TY - JOUR
T1 - Radiographic features associated with differing impinging hip morphologies with special attention to coxa profunda
AU - Boone, Gregory
AU - Pagnotto, Michael R.
AU - Walker, Justin A.
AU - Trousdale, Robert T.
AU - Sierra, Rafael J.
PY - 2012/12
Y1 - 2012/12
N2 - Background: Combined with clinical examination and MRI, radiographs have been mainstays in the management femoroacetabular impingement (FAI). Because hip morphology often portends intraoperative damage, radiographic features should inform surgical management. Questions/Purposes: We determined (1) the radiographic features of the various hip morphologies; (2) the prevalence of radiographic coxa profunda in each group; (3) the radiographic differences between hips with and without coxa profunda; and (4) its sensitivity and specificity as a measure of global acetabular overcoverage. Methods: We reviewed preoperative radiographs and operative notes of 144 hips that underwent surgical dislocation and correction for FAI between August 2002 and February 2011. Hips were divided into four FAI subtypes by radiographic analysis (cam, global overcoverage, retroversion, and combined) and three subtypes (cam, pincer, or combined) by intraarticular pathology. Standard radiographic measurements were performed, and we introduce a novel measurement that assesses femoral head coverage. Results: We found differences in median Angle of Sharp, femoral head-neck angle, and median roof length (and its subset) among the FAI morphologies. The prevalence of radiographic coxa profunda was 48% in cam hips, 85% in global overcoverage hips, 66% in retroverted hips, and 32% in combined hips. The sensitivity and specificity of radiographic coxa profunda as a measure of global overcoverage was 75% (95% CI, 0.62-0.85) and 62% (95% CI, 0.51-0.73), respectively. Conclusions: We found major differences in radiographic measurements between FAI morphologies. Radiographic coxa profunda was poorly specific for global overcoverage. Measurement of roof length and ratio should be used to determine the morphology of the impinging hip. Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
AB - Background: Combined with clinical examination and MRI, radiographs have been mainstays in the management femoroacetabular impingement (FAI). Because hip morphology often portends intraoperative damage, radiographic features should inform surgical management. Questions/Purposes: We determined (1) the radiographic features of the various hip morphologies; (2) the prevalence of radiographic coxa profunda in each group; (3) the radiographic differences between hips with and without coxa profunda; and (4) its sensitivity and specificity as a measure of global acetabular overcoverage. Methods: We reviewed preoperative radiographs and operative notes of 144 hips that underwent surgical dislocation and correction for FAI between August 2002 and February 2011. Hips were divided into four FAI subtypes by radiographic analysis (cam, global overcoverage, retroversion, and combined) and three subtypes (cam, pincer, or combined) by intraarticular pathology. Standard radiographic measurements were performed, and we introduce a novel measurement that assesses femoral head coverage. Results: We found differences in median Angle of Sharp, femoral head-neck angle, and median roof length (and its subset) among the FAI morphologies. The prevalence of radiographic coxa profunda was 48% in cam hips, 85% in global overcoverage hips, 66% in retroverted hips, and 32% in combined hips. The sensitivity and specificity of radiographic coxa profunda as a measure of global overcoverage was 75% (95% CI, 0.62-0.85) and 62% (95% CI, 0.51-0.73), respectively. Conclusions: We found major differences in radiographic measurements between FAI morphologies. Radiographic coxa profunda was poorly specific for global overcoverage. Measurement of roof length and ratio should be used to determine the morphology of the impinging hip. Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
UR - http://www.scopus.com/inward/record.url?scp=84871624257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871624257&partnerID=8YFLogxK
U2 - 10.1007/s11999-012-2539-5
DO - 10.1007/s11999-012-2539-5
M3 - Article
C2 - 22926444
AN - SCOPUS:84871624257
SN - 0009-921X
VL - 470
SP - 3368
EP - 3374
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
IS - 12
ER -