Advertisement

Clinical Orthopaedics and Related Research®

, Volume 472, Issue 12, pp 3912–3922 | Cite as

Subject-specific Patterns of Femur-labrum Contact are Complex and Vary in Asymptomatic Hips and Hips With Femoroacetabular Impingement

  • Ashley L. Kapron
  • Stephen K. Aoki
  • Christopher L. Peters
  • Andrew E. AndersonEmail author
Basic Research

Abstract

Background

Femoroacetabular impingement (FAI) may constrain hip articulation and cause chondrolabral damage, but to our knowledge, in vivo articulation and femur-labrum contact patterns have not been quantified.

Purpose

In this exploratory study, we describe the use of high-speed dual-fluoroscopy and model-based tracking to dynamically measure in vivo hip articulation and estimate the location of femur-labrum contact in six asymptomatic hips and three hips with FAI during the impingement examination. We asked: (1) Does femur-labrum contact occur at the terminal position of impingement? (2) Could range of motion (ROM) during the impingement examination appear decreased in hips with FAI? (3) Does the location of femur-labrum contact coincide with that of minimum bone-to-bone distance? (4) In the patients with FAI, does the location of femur-labrum contact qualitatively correspond to the location of damage observed intraoperatively?

Methods

High-speed dual-fluoroscopy images were acquired continuously as the impingement examination was performed. CT arthrogram images of all subjects were segmented to generate three-dimensional (3-D) surfaces for the pelvis, femur, and labrum. Model-based tracking of the fluoroscopy images enabled dynamic kinematic observation of the 3-D surfaces. At the terminal position of the examination, the region of minimal bone-to-bone distance was compared with the estimated location of femur-labrum contact. Each patient with FAI underwent hip arthroscopy; the location of femur-labrum contact was compared qualitatively with damage found during surgery. As an exploratory study, statistics were not performed.

Results

Femur-labrum contact was observed in both groups, but patterns of contact were subject-specific. At the terminal position of the impingement examination, internal rotation and adduction angles for each of the patients with FAI were less than the 95% confidence intervals (CIs) for the asymptomatic control subjects. The location of minimum bone-to-bone distance agreed with the region of femur-labrum contact in two of nine hips. The locations of chondrolabral damage identified during surgery qualitatively coincided with the region of femur-labrum contact.

Conclusions

Dual-fluoroscopy and model-based tracking provided the ability to assess hip kinematics in vivo during the entire impingement examination. The high variability in observed labrum-femur contact patterns at the terminal position of the examination provides evidence that subtle anatomic features could dictate underlying hip biomechanics. Although femur-labrum contact occurs in asymptomatic and symptomatic hips at the terminal position of the impingement examination, contact may occur at reduced adduction and internal rotation in patients with FAI. Use of minimum bone-to-bone distance may not appropriately identify the region of femur-labrum contact. Additional research, using a larger cohort and appropriate statistical tests, is required to confirm the findings of this exploratory study.

Keywords

Internal Rotation Terminal Position Femoroacetabular Impingement Bony Impingement Anatomic Coordinate System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Blake Zimmerman, Department of Bioengineering, University of Utah, and Justine Goebel, Department of Bioengineering, University of Utah, for assistance with segmentation and model-based tracking.

Supplementary material

Supplementary material 1 (MPG 4120 kb)

References

  1. 1.
    Audenaert E, Van Houcke J, Maes B, Vanden Bossche L, Victor J, Pattyn C. Range of motion in femoroacetabular impingement. Acta Orthop Belg. 2012;78:327–332.PubMedGoogle Scholar
  2. 2.
    Audenaert EA, Mahieu P, Pattyn C. Three-dimensional assessment of cam engagement in femoroacetabular impingement. Arthroscopy. 2011;27:167–171.PubMedCrossRefGoogle Scholar
  3. 3.
    Audenaert EA, Peeters I, Vigneron L, Baelde N, Pattyn C. Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. Am J Sports Med. 2012;40:1329–1336.PubMedCrossRefGoogle Scholar
  4. 4.
    Beaule PE, Hynes K, Parker G, Kemp KA. Can the alpha angle assessment of cam impingement predict acetabular cartilage delamination? Clin Orthop Relat Res. 2012;470:3361–3367.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Beaule PE, O’Neill M, Rakhra K. Acetabular labral tears. J Bone Joint Surg Am. 2009;91:701–710.PubMedCrossRefGoogle Scholar
  6. 6.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.PubMedCrossRefGoogle Scholar
  7. 7.
    Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;27:235–251.PubMedCrossRefGoogle Scholar
  8. 8.
    Bedi A, Dolan M, Magennis E, Lipman J, Buly R, Kelly BT. Computer-assisted modeling of osseous impingement and resection in femoroacetabular impingement. Arthroscopy. 2012;28:204–210.PubMedCrossRefGoogle Scholar
  9. 9.
    Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng. 2006;128:604–609.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Bingham JT, Papannagari R, Van de Velde SK, Gross C, Gill TJ, Felson DT, Rubash HE, Li G. In vivo cartilage contact deformation in the healthy human tibiofemoral joint. Rheumatology (Oxford). 2008;47:1622–1627.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Chang TC, Kang H, Arata L, Zhao W. A pre-operative approach of range of motion simulation and verification for femoroacetabular impingement. Int J Med Robot. 2011 Jun 18 [Epub ahead of print].Google Scholar
  12. 12.
    Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638–644.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMedGoogle Scholar
  14. 14.
    Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105:136–144.PubMedCrossRefGoogle Scholar
  15. 15.
    Harris MD, Anderson AE, Henak CR, Ellis BJ, Peters CL, Weiss JA. Finite element prediction of cartilage contact stresses in normal human hips. J Orthop Res. 2012;30:1133–1139.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Hunt MA, Guenther JR, Gilbart MK. Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement. Clin Biomech (Bristol, Avon). 2013;28:519–523.Google Scholar
  17. 17.
    Kapron A, Aoki S, Peters CL, Mass SA, Bey MJ, Zauel R, Anderson AE. Accuracy and feasibility of dual fluoroscopy and model-based tracking to quantify in vivo hip kinematics during clinical exams. J Appl Biomech. 2014 Feb 25 [Epub ahead of print].Google Scholar
  18. 18.
    Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait walking biomechanics of FAI. Gait Posture. 2009;30:41–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Lamontagne M, Kennedy MJ, Beaule PE. The effect of cam FAI on hip and pelvic motion during maximum squat. Clin Orthop Relat Res. 2009;467:645–650.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Lee CB, Clark J. Fluoroscopic demonstration of femoroacetabular impingement during hip arthroscopy. Arthroscopy. 2011;27:994–1004.PubMedCrossRefGoogle Scholar
  22. 22.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.PubMedCrossRefGoogle Scholar
  23. 23.
    Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15:908–914.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–1047.PubMedCrossRefGoogle Scholar
  25. 25.
    Rylander J, Shu B, Favre J, Safran M, Andriacchi T. Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome. J Orthop Res. 2013;31:1461–1468.PubMedCrossRefGoogle Scholar
  26. 26.
    Safran MR, Giordano G, Lindsey DP, Gold GE, Rosenberg J, Zaffagnini S, Giori NJ. Strains across the acetabular labrum during hip motion: a cadaveric model. Am J Sports Med. 2011;39(suppl):92S–102S.PubMedCrossRefGoogle Scholar
  27. 27.
    Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007;25:122–131.PubMedCrossRefGoogle Scholar
  28. 28.
    Wan L, de Asla RJ, Rubash HE, Li G. In vivo cartilage contact deformation of human ankle joints under full body weight. J Orthop Res. 2008;26:1081–1089.PubMedCrossRefGoogle Scholar
  29. 29.
    Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I; Standardization and Terminology Committee of the International Society of Biomechanics. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion: part I. Ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002;35:543–548.Google Scholar
  30. 30.
    Zebala LP, Schoenecker PL, Clohisy JC. Anterior femoroacetabular impingement: a diverse disease with evolving treatment options. Iowa Orthop J. 2007;27:71–81.PubMedCentralPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Ashley L. Kapron
    • 1
    • 2
  • Stephen K. Aoki
    • 1
  • Christopher L. Peters
    • 1
  • Andrew E. Anderson
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  2. 2.Department of BioengineeringUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Physical TherapyUniversity of UtahSalt Lake CityUSA
  4. 4.Scientific Computing and Imaging InstituteUniversity of UtahSalt Lake CityUSA

Personalised recommendations