Hip Impingement Location in Maximal Hip Flexion in Patients With Femoroacetabular Impingement With and Without Femoral Retroversion

Lerch, Till; Antioco, Tiziano; Boschung, Adam; Meier, Malin; Schmaranzer, Florian; Novais, Eduardo N.; Tannast, Moritz; Steppacher, Simon D.

doi:10.1177/03635465221110887

Cited by 5 publications

(10 citation statements)

References 62 publications

(105 reference statements)

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“…Furthermore, the study results have implications for daily activities and sports: deep flexion during squats should be avoided in patients with femoral retroversion. 21 In addition, femoral retroversion was previously identified for patients with slipped capital femoral epiphysis. 32,41 Subspine impingement could be a problem for those patients as well, but further studies are needed to investigate this.…”

Section: Discussionmentioning

confidence: 99%

Large Hip Impingement Area and Subspine Hip Impingement in Patients With Absolute Femoral Retroversion or Decreased Combined Version

Boschung

Antioco

Novais

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: It remains unclear if femoral retroversion is a contraindication for hip arthroscopy in patients with femoroacetabular impingement (FAI). Purpose: To compare the area and location of hip impingement at maximal flexion and during the FADIR test (flexion, adduction, internal rotation) in FAI hips with femoral retroversion, hips with decreased combined version, and asymptomatic controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-four symptomatic patients (37 hips) with anterior FAI were evaluated. All patients had femoral version (FV) <5° according to the Murphy method. Two subgroups were analyzed: 13 hips with absolute femoral retroversion (FV <0°) and 29 hips with decreased combined version (McKibbin index <20°). All patients were symptomatic and had anterior groin pain and a positive anterior impingement test ; all had undergone pelvic computed tomography (CT) scans to measure FV. The asymptomatic control group consisted of 26 hips. Dynamic impingement simulation of maximal flexion and FADIR test at 90° of flexion was performed with patient-specific CT-based 3-dimensional models. Extra- or intra-articular hip impingement area and location were compared between the subgroups and with control hips using nonparametric tests. Results: Impingement area was significantly larger for hips with decreased combined version (<20°) versus combined version (≥20°) (mean ± SD; 171 ± 140 vs 78 ± 55 mm2; P = .012) and was significantly larger for hips with FV <0° (absolute femoral retroversion) vs FV >0° ( P = .025). Hips with absolute femoral retroversion had a significantly higher frequency of extra-articular subspine impingement versus controls (92% vs 0%; P < .001), compared to 84% of patients with decreased combined version. Intra-articular femoral impingement location was most often (95%) anterosuperior and anterior (2-3 o’clock). Anteroinferior femoral impingement location was significantly different at maximal flexion (anteroinferior [4-5 o’clock]) versus the FADIR test (anterosuperior and anterior [2-3 o’clock]) ( P < .001). Conclusion: Patients with absolute femoral retroversion (FV <0°) had a larger hip impingement area, and most exhibited extra-articular subspine impingement. Preoperative FV assessment with advanced imaging (CT/magnetic resonance imaging) could help to identify these patients (without 3-dimensional modeling). Femoral impingement was located anteroinferiorly at maximal flexion and anterosuperiorly and anteriorly during the FADIR test.

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Section: Discussionmentioning

confidence: 99%

Large Hip Impingement Area and Subspine Hip Impingement in Patients With Absolute Femoral Retroversion or Decreased Combined Version

Boschung

Antioco

Novais

et al. 2023

Orthopaedic Journal of Sports Medicine

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Section: Methodsmentioning

confidence: 99%

“…The methods for 3D modelling and impingement simulation were previously reported. 19,29,30 Before motion was simulated, the neutral position of the pelvis was defined using the anterior pelvic plane (APP). The acetabular reference coordinate system was APP (Table III) using the landmarks of both anterosuperior iliac spines and the pubic tubercles.…”

Section: Methodsmentioning

confidence: 99%

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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

Boschung

Faulhaber

Kiapour

et al. 2023

Bone & Joint Research

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Aims Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients. Methods A retrospective study involving 24 patients (37 hips) with FAI and femoral retroversion (femoral version (FV) < 5° per Murphy method) was performed. All patients were symptomatic (mean age 28 years (SD 9)) and had anterior hip/groin pain and a positive anterior impingement test. Cam- and pincer-type subgroups were analyzed. Patients were compared to an asymptomatic control group (26 hips). All patients underwent pelvic CT scans to generate personalized CT-based 3D models and validated software for patient-specific impingement simulation (equidistant method). Results Mean impingement-free flexion of patients with mixed-type FAI (110° (SD 8°)) and patients with pincer-type FAI (112° (SD 8°)) was significantly (p < 0.001) lower compared to the control group (125° (SD 13°)). The frequency of extra-articular subspine impingement was significantly (p < 0.001) increased in patients with pincer-type FAI (57%) compared to cam-type FAI (22%) in 125° flexion. Bony impingement in maximal flexion was located anterior-inferior at femoral four and five o’clock position in patients with cam-type FAI (63% (10 of 16 hips) and 37% (6 of 10 hips)), and did not involve the cam deformity. The cam deformity did not cause impingement in maximal flexion. Conclusion Femoral impingement in maximal flexion was located anterior-inferior distal to the cam deformity. This differs to previous studies, a finding which could be important for FAI patients in order to avoid exacerbation of hip pain in deep flexion (e.g. during squats) and for hip arthroscopy (hip-preservation surgery) for planning of bone resection. Hip impingement in flexion has implications for daily activities (e.g. putting on shoes), sports, and sex. Cite this article: Bone Joint Res 2023;12(1):22–32.

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Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome

Murphy

Eyles

Spiers

et al. 2023

Journal Orthopaedic Research

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This study sought to explore, in people with symptoms, signs and imaging findings of femoroacetabular impingement (FAI syndrome): (1) whether more severe labral damage, synovitis, bone marrow lesions, or subchondral cysts assessed on magnetic resonance imaging (MRI) were associated with poorer cartilage health, and (2) whether abnormal femoral, acetabular, and/or combined femoral and acetabular versions were associated with poorer cartilage health. This cross‐sectional study used baseline data from the 50 participants with FAI syndrome in the Australian FASHIoN trial (ACTRN12615001177549) with available dGEMRIC scans. Cartilage health was measured using delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) score sampled at the chondrolabral junction on three midsagittal slices, at one acetabular and one femoral head region of interest on each slice, and MRI features were assessed using the Hip Osteoarthritis MRI Score. Analyses were adjusted for alpha angle and body mass index, which are known to affect dGEMRIC score. Linear regression assessed the relationship with the dGEMRIC score of (i) selected MRI features, and (ii) femoral, acetabular, and combined femoral and acetabular versions. Hips with more severe synovitis had worse dGEMRIC scores (partial η2 = 0.167, p = 0.020), whereas other MRI features were not associated. A lower combined femoral and acetabular version was associated with a better dGEMRIC score (partial η2 = 0.164, p = 0.021), whereas isolated measures of femoral and acetabular version were not associated. In conclusion, worse synovitis was associated with poorer cartilage health, suggesting synovium and cartilage may be linked to the pathogenesis of FAI syndrome. A lower combined femoral and acetabular version appears to be protective of cartilage health at the chondrolabral junction.

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Hip Impingement Location in Maximal Hip Flexion in Patients With Femoroacetabular Impingement With and Without Femoral Retroversion

Cited by 5 publications

References 62 publications

Large Hip Impingement Area and Subspine Hip Impingement in Patients With Absolute Femoral Retroversion or Decreased Combined Version

Large Hip Impingement Area and Subspine Hip Impingement in Patients With Absolute Femoral Retroversion or Decreased Combined Version

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

Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome

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