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Correlation between the presence of herniation pit and femoroacetabular impingement: a systematic review and meta-analysis

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The purpose of this systematic review and meta-analysis was to evaluate the correlation between the incidence of herniation pits (HPs) and femoroacetabular impingement (FAI)-related morphologies.


A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed for studies evaluating the relationship between the incidence of HPs and FAI-related morphologies published up to August 16, 2019. Subgroup analyses were also performed to determine the differences in the relationship between the presence/absence of hip symptoms and cam-/pincer-type FAI.


Seven studies involving 7950 hips were included. The pooled odds ratio (OR) for the incidence of HPs in the presence of an FAI-related morphology was 1.64 (95% confidence interval [CI] = 1.09–2.46; P = 0.02). In the subgroup analyses, the ORs for the incidence of HPs in the symptomatic and asymptomatic hips were 1.00 (95% CI 0.40–2.51; P = 1.00) and 1.59 (95% CI 1.42–1.77; P < 0.0001), respectively; the ORs for the incidence of HPs in the cam- and pincer-type FAI were 1.61 (95% CI 1.43–1.81; P < 0.0001) and 1.42 (95% CI 0.77–2.61; P = n.s.), respectively.


The incidence of HPs has a significant relationship with FAI-related morphology, especially in asymptomatic patients and those with cam-type FAI morphology.

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  1. 1.

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

  2. 2.

    Guo Z, Xu L, Su YB, Cheng XG (2013) Correlation between the prevalence of herniation pits and the alpha angle of the hip: computed tomography evaluation in healthy Chinese adults. BMC Musculoskelet Disord 14:288

  3. 3.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

  4. 4.

    Higgins JPT GS (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011. https://handbook.cochrane.org/. The Cochrane Collaboration

  5. 5.

    Ji HM, Baek JH, Kim KW, Yoon JW, Ha YC (2014) Herniation pits as a radiographic indicator of pincer-type femoroacetabular impingement in symptomatic patients. Knee Surg Sports Traumatol Arthrosc 22(4):860–866

  6. 6.

    Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2005) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236(2):588–592

  7. 7.

    Keats T (1973) Atlas of normal Roentgen variants that may simulate disease, 5th edn. Mosby year book, St. Louis, pp 501–502

  8. 8.

    Kim JA, Park JS, Jin W, Ryu K (2011) Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement? Skeletal Radiol 40(2):167–172

  9. 9.

    Lee E, Choi JA (2015) Associations between alpha angle and herniation Pit on MRI revisited in 185 asymptomatic hip joints. Korean J Radiol 16(6):1319–1325

  10. 10.

    Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R (2005) Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 236(1):237–246

  11. 11.

    Mineta K, Goto T, Wada K, Tamaki Y, Hamada D, Higashino K, Sairyo K (2016) Comparison of femoroacetabular impingement-related radiographic features in a convenience sample of Japanese patients with and without herniation pits. Skeletal Radiol 45(8):1079–1088

  12. 12.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1

  13. 13.

    Panzer S, Augat P, Esch U (2008) CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement. Eur Radiol 18(9):1869–1875

  14. 14.

    Pitt MJ, Graham AR, Shipman JH, Birkby W (1982) Herniation pit of the femoral neck. AJR Am J Roentgenol 138(6):1115–1121

  15. 15.

    Scheyerer MJ, Copeland CE, Stromberg J, Ruckstuhl T, Werner CM (2014) Radiographic markers of femoroacetabular impingement: correlation of herniation pit and femoral bump with a positive cross-over ratio. Adv Orthop 2014:432728

  16. 16.

    Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10

  17. 17.

    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

  18. 18.

    Sullivan C, Chakraverty J, Foley K, Narayanaswamy S, Kamath S (2013) Femoroacetabular impingement: presence of FAI-like features on conventional radiography in young patients presenting to primary care with hip pain. Acta Radiol 54(6):690–697

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Correspondence to Jun Ho Kim.

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Kim, C., Han, S., Yang, C. et al. Correlation between the presence of herniation pit and femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-05888-8

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  • Herniation pit
  • Femoroacetabular impingement
  • Correlation