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The Otto Aufranc Award. On the Etiology of the Cam Deformity: A Cross-sectional Pediatric MRI Study

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain as well as a cause of hip arthritis, yet despite this, little is known about the etiology of the cam morphology or possible risk factors associated with its development.

Questions/purposes

The purposes of our study were to determine when the cam morphology associated with FAI developed in a cross-sectional cohort study of pediatric patients pre- and postphyseal closure using MRI and whether increased activity level during the period of physeal closure is associated with an increased likelihood that the cam deformity will develop.

Methods

Alpha angles were measured at the 3 o’clock (anterior head-neck junction) and 1:30 (anterosuperior head-neck junction) positions in both hips with a cam deformity defined as an alpha angle ≥ 50.5° at the 3 o’clock position. Forty-four volunteers (88 hips) were studied: 23 with open physes (12 females, mean age 9.7 years; 11 males, age 11.7 years) and 21 with closed physes (five females, age 15.2 years; 16 males, age 16.2 years). Daily activity level using the validated Habitual Activity Estimation Scale was compared for patients in whom cam morphology did and did not develop.

Results

None of the 23 (0%) patients prephyseal closure had cam morphology, whereas three of 21 (14%, p = 0.02; all males) postclosure had at least one hip with cam morphology. Daily activity level was higher (p = 0.02) for patients with the cam morphology (7.1 hours versus 2.9 hours). Mean alpha angles at the 3 o’clock head-neck position were 38° (95% confidence interval [CI], 37.2°–39.1°) in the open physes group and 42° (95% CI, 40.16°–43.90°) in the closed physes group; at the 1:30 head-neck position, they were 45° (95% CI, 44.0°–46.4°) in the open physes group and 50° (47.9°–52.3°) in the closed physes group.

Conclusions

The fact that cam morphology was present exclusively in the closed physeal group strongly supports its development during the period of physeal closure with increased activity level as a possible risk factor.

Level of Evidence

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

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References

  1. Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am. 1963;45:1–14.

    PubMed  Google Scholar 

  2. Beaule PE, Zaragoza EJ, Motamedic K, Copelan N, Dorey J. Three-dimensional computed tomography of the hip in the assessment of femoro-acetabular impingement. J Orthop Res. 2005;23:1286–1292.

    PubMed  Google Scholar 

  3. Beck M, Kalhor M, Leunig M, Ganz R. 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. 2005;87:1012–1018.

    Article  CAS  PubMed  Google Scholar 

  4. Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop. 2001;21:549–555.

    CAS  PubMed  Google Scholar 

  5. Fraitzl CR, Kafer W, Nelitz M, Reichel H. Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ. J Bone Joint Surg Br. 2007;89:1592–1596.

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  7. Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Sublinical slipped capital femoral epiphysis. J Bone Joint Surg Am. 1997;79:1489–1497.

    CAS  PubMed  Google Scholar 

  8. Gosvig KK, Jacobsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint:a survey of 4151 subjects of the Copenhagen Osteoarthritis Study. Acta Radiol. 2008;49:436–441.

    Article  CAS  PubMed  Google Scholar 

  9. Hack K, Diprimio G, Rakhra K, Beaule PE. Prevalence of CAM type femoroacetabular impingement in asymptomatic volunteers. J Bone Joint Surg Am. 2010;92:2436–2444.

    Article  PubMed  Google Scholar 

  10. Hay JA. Development and testing of the Habitual Activity Estimation Scale. In: Armstrong N, ed. Children and Exercise XIX. Volume 2006. 2nd ed. Exeter, UK: Singer Press; 1997:125–129.

  11. Hay JA, Cairney J. Development of the Habitual Activity Estimation Scale for clinical research: a systematic approach. Ped Exerc Sci. 2006;18:193–202.

    Google Scholar 

  12. Ito K, Minka-II MA, Leunig S, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. J Bone Joint Surg Br. 2001;83:171–176.

    Article  CAS  PubMed  Google Scholar 

  13. Kamegaya M, Saisu T, Nakamura J, Murakami R, Segawa Y, Wakou M. Drehmann sign and femoro-acetabular impingement in SCFE. J Pediatr Orthop. 2011;31:853–857.

    Article  PubMed  Google Scholar 

  14. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, Peters CL. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS Exhibit Selection. J Bone Joint Surg Am. 2011;93:e111–10.

    Article  Google Scholar 

  15. Kim YJ, Novais EN. Diagnosis and treatment of femoroacetabular impingement in Legg-Calve-Perthes disease. J Pediatr Orthop. 2011;31:S235–S240.

    Article  PubMed  Google Scholar 

  16. Leunig M, Beaule PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res. 2009;467:616–622.

    Article  PubMed  Google Scholar 

  17. Leunig M, Beck M, Dora C, Ganz R. Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade. 2006;35:77–84.

    Article  CAS  PubMed  Google Scholar 

  18. Murray RO, Duncan C. Athletic activity in adolescence as an etiological factor in degenerative hip disease. J Bone Joint Surg Br. 1971;53:406–419.

    CAS  PubMed  Google Scholar 

  19. Naal FD, Miozzari HH, Wyss TF, Notzli HP. Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med. 2011;39:544–550.

    Article  PubMed  Google Scholar 

  20. Ng VY, Ellis TJ. Letter to the editor: the cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469:3506–3507.

    Article  PubMed  Google Scholar 

  21. Ng VY, Ellis TJ. More than just a bump: cam-type femoroacetabular impingement and the evolution of the femoral neck. Hip Int. 2011;21:1–8.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  23. Pfirrmann CW, Mengiardi B, Dora C, Kalverer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characterstic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.

    Article  PubMed  Google Scholar 

  24. Rakhra K, Sheikh AM, Allen DJ, Beaule PE. Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:660–665.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Reichenbach S, Leunig M, Werlen S, Nuesch E, Pfirrmann CW, Bonel H, Odermatt A, Hofstetter W, Ganz R, Juni P. Association between cam-type deformities and magnetic resonance imaging-detected structural hip damage: a cross-sectional study in young men. Arthritis Rheum. 2011;63:4023–4030.

    Article  PubMed  Google Scholar 

  27. Siebenrock KA, Ferner F, Noble PC, Santore RF, Werlen S, Mamisch TC. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469:3229–3240.

    Article  CAS  PubMed  Google Scholar 

  28. Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Cordell LD, Harris WH, Ramsey PL, MacEwen GD, eds. The Hip: Proceedings of the Third Open Scientific Meeting of the Hip Society. St Louis, MO, USA: CV Mosby; 1975:212–228.

    Google Scholar 

  29. Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–177.

    Article  PubMed  Google Scholar 

  30. Wells GD, Wilkes DL, Schneiderman-Walker J, Elmi M, Tullis E, Lands LC, Ratjen F, Coates AL. Reliability and validity of the Habitual Activity Estimation Scale (HAES) in patients with cystic fibrosis. Pediatr Pulmonol. 2008;43:345–353.

    Article  PubMed  Google Scholar 

  31. Wenger DE, Kendall KR, Miner M, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–150.

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the contributions of the Children’s Hospital of Eastern Ontario Bone Health Research Team, Steve Anderson, and Kyle Kemp, who have been integral to the completion of the study.

Author information

Authors and Affiliations

  1. Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Sasha Carsen MD, MBA, Paul J. Moroz MD, MSc, R. Baxter Willis MD & Paul E. Beaulé MD

  2. Department of Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada

    Kawan Rakhra MD & Hal Dunlap MD

  3. Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada

    Paul J. Moroz MD, MSc, Leanne M. Ward MD, Hal Dunlap MD & R. Baxter Willis MD

  4. Brock University, St Catherines, Ontario, Canada

    John A. Hay PhD

  5. The Ottawa Hospital, 501 Smyth Road, CCW 1646, Ottawa, Ontario, K1H 8L6, Canada

    Paul E. Beaulé MD

Authors
  1. Sasha Carsen MD, MBA
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  2. Paul J. Moroz MD, MSc
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  3. Kawan Rakhra MD
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  4. Leanne M. Ward MD
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  5. Hal Dunlap MD
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  6. John A. Hay PhD
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  7. R. Baxter Willis MD
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  8. Paul E. Beaulé MD
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Corresponding author

Correspondence to Paul E. Beaulé MD.

Additional information

This research project was funded through only internal funding, from the Children’s Hospital of Eastern Ontario Bone Health Research Group (LMW) and the Department of Surgery Research Fund (RBW) as well as The Discovery Fund (PEB).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This research was performed at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

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Carsen, S., Moroz, P.J., Rakhra, K. et al. The Otto Aufranc Award. On the Etiology of the Cam Deformity: A Cross-sectional Pediatric MRI Study. Clin Orthop Relat Res 472, 430–436 (2014). https://doi.org/10.1007/s11999-013-2990-y

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  • DOI: https://doi.org/10.1007/s11999-013-2990-y

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