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Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular impingement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear.

Questions/purposes

We therefore determined the reliability of CT assessment of FAI and whether CT findings of hip disease predict arthroscopic findings.

Methods

We retrospectively assessed the preoperative CT scans of 118 patients who underwent primary hip arthroscopy. Intraoperative findings, including size of the cam lesion, presence of an acetabular labral articular disruption lesion, and one of four types of labral tear were recorded and compared with the retrospectively read CT findings.

Results

Agreement analysis between CT and intraoperative detection of FAI yielded kappa values of 0.48 for cam lesions and 0.16 for pincer lesions. Increasing values for the CT-based alpha angle correlated with increasing severity of arthroscopically assessed acetabular labral articular disruption grade. Each pattern of FAI predicted a specific labral tear type.

Conclusions

Our data suggest CT has moderate value in predicting mechanically based labral tear patterns, although better parameters for assessment of pincer lesions are needed. Diagnostic assessment of patients with suspected FAI may be improved with use of 3D CT.

Level of Evidence

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Steven Albert MD, Douglas Decorato MD, Robert Ludwig MD, and Gavin L. Duke MD for assistance in evaluating CT scans for this study.

Author information

Authors and Affiliations

  1. Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Benton E. Heyworth MD

  2. Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mark M. Dolan MD

  3. Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA

    Joseph T. Nguyen MPH

  4. Philadelphia Hand Center, Philadelphia, PA, USA

    Neal C. Chen MD

  5. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell School of Medicine, New York, NY, USA

    Bryan T. Kelly MD

Authors
  1. Benton E. Heyworth MD
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  2. Mark M. Dolan MD
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  3. Joseph T. Nguyen MPH
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  4. Neal C. Chen MD
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  5. Bryan T. Kelly MD
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Corresponding author

Correspondence to Benton E. Heyworth MD.

Additional information

One author (BTK) has consultancies (Pivot Medical – Sunnyvale, CA; A2 Medical – Dallas, TX; Smith and Nephew Endoscopy – Andover, MA) and stock ownership (Pivot Medical – Sunnyvale, CA) that may pose a conflict of interest. All other authors certify that neither he, nor a member of their immediate family, has consultancies, stock ownership, equity interest, or patent/licensing arrangements in any companies that may pose a conflict of interest.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at the Hospital for Special Surgery, New York, NY, USA.

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Heyworth, B.E., Dolan, M.M., Nguyen, J.T. et al. Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy. Clin Orthop Relat Res 470, 1950–1957 (2012). https://doi.org/10.1007/s11999-012-2331-6

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  • DOI: https://doi.org/10.1007/s11999-012-2331-6

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