Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement

  • Kailai Zhang
  • Darren de SA
  • Hang Yu
  • Hema Nalini Choudur
  • Nicole Simunovic
  • Olufemi Rolland Ayeni
Hip

Abstract

Purpose

Femoroacetabular impingement (FAI) is a clinical entity of the hip causing derangements in range of motion, pain, gait, and function. Computer-assisted modeling and clinical studies suggest that patients with FAI have increased capsular thickness compared to those without.A retrospective chart review was performed to assess relationships between capsular thickness, hip range of motion, and demographic factors in patients with FAI.

Methods

Local Research Ethics Board approval was obtained to extract electronic medical records for 188 patients at a single institution who had undergone hip arthroscopy. Procedures were performed from 2009 to 2017 by a single, fellowship-trained, board-certified sports medicine orthopaedic surgeon. Inclusion criteria were preoperative hip range of motion testing, positive clinical impingement testing, and magnetic resonance imaging (MRI) of the affected hip. Patient demographics, hip range of motion, and time to surgery were recorded. MRIs were reviewed by a board-certified musculoskeletal radiologist blinded to clinical data. Maximum thickness of the anterior hip capsule was measured in axial, axial oblique, and sagittal oblique sequences. Anterior capsular thickness was also measured at the level of the femoral head–neck junction in axial sequences (axial midline).

Results

Axial midline capsular thickness was negatively correlated with hip flexion (r = − 0.196, p = 0.0042) and internal rotation (r = − 0.143, p = 0.0278). Significant differences were seen between genders in axial midline thickness (5.3 ± 1.4 mm males/4.8 ± 1.3 mm females, p = 0.0079), flexion (113° ± 18° males/120° ± 17° females, p = 0.0029), and internal rotation (23° ± 13° males/29° ± 12° females, p = 0.0155). Significant differences also existed between side affected in flexion (116° ± 17° right/119° ± 17° left, p = 0.0396) and internal rotation (26° ± 12° right/29° ± 13° left, p = 0.0029). Positive correlation was observed between axial oblique capsular thickness and flexion (r = 0.2345) (p = 0.0229).

Conclusions

Increased anterior hip capsular thickness at the femoral head–neck correlates with limitations in hip range of motion in FAI. The strength of this relationship may be affected between pathologies, genders, and affected side. Pathologic thickening of the hip capsule may contribute to restricted hip mobility on clinical examination, and elucidation of this relationship may provide guidance into capsular management during hip arthroscopy.

Level of evidence

4, retrospective case series.

Keywords

Impingement Hip Capsule MRI Arthroscopy Femoroacetabular Mobility Surgery 

Notes

Author contributions

KZ performed the data collection and analysis, created figures and tables, and drafted the manuscript. DdS aided in drafting the manuscript, as well as contributing to conception of the study purpose, coordination, and design. HY contributed to data collection and analysis, and aided in drafting the manuscript. HNC analyzed and collected radiographic data, and contributed to the initial study design. NS was consulted for statistical analysis and contributed to initial study design. ORA conceived of the study, provided access to patient data, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

Ethics approval for this retrospective study was granted following review by the Hamilton Integrated Research Ethics Board (HiREB) in affiliation with McMaster University, Hamilton, Canada (reference number 2017-3490-C).

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Kailai Zhang
    • 1
  • Darren de SA
    • 2
  • Hang Yu
    • 1
  • Hema Nalini Choudur
    • 3
  • Nicole Simunovic
    • 4
  • Olufemi Rolland Ayeni
    • 4
    • 5
  1. 1.Michael G. DeGroote School of MedicineHamiltonCanada
  2. 2.UPMC Center for Sports MedicinePittsburghUSA
  3. 3.Department of RadiologyHamilton General HospitalHamiltonCanada
  4. 4.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical CentreMcMaster UniversityHamiltonCanada
  5. 5.Department of Orthopedic SurgeryMcMaster UniversityHamiltonCanada

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