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Radiographic Predictors of Hip Pain in Femoroacetabular Impingement

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HSS Journal ®

Abstract

The primary diagnosis of femoroacetabular impingement is based on clinical symptoms, physical exam findings, and radiographic abnormalities. The study objective was to determine the radiographic findings that correlate with and are predictive of hip pain in femoroacetabular impingement (FAI). One hundred prospective patients with unilateral FAI symptoms based on clinical and radiographic findings were included in this study. All patients filled out a WOMAC pain questionnaire. Two independent-blinded surgeons assessed antero-posterior and lateral radiographs for 33 radiographic parameters of FAI. Correlations between pain scores and radiographic findings were calculated. A matched radiographic analysis was performed comparing symptomatic versus asymptomatic hips. Radiograph findings were also compared between males and females. Weak positive correlations were identified between increasing pain scores with radiographic findings of posterior wall dysplasia, presence of a shallow socket, and a more lateral acetabular fossa relative to the Ilioischial line. A symptomatic hip had a lower neck shaft angle, greater distance from Ilioischial line to acetabular fossa and larger distance from cross-over sign to superolateral point of the acetabulum when compared to the asymptomatic hip in the same patient. Symptomatic hips in males had more joint space narrowing, femoral osteophytes, higher alpha angles and larger, more incongruent femoral heads compared to females. Females had more medial acetabular fossa relative to the Ilioischial line and smaller femoral head extrusion index. Similar to other musculoskeletal conditions, radiographic findings of FAI are poor predictors of hip pain.

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Authors and Affiliations

  1. Orthopedic, Schulthess Klinik, Lengghalde 2, CH-8008, Zurich, Switzerland

    Ben Schulz MD, Sebastian F. Baumbach MD & Reinhold Ganz MD

  2. Schulthess Klinik, Joint Center Lower Extremities, Lengghalde 2, CH-8008, Zurich, Switzerland

    Michael Leunig MD

  3. Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Anil S. Ranawat MD & Morteza Meftah MD

Authors
  1. Anil S. Ranawat MD
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  2. Ben Schulz MD
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  3. Sebastian F. Baumbach MD
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  4. Morteza Meftah MD
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  5. Reinhold Ganz MD
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  6. Michael Leunig MD
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Correspondence to Anil S. Ranawat MD.

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

Institutional Review Board was obtained. Informed consent was given prior to inclusion in this study by all patients. This study was carried out in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA).

Levels of Evidence: III

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Ranawat, A.S., Schulz, B., Baumbach, S.F. et al. Radiographic Predictors of Hip Pain in Femoroacetabular Impingement. HSS Jrnl 7, 115–119 (2011). https://doi.org/10.1007/s11420-010-9192-x

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  • DOI: https://doi.org/10.1007/s11420-010-9192-x

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