A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

Abstract

OBJECTIVE:To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain.METHODS:A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45°, and Ducroquet.RESULTS:A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45° view (p = 0.008). The difference in the α angle in the anteroposterior, Dunn, Dunn 45°, and Ducroquet views for all of the cases studied was p<0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively).CONCLUSIONS:We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45°, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.

Prevalence of Cam Morphology in Females with Femoroacetabular Impingement

“…While these studies suggest that cam deformities are rare in women, they are cross-sectional evaluations of asymptomatic patients and do not represent females who present with symptomatic impingement. Cam lesions can produce significant hip pain and motion restrictions ( 23 , 24 ), and Miguel et al have shown that symptomatic patients have significantly higher α angles compared to asymptomatic controls ( 25 ). Therefore, the prevalence of cam deformities in asymptomatic females may underestimate the prevalence of such deformities in those with symptoms.…”

What is the Prevalence of Radiographic Hip Findings Associated With Femoroacetabular Impingement in Asymptomatic Asian Volunteers?

“…This had led many clinicians to question the prevalence of FAI-related morphologic features in asymptomatic individuals [5,10,17,22,23,26,27]. Studies from Western countries have reported a relatively high prevalence of these findings-up to 66% [5,10,17,22,23,26,27,29]. Based on these studies, the emphasis is shifting to careful and prudent selection of surgical candidates for FAI.…”

“…Based on these studies, the emphasis is shifting to careful and prudent selection of surgical candidates for FAI. Many clinicians agree that FAI is a clinical diagnosis and treatment decisions should not be made based on radiographic findings alone [2,29,32,33,36,39].…”

The Effect of Acetabular Rim Recession on Anterior Acetabular Coverage

“…Little has been studied with regard to both the falseprofile view and the anterior CE angle. In a radiologic study comparing 2 cohorts of patients with asymptomatic and symptomatic hips, Miguel et al 19 noted no statistically significant difference between the groups when using the false-profile view and anterior CE angle criteria.…”