Skip to main content

Advertisement

SpringerLink
Log in

The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to evaluate whether the mechanical axis deviation (MAD) of the leg correlates with an increased hip alpha angle as described by Nötzli, which is associated with femoroacetabular impingement (FAI).

Methods

In a retrospective analysis, standing full-length anteroposterior radiographs were analysed in patients who suffered from symptomatic leg alignment. The study included 85 radiographs of 80 patients with an average age of 43.11 years (range 18–60 years). Five patients underwent a bilateral long-leg X-ray examination. All radiographs were transferred as Digital Imaging and Communications in Medicine data files from the Picture Archiving and Communications System into the OrthoPlanner software version 2.3.2. The radiographs were measured by one orthopaedic surgeon and one independent radiologist.

Results

The mean value of the alpha angle of Nötzli was 61.43° (49.07–74.04°). A total of 57 (67 %) radiographs showed a varus deviation, 25 (29.5 %) had a valgus malalignment and three (3.5 %) a straight leg axis. Of 82 radiographs, 40 (48.8 %) had a moderate axis deviation with a MAD <15 or > − 15 mm and a mean alpha angle of 57.81°, and 42 (51.2 %) with extended axis deviation of a MAD > 15 or < − 15 mm had a mean alpha angle of 62.93°; 40 (95.2 %) of these 42 showed an alpha angle > 55°. The alpha angle was significantly increased in extended axis deviation compared to moderate axis deviation (P = 0.001).

Conclusions

This study confirmed that increased alpha angles were found significantly at higher degrees of axis deviation on the full-length radiograph. In cases of a MAD >15 or < − 15 mm and symptomatic coxalgia, diagnostic tests must be pursued for FAI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. Lancet 380(9855):1768–1777

    Article  PubMed  Google Scholar 

  2. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87(7):1012–1018

    Article  CAS  PubMed  Google Scholar 

  3. Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272

    Article  PubMed  Google Scholar 

  4. Leunig M, Ganz R (2005) Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis. Unfallchirurg 108(1):9–10, 12–17

    Article  CAS  PubMed  Google Scholar 

  5. Imam S, Khanduja V (2011) Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop 35(10):1427–1435

    Article  PubMed Central  PubMed  Google Scholar 

  6. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    PubMed  Google Scholar 

  7. Kim WY, Hutchinson CE, Andrew JG, Allen PD (2006) The relationship between acetabular retroversion and osteoarthritis of the hip. J Bone Joint Surg Br 88(6):727–729

    Article  CAS  PubMed  Google Scholar 

  8. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73

    Article  PubMed  Google Scholar 

  9. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560

    Article  PubMed  Google Scholar 

  10. Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R (2004) Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 418:54–60

    Article  PubMed  Google Scholar 

  11. Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, Ganz R (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71:370–375

    Article  CAS  PubMed  Google Scholar 

  12. Snow SW, Keret D, Scarangella S, Bowen JR (1993) Anterior impingement of the femoral head: a late phenomenon of Legg-Calvé-Perthes’ disease. J Pediatr Orthop 13:286–289

    Article  CAS  PubMed  Google Scholar 

  13. Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL (2007) The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res 462:115–121

    Article  PubMed  Google Scholar 

  14. Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2005) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236(2):588–592

    Article  PubMed  Google Scholar 

  15. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M (2013) Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clin Orthop Relat Res Mar 6 [Epub ahead of print]

  16. Brown G, Amendola A (2000) Radiographic evaluation and preoperative planning for high tibial osteotomies. Oper Tech Sports Med 8:2–14

    Article  Google Scholar 

  17. Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E (2007) A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg Br 89(10):1309–1316

    Article  CAS  PubMed  Google Scholar 

  18. Hack K, Di Primio G, Rakhra K, Beaulé PE (2010) Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92(14):2436–2344

    Article  PubMed  Google Scholar 

  19. Pollard TC, Villar RN, Norton MR, Fern ED, Williams MR, Murray DW, Carr AJ (2010) Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. J Bone Joint Surg Br 92(2):209–216

    Article  CAS  PubMed  Google Scholar 

  20. Reichenbach S, Jüni P, Werlen S, Nüesch E, Pfirmann CW, Trelle S, Odermatt A, Hofstetter W, Ganz R, Leunig M (2010) Prevalence of cam-type deformity on hip magnetic resonance imaging in young males: a cross-sectional study. Arthritis Care Res (Hoboken) 62(9):1319–1327

    Article  Google Scholar 

  21. Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V (2012) Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop 36(5):903–914

    Article  PubMed Central  PubMed  Google Scholar 

  22. Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140

    CAS  PubMed  Google Scholar 

  23. Pape D, Seil R, Adam F, Rupp S, Kohn D, Lobenhoffer P (2004) Imaging and preoperative planning of osteotomy of tibial head osteotomy. Orthopade 33(2):122–134

    Article  CAS  PubMed  Google Scholar 

  24. Barton C, Salineros MJ, Rakhra KS, Beaulé PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469

    Article  PubMed  Google Scholar 

  25. Lerch S, Kasperczyk A, Warnecke J, Berndt T, Rühmann O (2013) Evaluation of Cam-type femoroacetabular impingement by ultrasound. Int Orthop 37(5):783–788

    Article  PubMed  Google Scholar 

  26. Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23(6):1286–1292

    PubMed  Google Scholar 

  27. Dudda M, Albers C, Mamisch TC, Werlen S, Beck M (2009) Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin Orthop Relat Res 467(3):651–659

    Article  PubMed  Google Scholar 

  28. Rakhra KS, Sheikh AM, Allen D, Beaulé PE (2009) Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res 467(3):660–665

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Nina Lahner for linguistic support and preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Surgery, St. Josef-Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany

    Matthias Lahner

  2. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany

    Nadine-Lucie Jahnke

  3. Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany

    Sonja Zirke, Wolfram Teske, Gregor Vetter & Christoph von Schulze Pellengahr

  4. Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Hannover, Germany

    Kiriakos Daniilidis

  5. Biomechanics Laboratory Department of Sport and Movement Sciences, University of Duisburg-Essen, Essen, Germany

    Marco Hagen

  6. Faculty of Health Sciences, University of Witten/Herdecke, Witten, Germany

    Lars Victor von Engelhardt

Authors
  1. Matthias Lahner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nadine-Lucie Jahnke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonja Zirke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfram Teske
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregor Vetter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph von Schulze Pellengahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiriakos Daniilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marco Hagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lars Victor von Engelhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Lahner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lahner, M., Jahnke, NL., Zirke, S. et al. The deviation of the mechanical leg axis correlates with an increased hip alpha angle and could be a predictor of femoroacetabular impingement. International Orthopaedics (SICOT) 38, 19–25 (2014). https://doi.org/10.1007/s00264-013-2085-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-2085-0

Keywords

Search

Navigation