Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Boschung, Adam; Faulhaber, Senta; Kiapour, Ata; Kim, Young-Jo; Novais, Eduardo N.; Steppacher, Simon D.; Tannast, Moritz; Lerch, Till

doi:10.1302/2046-3758.121.bjr-2022-0263.r1

Cited by 3 publications

(3 citation statements)

References 61 publications

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“…This would increase the risk of anterior femoroacetabular impingement (FAI), given the established association between reduced femoral torsion and anterior FAI [28]. In their recent study, Boschung et al successfully identified the areas of conflict around the hip joint in deep hip flexion for patients with reduced femoral torsion [1]. This conflict is prevented in individuals with increased femoral anteversion when MPTA is decreased.…”

Section: Discussionmentioning

confidence: 99%

Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4

Ziegenhorn,

Kirschberg,

Heinecke

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type.MethodsFive hundred patients (1000 legs) were included, who received a whole leg standing three‐dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip–knee–ankle angle (aHKA) and joint‐line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK.ResultsThe mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion.ConclusionThere is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4

Ziegenhorn,

Kirschberg,

Heinecke

et al. 2024

Knee surg. sports traumatol. arthrosc.

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show abstract

Section: Discussionmentioning

confidence: 99%

“…2,30,35 Femoral retroversion alters the pattern of impingement, with the contact of the acetabular rim with the anteroinferior femoral neck, which should be considered during surgical planning. 29,36 Nonetheless, there is some concern that cam resection without capsular closure could increase joint microinstability due to the disruption of the labral seal in deep flexion. 37 The FEA studies showed that cam FAI results in substantially elevated CP, 7,8,10,11 and in a DEA study the peak contact stress normalized after accurate arthroscopic cam correction.…”

Section: Labrum and Fai Pathomorphologymentioning

confidence: 99%

Hip joint contact pressure and force: a scoping review of in vivo and cadaver studies

Dantas,

Gonçalves,

Grenho

et al. 2023

Bone Joint Res

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AimsResearch on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters.MethodsWe used the PRISMA extension for scoping reviews for this literature search in three databases. After screening, 16 studies were included for the final analysis.ResultsThe studies assessed different hip conditions like labrum status, the biomechanical effect of the cam, femoral version, acetabular coverage, and the effect of rim trimming. The testing and loading conditions were also quite diverse, and this disparity limits direct comparisons between the different researches. With normal anatomy the mean contact pressures ranged from 1.54 to 4.4 MPa, and the average peak contact pressures ranged from 2 to 9.3 MPa. Labral tear or resection showed an increase in contact pressures that diminished after repair or reconstruction of the labrum. Complete cam resection also decreased the contact pressure, and acetabular rim resection of 6 mm increased the contact pressure at the acetabular base.ConclusionTo date there is no standardized methodology to access hip contact biomechanics in hip arthroscopy, or with the preservation of the periarticular soft-tissues. A tendency towards improved biomechanics (lower contact pressures) was seen with labral repair and reconstruction techniques as well as with cam correction.Cite this article: Bone Joint Res 2023;12(12):712–721.

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Sex-Based Differences and Asymmetry in Hip Kinematics During Unilateral Extension From Deep Hip Flexion

Johnson,

Ruh,

Frankston

et al. 2024

Journal of Biomechanical Engineering

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The purpose of this study was to identify side-to-side and sex-based differences in hip kinematics during a unilateral step-up from deep flexion. Twelve (8 men, 4 women) asymptomatic young adults performed a step ascent motion while synchronized biplane radiographs of the hip were collected at 50 images per second. Femur and pelvis position were determined using a validated volumetric model-based tracking technique that matched digitally reconstructed radiographs created from subject-specific computed tomography (CT) bone models to each pair of synchronized radiographs. Hip kinematics and side-to-side differences were calculated and a linear mixed effects model evaluated sex-based differences. Women were on average 10.2° more abducted and 0.2mm more medially translated than men across the step up motion (p<0.001). Asymmetry between hips was up to 14.1 ± 12.1° in internal rotation and 1.3 ± 1.4mm in translation. This dataset demonstrates the inherent asymmetry during movements involving unilateral hip extension from deep flexion and may be used provide context for observed kinematics differences following surgery or rehabilitation. Previously reported kinematic differences between total hip arthroplasty and contralateral hips may be well within the natural side-to-side differences that exist in asymptomatic native hips.

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Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion

Cited by 3 publications

References 61 publications

Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4

Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4

Hip joint contact pressure and force: a scoping review of in vivo and cadaver studies

Sex-Based Differences and Asymmetry in Hip Kinematics During Unilateral Extension From Deep Hip Flexion

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