The lateral view head-neck index (LVHNI): A diagnostic tool for the sequelae of slipped capital femoral epiphysis

Murgier, Jérôme; Chiron, Philippe; Cavaignac, Étienne; Espié, A.; Bayle-Iniguez, Xavier; Lepage, Benoît

doi:10.1016/j.otsr.2013.03.020

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…1). Such a slip-like morphology has already been described in previous studies based on an osteologic collection [7] or conventional radiographs [13,15]. Drawbacks of these studies included lack of clinical information [7], a potential influence of secondary degenerative changes [14], and/or the use of two-dimensional (2-D) plain radiography [13,14] to evaluate a threedimensional (3-D) problem.…”

Section: Introductionmentioning

confidence: 78%

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Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

Albers

Steppacher

Haefeli

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background In some hips with cam-type femoroacetabular impingement (FAI), we observed a morphology resembling a more subtle form of slipped capital femoral epiphysis (SCFE). Theoretically, the morphology in these hips should differ from hips with a primary cam-type deformity. Questions/purposes We asked if (1) head-neck offset; (2) epiphyseal angle; and (3) tilt angle differ among hips with a slip-like morphology, idiopathic cam, hips after in situ pinning of SCFE, and normal hips; and (4) what is the prevalence of a slip-like morphology among cam-type hips?Methods We retrospectively compared the three-dimensional anatomy of hips with a slip-like morphology (29 hips), in situ pinning for SCFE (eight hips), idiopathic cam deformity (171 hips), and 30 normal hips using radial MRI arthrography. Normal hips were derived from 17 asymptomatic volunteers. All other hips were recruited from a series of 277 hips (243 patients) seen at a specialized academic hip center between 2006 and 2010. Forty-one hips with isolated pincer deformity were excluded. Thirtysix of 236 hips had a known cause of cam impingement (secondary cam), including eight hips after in situ pinning of SCFE (postslip group). The 200 hips with a primary cam were separated in hips with a slip-like morphology (combination of positive fovea sign [if the neck axis did not intersect with the fovea capitis] and a tilt angle [between the neck axis and perpendicular to the basis of the epiphysis] exceeding 4°) and hips with an idiopathic cam. We evaluated offset ratio, epiphyseal angle (angle between the neck axis and line connecting the center of the femoral head and the point where the physis meets the articular surface), and tilt angle circumferentially around the femoral head-neck axis. Prevalence of slip-like morphology was determined based on the total of 236 hips with cam deformities. Results Offset ratio was decreased anterosuperiorly in idiopathic cam, slip-like, and postslip (eg, 1 o'clock position with a mean offset ranging from 0.00 to 0.14; p \ 0.001 for all groups) compared with normal hips Conclusions The slip-like morphology is the second most frequent pathomorphology in hips with primary cam deformity. MRI arthrography of the hip allows identifying a slip-like morphology, which resembles hips after in situ pinning of SCFE and distinctly differs from hips with idiopathic cam. These results support previous studies reporting that SCFE might be a risk factor for cam-type FAI. Level of Evidence Level III, prognostic study.

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Section: Introductionmentioning

confidence: 78%

“…5). [13] The epiphyseal angle can be used as a measure for head tilt or epiphyseal overgrowth [20]. It was constructed by the true femoralneck axis and a line through the center of the femoral head and the point where the physis meets the articular surface ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

Albers

Steppacher

Haefeli

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The primary outcome was the LVHNI; a value ≥ 9% was evidence of SUFE-like deformity. 17 Secondary outcomes were the α angle 24 and the Tönnis OA stage. 29 Automated digital measurements of each hip were taken using Pictin imaging software (Aria Sarl, Houdain, France), into which the various required measurements had been integrated.…”

Section: Methodsmentioning

confidence: 99%

“…In most cases, the origin of FAI is uncertain, meaning that it is usually termed primary hip impingement. 16 We developed a radiological measurement tool called the lateral view head-neck index (LVHNI) 17 and used it to detect SUFE-like deformity, which is surprisingly common and often goes undetected in teenagers. 18 It seems difficult to relate such a morphological abnormality to an asymptomatic pathology during childhood or adolescence; however, several studies have reported the presence of FAI following SUFE [19][20][21] ; none have looked into the frequency of residual SUFE-like deformities in symptomatic patients.…”

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confidence: 99%

The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoroacetabular impingement

Murgier¹,

Reina²,

Cavaignac³

et al. 2014

The Bone & Joint Journal

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Slipped upper femoral epiphysis (SUFE) is one of the known causes of cam-type femoroacetabular impingement (FAI). The aim of this study was to determine the proportion of FAI cases considered to be secondary to SUFE-like deformities. We performed a case-control study on 96 hips (75 patients: mean age 38 years (15.4 to 63.5)) that had been surgically treated for FAI between July 2005 and May 2011. Three independent observers measured the lateral view head-neck index (LVHNI) to detect any SUFE-like deformity on lateral hip radiographs taken in 45° flexion, 45° abduction and 30° external rotation. A control group of 108 healthy hips in 54 patients was included for comparison (mean age 36.5 years (24.3 to 53.9). The impingement group had a mean LVHNI of 7.6% (16.7% to -2%) versus 3.2% in the control group (10.8% to -3%) (p < 0.001). A total of 42 hips (43.7%) had an index value > 9% in the impingement group versus only six hips (5.5%) in the control group (p < 0.001). The impingement group had a mean α angle of 73.9° (96.2° to 53.4°) versus 48.2° (65° to 37°) in the control group (p < 0.001). Our results suggest that SUFE is one of the primary aetiological factors for cam-type FAI.

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“…However, some authors believe it useful and even superior to other radiographic incidences for FAI [12,16]. Several studies have demonstrated the values of interest [2,4,5,[17][18][19]. One of its advantages is that there is no accurate coding for the classic FL.…”

Section: Discussionmentioning

confidence: 99%

Modified head-neck offset for diagnosing anterior femoro-acetabular impingement

Espié

Elia²,

Murgier³

et al. 2015

International Orthopaedics (SICOT)

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The lateral view head-neck index (LVHNI): A diagnostic tool for the sequelae of slipped capital femoral epiphysis

Abstract: Level IV, prospective diagnostic study without control group.

Cited by 9 publications

References 30 publications

Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoroacetabular impingement

Modified head-neck offset for diagnosing anterior femoro-acetabular impingement

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