Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI

Abstract

Background Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI). Questions/purposes We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI. Methods Surface models based on CT scan reconstructions of 13 valgus hips with increased antetorsion, 22 hips with FAI, and 27 normal hips were included. Validated three-dimensional collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and the femoral sides. Results Hips with coxa valga and antetorsion showed decreased extension, external rotation, and adduction, whereas internal rotation in 90°of flexion was increased. Impingement zones were more anteroinferior on the femur and posteroinferior on the acetabular (pelvic) side; and the zones were more frequently extraarticular, posterior, or to a lesser degree anterior against the inferior iliac spine. We found a higher prevalence of extraarticular impingement for valgus hips with increased antetorsion. Conclusions Valgus hips with increased antetorsion predispose to posterior extraarticular FAI and to a lesser degree anteroinferior spine impingement. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

“…The impingement conflict occurs between the greater or lesser trochanter on the femoral side and the ischium or supraacetabular ilium on the pelvic side [42]. Extraarticular impingement is rarely reported but can occur with complex deformities of the proximal femur [1,18,38]. The deformities are often the sequelae of Legg-Calvé-Perthes disease (LCPD) or ''Perthes-like'' deformities such as sequelae of slipped capital femoral epiphysis (SCFE), postseptic arthritis, and trauma [1,2,23,37].…”

Current concepts and trends for operative treatment of FAI: hip arthroscopy

“…In fact, in a recent unpublished study looking at more than 400 CT scans in asymptomatic hips, a positive posterior wall sign (30 %) and acetabular retroversion (15 %) were common findings in asymptomatic hips and more common in males indicating that these imaging findings may be normal variants for a number of patients (Larson CM, et al, unpublished data). As noted previously, increased femoral antetorsion predisposed to posterior extra-articular impingement using 3D CT motion analysis software [17]. In addition, a recent study looked at femoral version in a cohort of 67 consecutive arthroscopic psoas tenotomies [21].…”

“…Anterior trochanteric impingement with flexion internal rotation can be seen in the setting of relative femoral retroversion whereas posterior trochanteric impingement with external rotation can be seen in the setting of increased femoral anteversion. A recent study using 3D CT scan motion analysis evaluated 13 hips with valgus hips and increased antetorsion compared with 22 hips with FAI and 27 normal hips [17]. Hips with coxa valga and increased antetorsion had impingement zones that were more frequently posterior and extra-articular and to a lesser extent anterior against the AIIS [17].…”

“…A recent study using 3D CT scan motion analysis evaluated 13 hips with valgus hips and increased antetorsion compared with 22 hips with FAI and 27 normal hips [17]. Hips with coxa valga and increased antetorsion had impingement zones that were more frequently posterior and extra-articular and to a lesser extent anterior against the AIIS [17]. Dynamic ultrasound can assist in the diagnosis, and open trochanteric transfer procedures have been recommended for persistent limiting symptoms.…”

Current concepts in the diagnosis and management of extra-articular hip impingement syndromes

“…Compared with a quadratus femoris tear where oedema is more concentrated at the musculotendinous junction, in ischiofemoral impingement, the oedema in the quadratus femoris is more diffuse and the muscle fibres are not disrupted [3]. [6] Woman gender (increased width of pelvis) [7][8][9][10] Coxa profunda [2] Coxa valga [11] Valgus hip due to proximal femoral osteotomy [2] Legg-Calve-Perthes disease [12] Total hip replacement with reduced femoral offset or medialized socket [2] Peritrochanteric fractures with involvement of lesser trochanter [2] Abductor muscle injury causing uncompensated hip adduction during gait [8,10] Multiple or isolated exostoses [6] The mainstay of treatment in these patients is non-operative with rest, modification of activities and anti-inflammatories. CT-guided local anaesthetic and steroid injection around the quadratus femoris may also relieve pain [7,9].…”