Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects

Diesel, Cristiano Valter; Ribeiro, Tiango Aguiar; Coussirat, C.; Scheidt, Rodrigo Benedet; Macedo, Carlos Alberto Souza

doi:10.1302/0301-620x.97b4.34577

Cited by 32 publications

(23 citation statements)

References 49 publications

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“…However, coxa profunda sign was found as a common radiographic finding even in healthy and asymptomatic subjects, so it was considered as a benign alteration in the hip morphology as well as a nonspecific radiographic indicator of pincer type FAI. [16,17] The findings of our study including limited number of cases are not compatible with the ones of the previously mentioned studies. We believe that coxa profunda sign needs to be revisited in larger FAI case series including symptomatic and surgically treated patients.…”

Section: Discussioncontrasting

confidence: 97%

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

İnan

Harmanşa

Ömeroğlu

2016

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada tek bir merkezde güvenli cerrahi kalça dislokasyonu (GCKD) tekniği kullanılarak karışık tipteki femoroasetabüler sıkışma (FAS) tedavisinde edinilen deneyim değerlendirildi. Hastalar ve yöntemler: Çalışmada Ekim 2009 -Ekim 2014 tarihleri arasında kliniğimizde GCKD tekniği ile tedavi edilen 21 hastanın (7 erkek, 14 kadın; ort. yaş 33.8±10.6 yıl; dağılım 19-52 yıl) 22 kalçası geriye dönük olarak değerlendirildi. Ameliyat öncesi ve son Harris kalça skorları (HKS) ve alfa açıları karşılaştırıldı. Yaş, cinsiyet, taraf, sıkışma testleri, ameliyat öncesi HKS, tümsek ve kıskaç tip FAS radyografik göstergeleri ve ameliyat sırasındaki eklem bulguları en son işlevsel sonuçlar üzerindeki etkileri yönünden değerlendirildi. Bulgular: Semptomların ortalama süresi 29.5 aydı. Kalçanın fleksiyonu ve iç rotasyonu ile ortaya çıkan kasık ağrısı başlıca semptomdu. Tüm kalçalara radyografik olarak "karışık tipte FAS" tanısı konuldu. Yirmi iki kalçanın ortalama izlem süresi 48 aydı. Ameliyat öncesi ve en son ortalama HKS arasındaki farklılık istatistiksel olarak anlamlıydı (60.0'a karşın 87.6 puan, p<0.001). Yirmi iki kalçadan ortalama HKS'si 95.0 puan olan 17 kalçada (%77) tedavi yeterli olarak değerlendirildi. Ameliyat öncesi HKS'si 60 puanın altında olan kalçalar yetersiz sonuca biraz daha fazla yatkındı. Araştırılan hasta bağımlı, klinik, radyografik değişkenler ve ameliyat sırasındaki eklem bulguları içinde düz bir grafideki koksa profunda belirtisi daha yüksek bir yetersiz sonuç oranı ile ilişkili bulundu (p= 0.040). Sonuç: Güvenli cerrahi kalça dislokasyonu işlemi ortalama dört yıllık izlem sonrasında %77'lik bir başarı oranına sahiptir. Koksa profunda belirtisi yetersiz klinik sonuç ile bağlantılıdır. Ameliyat öncesi 60 puanın altındaki bir HKS klinik sonuç üzerinde negatif belirleyici bir değişken olarak görünmektedir.Anahtar sözcükler: Femoroasetabüler sıkışma; işlevsel sonuç; cerrahi kalça dislokasyonu; tedavi. ABSTRACT Objectives:This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. Patients and methods: In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Results: Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 8...

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Section: Discussioncontrasting

confidence: 97%

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

İnan

Harmanşa

Ömeroğlu

2016

Eklem Hastalik Cerrahisi

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“…1,2 Specifically, there has not been any study on whether or not the hip capsule is thickened in diseased hips requiring surgery compared with normal hips.…”

Section: Introductionmentioning

confidence: 99%

Is the hip capsule thicker in diseased hips?

Rakhra

Bonura

Nairn³

et al. 2016

Bone & Joint Research

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ObjectivesThe purpose of this study was to compare the thickness of the hip capsule in patients with surgical hip disease, either with cam-femoroacetabular impingement (FAI) or non-FAI hip pathology, with that of asymptomatic control hips.MethodsA total of 56 hips in 55 patients underwent a 3Tesla MRI of the hip. These included 40 patients with 41 hips with arthroscopically proven hip disease (16 with cam-FAI; nine men, seven women; mean age 39 years, 22 to 58) and 25 with non-FAI chondrolabral pathology (four men, 21 women; mean age 40 years, 18 to 63) as well as 15 asymptomatic volunteers, whose hips served as controls (ten men, five women; mean age 62 years, 33 to 77). The maximal capsule thickness was measured anteriorly and superiorly, and compared within and between the three groups with a gender subanalysis using student’s t-test. The correlation between alpha angle and capsule thickness was determined using Pearson’s correlation coefficient.ResultsSuperiorly, the hip capsule was significantly greater in cam- (p = 0.028) and non-FAI (p = 0.048) surgical groups compared with the asymptomatic group. Within groups, the superior capsule thickness was significantly greater than the anterior in cam- (p < 0.001) and non-FAI (p < 0.001) surgical groups, but not in the control group. There was no significant correlation between the alpha angle and capsule thickness. There were no gender differences identified in the thickness of the hip capsule.ConclusionThe thickness of the capsule does not differ between cam- and non-FAI diseased hips, and thus may not be specific for a particular aetiology of hip disease. The capsule is, however, thicker in diseased surgical hips compared with asymptomatic control hips.Cite this article: K. S. Rakhra, A. A. Bonura, R. Nairn, M. E. Schweitzer, N. M. Kolanko, P. E. Beaule. Is the hip capsule thicker in diseased hips? Bone Joint Res 2016;5:586–593. DOI: 10.1302/2046-3758.511.2000495.

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“…A study by Diesel et al found coxa profunda in 77% of asymptomatic volunteers, as demonstrated on radiography, with an increased prevalence in women. 37 Nepple et al reported evidence of coxa profunda in 76% in a retrospective study with 33 asymptomatic patients who received radiographs for nonhip-related indications. 38 This led them to conclude that coxa profunda is a nonspecific finding and not useful in the diagnosis of pincer FAI.…”

Section: Discussionmentioning

confidence: 99%

Pincer‐type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement

Bensler

Dietrich

Zubler

et al. 2018

Magnetic Resonance Imaging

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Background In daily routine, pincer femoroacetabular impingement (FAI) findings are often seen without a clinical diagnosis of pincer FAI. Purpose To assess the presence of pincer FAI MRI findings in asymptomatic volunteers with negative impingement test versus patients with clinically confirmed FAI. Study Type Case–control study. Population Sixty‐three asymptomatic volunteers and 63 matched patients with FAI were included. Field Strength/ Sequence A coronal T1‐weighted turbo spin‐echo sequence as well as a 3D oblique transverse water‐excitation true fast imaging sequence at 1.5T. Assessment The volunteers underwent standard MRI of the hip, and patients underwent MR arthrography of the symptomatic hip using the same MR sequences. Measurements of cranial acetabular version, acetabular depth, and lateral center‐edge angle were performed independently by three fellowship‐trained musculoskeletal radiologists. Statistical Tests Descriptive statistics, Mann–Whitney U‐test, Unpaired t‐test, receiver operating characteristics (ROC), Intraclass correlation coefficient (ICC). Results Forty‐one percent (26/63, reader 1), 32% and 37% (20 and 23/63, reader 2/3) of asymptomatic volunteers had at least one positive MR finding for pincer‐FAI. Patients with pincer or mixed‐type FAI had cranial retroversion of the acetabulum of –0.2° ± 7.1 (mean ± standard deviation) for reader 1 and –0.3° ± 5.5/–0.2° ± 4.8 for reader 2 / reader 3, while asymptomatic volunteers had an anteversion of 6.2° ± 6.4 (reader 1) and 3.2° ± 4.9/3.1° ± 6.5 (readers 2/3): This difference was statistically significant (P ≤ 0.002), but there was a large overlap between the groups. Acetabular depth measurements were very similar for patients with either pincer or mixed‐type FAI (5.1–5.3 mm ± 3.1) and volunteers (5.2–6.1 mm ± 2.6), without a statistically significant difference (P ≤ 0.50). Lateral center‐edge angle was also similar in patients with either pincer or mixed‐type FAI (32.1–35.1° ± 9.1) and volunteers (30.7–33.2° ± 6.5), without a statistically significant difference (P ≤ 0.28). Data Conclusion There is a large overlap in pincer‐type MRI findings between patients with symptomatic FAI and asymptomatic volunteers. More than a third of volunteers exhibited at least one positive pincer‐type MRI finding. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1296–1303.

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Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects

Cited by 32 publications

References 49 publications

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

Is the hip capsule thicker in diseased hips?

Pincer‐type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement

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