Location of Intra- and Extra-articular Hip Impingement Is Different in Patients With Pincer-Type and Mixed-Type Femoroacetabular Impingement Due to Acetabular Retroversion or Protrusio Acetabuli on 3D CT–Based Impingement Simulation

Lerch, Till; Siegfried, Mathias; Schmaranzer, Florian; Leibold, Christiane Sylvia; Zurmühle, Corinne A.; Hanke, Markus S.; Ryan, Michael K.; Steppacher, Simon D.; Siebenrock, Klaus A.; Tannast, Moritz

doi:10.1177/0363546519897273

Cited by 35 publications

(40 citation statements)

References 72 publications

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“…Our findings suggest that patients with pincer-type FAI due to AR should present with increased iliac external rotation. Theoretically, if these patients are treated with anteverting PAO 30 , 34 to rotate the anterior-inferior iliac spine (AIIS) internally, the recently described extra-articular subspine FAI 37 could potentially be reduced. Patients with pincer-type FAI due to AR showed decreased PI, PT, and SS.…”

Section: Discussionmentioning

confidence: 99%

“…We do not report on parameters for the lumbar or thoracic spine because these were not visible on the pelvic CT scans. In addition, we do not report 3D impingement simulation 37 or clinical outcome because this was beyond the scope of this study. Second, we had a low number of hips with total AR and with high acetabular anteversion.…”

Section: Discussionmentioning

confidence: 99%

“…CT protocol included the entire pelvis, the endplate of S1, and the distal femoral condyles in all hips 37 . The CT scans were performed according to a previously described protocol 37 for calculation of femoral and acetabular version 25 and for preoperative planning. A slice thickness of 2 mm and an interval of reconstruction of 1.7 mm were chosen.…”

Section: Methodsmentioning

confidence: 99%

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Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

et al. 2021

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Aims The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version? Methods A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction. Results PI and PT were significantly decreased comparing AR (PI 42° (SD 10°), PT 4° (SD 5°)) with dysplastic hips (PI 55° (SD 12°), PT 10° (SD 6°)) and with the control group (PI 51° (SD 9°) and PT 13° (SD 7°)) (p < 0.001). External rotation of the iliac wing was significantly increased comparing AR (29° (SD 4°)) with dysplastic hips (20°(SD 5°)) and with the control group (25° (SD 5°)) (p < 0.001). Correlation between external rotation of the iliac wing and acetabular version was significant and strong (r = 0.81; p < 0.001). Correlation between PT and acetabular version was significant and moderate (r = 0.58; p < 0.001). Conclusion These findings could contribute to a better understanding of hip pain in a sitting position and extra-articular subspine FAI of patients with AR. These patients have increased iliac external rotation, a rotational abnormality of the iliac wing. This has implications for surgical therapy with hip arthroscopy and acetabular rim trimming or anteverting periacetabular osteotomy (PAO). Cite this article: Bone Jt Open 2021;2(10):813–824.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

et al. 2021

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“…Recent evidence performed simulated 3D ROM studies in patients with FAI using CT-based models although MRI is established as an ideal substitute also for this purpose [24,51]. In fact, MRI-based 3D models are expected to be adopted in future clinical practice as these allow radiation-free and patient-specific pre-operative 3D impingement simulation for surgical planning and simulation of HPS (Fig.…”

Section: Imaging-based Dynamic Range-of-motion Simulations and Virtual Surgerymentioning

confidence: 99%

Advances in FAI Imaging: a Focused Review

Mascarenhas

Caetano

Dantas

et al. 2020

Curr Rev Musculoskelet Med

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Purpose of Review Femoroacetabular impingement (FAI) is one of the main causes of hip pain in young adults and poses clinical challenges which have placed it at the forefront of imaging and orthopedics. Diagnostic hip imaging has dramatically changed in the past years, with the arrival of new imaging techniques and the development of magnetic resonance imaging (MRI). This article reviews the current state-of-the-art clinical routine of individuals with suspected FAI, limitations, and future directions that show promise in the field of musculoskeletal research and are likely to reshape hip imaging in the coming years. Recent Findings The largely unknown natural disease course, especially in hips with FAI syndrome and those with asymptomatic abnormal morphologies, continues to be a problem as far as diagnosis, treatment, and prognosis are concerned. There has been a paradigm shift in recent years from bone and soft tissue morphological analysis towards the tentative development of quantitative approaches, biochemical cartilage evaluation, dynamic assessment techniques and, finally, integration of artificial intelligence (AI)/deep learning systems. Summary Imaging, AI, and hip preserving care will continue to evolve with new problems and greater challenges. The increasing number of analytic parameters describing the hip joint, as well as new sophisticated MRI and imaging analysis, have carried practitioners beyond simplistic classifications. Reliable evidence-based guidelines, beyond differentiation into pure instability or impingement, are paramount to refine the diagnostic algorithm and define treatment indications and prognosis. Nevertheless, the boundaries of morphological, functional, and AI-aided hip assessment are gradually being pushed to new frontiers as the role of musculoskeletal imaging is rapidly evolving.

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“…FAI is usually believed to be a primary disease, and it may develop as a result of the following: prolonged epiphysis, ossification resulting from congenital abnormalities, infections and autoimmunological reactions, inflammatory diseases, and injuries [3,7]. The development of impingement may be impacted by: extensive femoral antetorsion, acetabular protrusion or retroversion, hip varus or valgus, and femoral fractures [9,10]. The surgical treatment of osteotomy and an overdeveloped greater trochanter are believed to cause secondary FAI [3,5].…”

Section: Introductionmentioning

confidence: 99%

Functional Condition of Patients after Unilateral Hip Arthroscopy in the Process of FAI—Femoroacetabular Impingement: A Case–Control Study and Preliminary Report

Nieszporska

Truszczyńska-Baszak

2021

JCM

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Introduction: Femoroacetabular impingement is a commonly recognized condition among people with hip pain. Aim: The aim of this study was to assess how arthroscopy and physiotherapy treatment influenced the quality of life and functional condition of patients after arthroscopic femoroacetabular impingement (FAI) surgery. Materials and methods: We examined 19 people for the study and included 12 (6 men and 6 women). Their mean age was 40.1 ± 9.7 years. Manual and digital goniometers were used for the range of motion (ROM) measurements, and a dynamometer for muscle strength was used. Results from the operated limb were compared to the nonoperated healthy limb. We examined the patient’s health and well-being using the Harris Hip Score (HHS) and Short-Form Health Survey (SF-36) scales. The mean follow-up period was 21.2 months. Results: The postsurgery mean range of motion for all movements was lower in the operated limb. Statistically significant differences between limbs in ROM were observed for flexion, abduction, extension, and external rotation. Muscle strength was comparable between hip joints, except extension and adduction, which were statistically significantly weaker. The mean strength of the hip flexors and internal rotators was higher in the operated limb. After surgery, 67% of patients returned to exercise at the same or higher level. The mean HHS results were good, with values of 88.00 ± 11.48. The SF-36 scores were >50. Conclusion: After surgery and physiotherapy of FAI, ROM remained lower in the operated limb. Flexion and rotations remained to cause pain. The strength of flexors and internal rotators improved, and there was a high rate of return to sport.

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Location of Intra- and Extra-articular Hip Impingement Is Different in Patients With Pincer-Type and Mixed-Type Femoroacetabular Impingement Due to Acetabular Retroversion or Protrusio Acetabuli on 3D CT–Based Impingement Simulation

Cited by 35 publications

References 72 publications

Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia

Advances in FAI Imaging: a Focused Review

Functional Condition of Patients after Unilateral Hip Arthroscopy in the Process of FAI—Femoroacetabular Impingement: A Case–Control Study and Preliminary Report

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