Do Normal Radiographs Exclude Asphericity of the Femoral Head-Neck Junction?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
- Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–1292.
- 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. CrossRef
- Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res. 2007;462:115–121. CrossRef
- Eijer H, Leunig M, Mahomed M, Ganz R. Crosstable lateral radiograph for screening of anterior femoral head-neck offset in patients with femoroacetabular impingement. Hip Int. 2001;11:37–41.
- Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124. CrossRef
- Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
- Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302. CrossRef
- Ito K, Minka MA, 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.
- Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;236:588–592. CrossRef
- Kubo T, Horii M, Harada Y, Noguchi Y, Yutani Y, Ohashi H, Hachiya Y, Miyaoka H, Naruse S, Hirasawa Y. Radial-sequence magnetic resonance imaging in evaluation of acetabular labrum. J Orthop Sci. 1999;4:328–332. CrossRef
- Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res. 2003;413:201–207. CrossRef
- Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–375. CrossRef
- Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. 2004;418:74–80. CrossRef
- Leunig M, Werlen S, Ungersbock A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br. 1997;79:230–234. CrossRef
- Locher S, Werlen S, Leunig M, Ganz R. Inadequate detectability of early stages of coxarthrosis with conventional roentgen images [in German]. Z Orthop Ihre Grenzgeb. 2001;139:70–74. CrossRef
- Locher S, Werlen S, Leunig M, Ganz R. MR-Arthrography with radial sequences for visualization of early hip pathology not visible on plain radiographs [in German]. Z Orthop Ihre Grenzgeb. 2002;140:52–57. CrossRef
- Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.
- 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. CrossRef
- Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785. CrossRef
- Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288. CrossRef
- Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248. CrossRef
- Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278–286.
- Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54–60. CrossRef
- Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY: Springer; 1987.
- Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39–47.
- Werlen S, Leunig M, Ganz R. Magnetic Resonance Arthrography of the hip in femoroacetabular impingement: technique and findings. Oper Tech Orthop. 2005;15:191–203. CrossRef
- Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. With special reference to the complications of osteoarthitis. Acta Chirurgica Scandinavica. 1939;58(Suppl):5–135.
- Yoon LS, Palmer WE, Kassarjian A. Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography. Skeletal Radiol. 2007;36:1029–1033. CrossRef
- Do Normal Radiographs Exclude Asphericity of the Femoral Head-Neck Junction?
Clinical Orthopaedics and Related Research
Volume 467, Issue 3 , pp 651-659
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, 3010, Bern, Switzerland
- 2. Department of Radiology, Hospital Sonnenhof, Bern, Switzerland