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Do Normal Radiographs Exclude Asphericity of the Femoral Head-Neck Junction?

  • Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Asphericity of the femoral head-neck junction is one cause for femoroacetabular impingement of the hip. However, the asphericity often is underestimated on conventional radiographs. This study compares the presence of asphericity on conventional radiographs with its appearance on radial slices of magnetic resonance arthrography (MRA). We retrospectively reviewed 58 selected hips in 148 patients who underwent a surgical dislocation of the hip. To assess the circumference of the proximal femur, alpha angle and height of asphericity were measured in 14 positions using radial slices of MRA. The hips were assigned to one of four groups depending on the appearance of the head-neck junction on anteroposterior pelvic and lateral crosstable radiographs. Group I (n = 19) was circular on both planes, Group II (n = 19) was aspheric on the crosstable view, Group III (n = 4) was aspheric on the anteroposterior view, and Group IV (n = 13) was aspheric on both views. In all four groups, the highest alpha angle was found in the anterosuperior area of the head-neck junction. Even when conventional radiographs appeared normal, an increased alpha angle was present anterosuperiorly. Without the use of radial slices in MRA, the asphericity would be underestimated in these patients.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Simon Steppacher, MD, Dept. of Orthopaedic Surgery, Inselspital, University of Berne, Switzerland and New England Baptist Hospital, Tufts University, Boston, USA and Moritz Tannast, MD, Dept. of Orthopaedic Surgery, Inselspital, University of Berne, Switzerland for help with the figures. Gert Muhr, MD, Professor of Surgery, Surgeon in Chief, Dept. of Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany supported my Fellowships at Childrens Hospital Boston, Harvard Medical School, USA and Inselspital Berne, University of Berne, Switzerland.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010, Bern, Switzerland

    Marcel Dudda MD, Christoph Albers MD, Tallal Charles Mamisch MD & Martin Beck MD

  2. Department of Radiology, Hospital Sonnenhof, Bern, Switzerland

    Stefan Werlen MD

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  1. Marcel Dudda MD
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  2. Christoph Albers MD
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  3. Tallal Charles Mamisch MD
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  4. Stefan Werlen MD
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  5. Martin Beck MD
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Correspondence to Marcel Dudda MD.

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Each author certifies that he has no commercial association (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Dudda, M., Albers, C., Mamisch, T.C. et al. Do Normal Radiographs Exclude Asphericity of the Femoral Head-Neck Junction?. Clin Orthop Relat Res 467, 651–659 (2009). https://doi.org/10.1007/s11999-008-0617-5

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  • DOI: https://doi.org/10.1007/s11999-008-0617-5

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