology in the dysplastic hip: three-dimensional characterizations with CT. Clin Orthop Relat Res 475:1045–1054.  https://doi.org/10.1007/s11999-016-5119-2 CrossRefPubMedGoogle Scholar
  22. 22.
    Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M (2007) Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med 35:1571–1580.  https://doi.org/10.1177/0363546507300258 CrossRefPubMedGoogle Scholar
  23. 23.
    Bittersohl B, Hosalkar HS, Hesper T, Tiderius CJ, Zilkens C, Krauspe R (2015) Advanced imaging in femoroacetabular impingement: current state and future prospects. Front Surg 2:34.  https://doi.org/10.3389/fsurg.2015.00034 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bouma HW, Hogervorst T, Audenaert E, Krekel P, van Kampen PM (2015) Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement? Clin Orthop Relat Res 473:1396–1403.  https://doi.org/10.1007/s11999-014-4037-4 CrossRefPubMedGoogle Scholar
  25. 25.
    Neumann J, Zhang AL, Schwaiger BJ et al (2018) Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference. Eur Radiol.  https://doi.org/10.1007/s00330-018-5623-8
  26. 26.
    Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC (2005) Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res 441:327–333.  https://doi.org/10.1097/01.blo.0000181147.86058.74 CrossRefPubMedGoogle Scholar
  27. 27.
    Kim J, Choi JA, Lee E, Lee KR (2015) Prevalence of imaging features on CT thought to be associated with femoroacetabular impingement: a retrospective analysis of 473 asymptomatic adult hip joints. AJR Am J Roentgenol 205:W100–W105.  https://doi.org/10.2214/AJR.14.13130 CrossRefPubMedGoogle Scholar
  28. 28.
    Ehrmann C, Rosskopf AB, Pfirrmann CW, Sutter R (2015) Beyond the alpha angle: alternative measurements for quantifying cam-type deformities in femoroacetabular impingement. J Magn Reson Imaging 42:1024–1031.  https://doi.org/10.1002/jmri.24861 CrossRefPubMedGoogle Scholar
  29. 29.
    Lohan DG, Seeger LL, Motamedi K, Hame S, Sayre J (2009) Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer? Skeletal Radiol 38:855–862.  https://doi.org/10.1007/s00256-009-0745-3 CrossRefPubMedGoogle Scholar
  30. 30.
    Magerkurth O, Jacobson JA, Jax F et al (2013) Femoroacetabular cam-type impingement: global assessment of the femoral head-neck junction on a single reformatted MR image. Radiology 268:822–830.  https://doi.org/10.1148/radiol.13121961 CrossRefPubMedGoogle Scholar
  31. 31.
    Smith KM, Gerrie BJ, McCulloch PC, Lintner DM, Harris JD (2017) Comparison of MRI, CT, Dunn 45° and Dunn 90° alpha angle measurements in femoroacetabular impingement. Hip Int 284:450–455Google Scholar
  32. 32.
    Yen YM, Kocher MS (2013) Clinical and radiographic diagnosis of femoroacetabular impingement. J Pediatr Orthop 33(Suppl 1):S112–S120CrossRefGoogle Scholar
  33. 33.
    Amanatullah DF, Antkowiak T, Pillay K et al (2015) Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics 38:185–199.  https://doi.org/10.3928/01477447-20150305-07 CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Zagazig University Hospitals and Faculty of MedicineZagazig UniversityZagazigEgypt
  2. 2.Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of Orthopedic SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  4. 4.Advanced Imaging Research CenterUniversity of Texas Southwestern Medical CenterDallasUSA
  5. 5.Departments of Bioengineering and Mechanical EngineeringThe University of Texas at DallasRichardsonUSA
  6. 6.Department of Physical Medicine and RehabilitationUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations