Radiologic Evaluation of the Adolescent Hip

  • Thierry Pauyo
  • Magdalena Tarchala
  • Neil SaranEmail author


Radiologic evaluation of the hip in adolescent patients requires a systematic approach in evaluating the various parameters used to identify and quantify both dysplasia and impingement. In dysplasia, the three-dimensional pathology affecting the acetabulum is evaluated with a two-dimensional image, while in impingement, a static image attempts to capture bony abutment often encountered in dynamic movement or at extremes of range of motion. And yet, plain radiographs manage to provide ample information to make a diagnosis and treatment plan in most cases. This chapter will discuss and illustrate the radiologic parameters utilized to describe acetabular dysplasia and hip impingement in adolescents and young adults.


Hip dysplasia Acetabular retroversion Hip impingement Femoroacetabular impingement Radiographic evaluation Radiographic examination 


  1. 1.
    Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol. 2007;188(6):1540–52.CrossRefGoogle Scholar
  2. 2.
    Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, et al. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–90.CrossRefGoogle Scholar
  3. 3.
    Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85-a(2):278–86.CrossRefGoogle Scholar
  4. 4.
    Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–8.CrossRefGoogle Scholar
  5. 5.
    Nho S, Leunig M, Larson CM, Bedi A, Kelly BT, editors. Hip arthroscopy and hip joint preservation surgery, vol. 1. New York: Springer; 2015.Google Scholar
  6. 6.
    Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77(7):985–9.CrossRefGoogle Scholar
  7. 7.
    Heyman CH, Herndon CH. Legg-Perthes disease; a method for the measurement of the roentgenographic result. J Bone Joint Surg Am. 1950;32 a(4):767–78.CrossRefGoogle Scholar
  8. 8.
    Ipach I, Rondak IC, Sachsenmaier S, Buck E, Syha R, Mittag F. Radiographic signs for detection of femoroacetabular impingement and hip dysplasia should be carefully used in patients with osteoarthritis of the hip. BMC Musculoskelet Disord. 2014;15:150.CrossRefGoogle Scholar
  9. 9.
    Pereira F, Giles A, Wood G, Board TN. Recognition of minor adult hip dysplasia: which anatomical indices are important? Hip Int. 2014;24(2):175–9.CrossRefGoogle Scholar
  10. 10.
    Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81(12):1747–70.CrossRefGoogle Scholar
  11. 11.
    Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48–53.CrossRefGoogle Scholar
  12. 12.
    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466(3):677–83.CrossRefGoogle Scholar
  13. 13.
    Diaz-Ledezma C, Novack T, Marin-Pena O, Parvizi J. The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement. Bone Joint J. 2013;95-b(7):893–9.CrossRefGoogle Scholar
  14. 14.
    Tannast M, Albers CE, Steppacher SD, Siebenrock KA. Hip pain in the young adult. In: Bentley G, editor. European instructional lectures. Vol 11, 2011. 12th EFORT congress, Copenhagen, Denmark. Berlin: Springer; 2011. p. 141–54.Google Scholar
  15. 15.
    Tönnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer; 1987.CrossRefGoogle Scholar
  16. 16.
    Mayo KA, Trumble SJ, Mast JW. Results of periacetabular osteotomy in patients with previous surgery for hip dysplasia. Clin Orthop Relat Res. 1999;363:73–80.CrossRefGoogle Scholar
  17. 17.
    Harris MD, Kapron AL, Peters CL, Anderson AE. Correlations between the alpha angle and femoral head asphericity: implications and recommendations for the diagnosis of cam femoroacetabular impingement. Eur J Radiol. 2014;83(5):788–96.CrossRefGoogle Scholar
  18. 18.
    Nepple JJ, Martel JM, Kim YJ, Zaltz I, Clohisy JC. Do plain radiographs correlate with CT for imaging of cam-type femoroacetabular impingement? Clin Orthop Relat Res. 2012;470(12):3313–20.CrossRefGoogle Scholar
  19. 19.
    Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556–60.CrossRefGoogle Scholar
  20. 20.
    Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(Suppl 4):47–66.CrossRefGoogle Scholar
  21. 21.
    Bardakos NV. Hip impingement: beyond femoroacetabular. J Hip Preserv Surg. 2015;2(3):206–23.CrossRefGoogle Scholar
  22. 22.
    Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT. Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res. 2013;471(8):2497–503.CrossRefGoogle Scholar
  23. 23.
    Larson CM, Moreau-Gaudry A, Kelly BT, Byrd JW, Tonetti J, Lavallee S, et al. Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res. 2015;473(4):1247–54.CrossRefGoogle Scholar
  24. 24.
    Humbert L, Carlioz H, Baudoin A, Skalli W, Mitton D. 3D evaluation of the acetabular coverage assessed by biplanar X-rays or single anteroposterior X-ray compared with CT-scan. Comput Methods Biomech Biomed Engin. 2008;11(3):257–62.CrossRefGoogle Scholar
  25. 25.
    Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J. Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br. 2008;90(11):1428–34.CrossRefGoogle Scholar
  26. 26.
    Hansen BJ, Harris MD, Anderson LA, Peters CL, Weiss JA, Anderson AE. Correlation between radiographic measures of acetabular morphology with 3D femoral head coverage in patients with acetabular retroversion. Acta Orthop. 2012;83(3):233–9.CrossRefGoogle Scholar
  27. 27.
    Dandachli W, UI Islam S, Tippett R, Hall-Craggs MA, Witt JD. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Skelet Radiol. 2011;40(7):877–83.CrossRefGoogle Scholar
  28. 28.
    Reikeras O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand. 1983;54(1):18–23.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Thierry Pauyo
    • 1
    • 2
    • 3
  • Magdalena Tarchala
    • 1
    • 2
    • 3
  • Neil Saran
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryShriners Hospital for Children CanadaMontrealCanada
  2. 2.Department of Paediatric SurgeryThe Montreal Children’s HospitalMontrealCanada
  3. 3.Division of Orthopaedic Surgery, Department of SurgeryMcGill UniversityMontrealCanada

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