Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 8, pp 1045–1049 | Cite as

The prevalence of a prominent anterior inferior iliac spine

  • Antonio KlasanEmail author
  • Thomas Neri
  • Sven Edward Putnis
  • Philipp Dworschak
  • Karl Friedrich Schüttler
  • Susanne Fuchs-Winkelmann
  • Markus D. Schofer
  • Thomas J. Heyse
Orthopaedic Surgery



Impingement of the prominent anterior inferior iliac spine (AIIS) against the femoral neck has recently been described as another type of impingement. The purpose of this study is to provide a distribution of AIIS types using the classification proposed by Hetsroni and thus report on the prevalence of prominent types.

Materials and methods

A total of 400 patients were included in the study with an average age 27.3 ± 6.9 years (range 18–40). All patients received a whole-body polytrauma computer tomography (CT) scan in the emergency room (ER) upon arrival. The classification of AIIS proposed by Hetsroni et al., which describes three morphological types, was used. Type II and III were grouped as prominent types. The measurements were performed in all three planes by two examiners.


Male to female ratio was 71:29. Type I was observed in 367 (91.7%) patients. Type II was observed in 31 (7.8%) patients and type III was observed in 2 (0.5%) patients, unilaterally. Prominent types were much more prevalent in men (10.5%) than in women (2.6%). The CT assessment demonstrated excellent intra- and interreliability (overall: 0.926, I/II: 0.906, III: 1.000).


A young population demonstrates a prevalence of a prominent AIIS of 11.5%. Prominent AIIS is more common in men than in women.


Anterior inferior iliac spine Impingement Prevalence CT 



We would like to thank Charlotte Sommer for her help with the measurements and data collection.

Compliance with ethical standards

Conflict of interest

Antonio Klasan has received research support from Implantcast, unrelated to this study. Thomas Neri has no conflicts of interest. Susanne Fuchs Winkelmann has no conflicts of interest. Swen Putnis has no conflicts of interest. Philipp Dworschak has no conflicts of interest. Karl Friedrich Schüttler has no conflicts of interest. Markus Schofer has been paid for presentations for Depuy and Smith & Nephew. Thomas Heyse has been paid for presentations for Smith & Nephew, Zimmer Biomet and Implantcast. He has received research support from Smith & Nephew, Zimmer Biomet and Implantcast. He is a consultant to Smith & Nephew.

Ethical approval

The authors’ university board of ethics reviewed the study and approved the study (0711/2017). The study was performed at the University Hospital Marburg, Center for Orthopedics and Traumatology, Baldingerstrasse, 35043 Marburg, Germany.


  1. 1.
    Samora JB, Ng VY, Ellis TJ (2011) Femoroacetabular impingement: a common cause of hip pain in young adults. Clin J Sport Med 21:51–56. CrossRefGoogle Scholar
  2. 2.
    Tamura S, Nishii T, Takao M et al (2013) Differences in the locations and modes of labral tearing between dysplastic hips and those with femoroacetabular impingement. Bone Joint J 95-B:1320–1325. CrossRefGoogle Scholar
  3. 3.
    Collins JA, Ward JP, Youm T (2014) Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med 42:3009–3015. CrossRefGoogle Scholar
  4. 4.
    Hetsroni I, Larson CM, Dela Torre K et al (2012) Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy 28:1644–1653. CrossRefGoogle Scholar
  5. 5.
    Hetsroni I, Poultsides L, Bedi A et al (2013) Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 471:2497–2503. CrossRefGoogle Scholar
  6. 6.
    Larson CM, Moreau-Gaudry A, Kelly BT et al (2015) Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res 473:1247–1254. CrossRefGoogle Scholar
  7. 7.
    Pan H, Kawanabe K, Akiyama H et al (2008) Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br 90:677–679. CrossRefGoogle Scholar
  8. 8.
    Hufeland M, Krüger D, Haas NP et al (2016) Arthroscopic treatment of femoroacetabular impingement shows persistent clinical improvement in the mid-term. Arch Orthop Trauma Surg 136:687–691. CrossRefGoogle Scholar
  9. 9.
    Carton P, Filan D (2016) Anterior inferior iliac spine (AIIS) and subspine hip impingement. Muscles Ligaments Tendons J 6:324–336. CrossRefGoogle Scholar
  10. 10.
    Williams M, Ashworth M (2018) An operative technique for psoas impingement following total hip arthroplasty: a case series of day case, extra articular, arthroscopic psoas tenotomy. Arch Orthop Trauma Surg. Google Scholar
  11. 11.
    Randelli F, Maglione D, Favilla S et al (2019) Os acetabuli and femoro-acetabular impingement: aetiology, incidence, treatment, and results. Int Orthop 43:35–38. CrossRefGoogle Scholar
  12. 12.
    Ryan JM, Harris JD, Graham WC et al (2014) Origin of the direct and reflected head of the rectus femoris: an anatomic study. Arthroscopy 30:796–802. CrossRefGoogle Scholar
  13. 13.
    Amar E, Druckmann I, Flusser G et al (2013) The anterior inferior iliac spine: size, position, and location. An anthropometric and sex survey. Arthroscopy 29:874–881. CrossRefGoogle Scholar
  14. 14.
    Nawabi DH, Degen RM, Fields KG et al (2017) Anterior inferior iliac spine morphology and outcomes of hip arthroscopy in soccer athletes: a comparison to nonkicking athletes. Arthroscopy 33:758–765. CrossRefGoogle Scholar
  15. 15.
    Krueger DR, Windler M, Geßlein M et al (2017) Is the evaluation of the anterior inferior iliac spine (AIIS) in the AP pelvis possible? Analysis of conventional X-rays and 3D-CT reconstructions. Arch Orthop Trauma Surg 137:975–980. CrossRefGoogle Scholar
  16. 16.
    Schindler BR, Venderley MB, Mikula JD et al (2017) Comparison of radiographs and computed tomography for the screening of anterior inferior iliac spine impingement. Arthroscopy 33:766–772. CrossRefGoogle Scholar
  17. 17.
    Willinger L, Schanda JE, Lorenz S et al (2017) Surgical treatment of two adolescent athletes with dislocated avulsion fracture of the anterior superior iliac spine (ASIS). Arch Orthop Trauma Surg 137:173–177. CrossRefGoogle Scholar
  18. 18.
    Larson CM, Kelly BT, Stone RM (2011) Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 27:1732–1737. CrossRefGoogle Scholar
  19. 19.
    Rajasekhar C, Kumar KS, Bhamra MS (2001) Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention. Int Orthop 24:364–365CrossRefGoogle Scholar
  20. 20.
    Matsuda DK, Calipusan CP (2012) Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics 35:e460–e463. CrossRefGoogle Scholar
  21. 21.
    Topcuoğlu OM, Ergen FB, Ardalı S et al (2018) Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population. Surg Radiol Anat 40:1275–1281. CrossRefGoogle Scholar
  22. 22.
    Wong TT, Igbinoba Z, Bloom MC et al (2018) Anterior inferior iliac spine morphology: comparison of symptomatic hips with femoroacetabular impingement and asymptomatic hips. AJR Am J Roentgenol 1–7.
  23. 23.
    Wilson R, Hansen P, Langley J, Derrett S (2014) A comparison of injured patient and general population valuations of EQ-5D health states for New Zealand. Health Qual Life Outcomes 12:21. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Antonio Klasan
    • 1
    Email author
  • Thomas Neri
    • 2
  • Sven Edward Putnis
    • 3
  • Philipp Dworschak
    • 1
  • Karl Friedrich Schüttler
    • 1
  • Susanne Fuchs-Winkelmann
    • 1
  • Markus D. Schofer
    • 4
  • Thomas J. Heyse
    • 4
  1. 1.Center for Orthopedics and TraumatologyUniversity Hospital MarburgMarburgGermany
  2. 2.Department of Orthopaedic SurgeryUniversity Hospital St EtienneSaint-Priest-en-JarezFrance
  3. 3.The GallerySydney Orthopaedic Research InstituteChatswoodAustralia
  4. 4.Orthomedic Frankfurt OffenbachOffenbachGermany

Personalised recommendations