, Volume 470, Issue 12, pp 3368-3374
Date: 25 Aug 2012

Radiographic Features Associated With Differing Impinging Hip Morphologies With Special Attention to Coxa Profunda

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Abstract

Background

Combined with clinical examination and MRI, radiographs have been mainstays in the management femoroacetabular impingement (FAI). Because hip morphology often portends intraoperative damage, radiographic features should inform surgical management.

Questions/Purposes

We determined (1) the radiographic features of the various hip morphologies; (2) the prevalence of radiographic coxa profunda in each group; (3) the radiographic differences between hips with and without coxa profunda; and (4) its sensitivity and specificity as a measure of global acetabular overcoverage.

Methods

We reviewed preoperative radiographs and operative notes of 144 hips that underwent surgical dislocation and correction for FAI between August 2002 and February 2011. Hips were divided into four FAI subtypes by radiographic analysis (cam, global overcoverage, retroversion, and combined) and three subtypes (cam, pincer, or combined) by intraarticular pathology. Standard radiographic measurements were performed, and we introduce a novel measurement that assesses femoral head coverage.

Results

We found differences in median Angle of Sharp, femoral head-neck angle, and median roof length (and its subset) among the FAI morphologies. The prevalence of radiographic coxa profunda was 48% in cam hips, 85% in global overcoverage hips, 66% in retroverted hips, and 32% in combined hips. The sensitivity and specificity of radiographic coxa profunda as a measure of global overcoverage was 75% (95% CI, 0.62–0.85) and 62% (95% CI, 0.51–0.73), respectively.

Conclusions

We found major differences in radiographic measurements between FAI morphologies. Radiographic coxa profunda was poorly specific for global overcoverage. Measurement of roof length and ratio should be used to determine the morphology of the impinging hip.

Level of Evidence

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

One of the authors (RJS) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of $10,000 from Biomet Inc (Warsaw, IN, USA). One of the authors (RTT) certifies has or may receive payments or benefits, in any one year, an amount in excess of $100,000 from DePuy Orthopaedics (Warsaw, IN, USA) and less than $10,000 from Mako Surgical (Fort Lauderdale, FL, USA) and Wright Medical (Arlington, TN, USA). No other authors have any conflicts.
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.