Skeletal Radiology

, Volume 44, Issue 2, pp 249–253 | Cite as

Pelvic morphology in ischiofemoral impingement

  • Miriam A. BredellaEmail author
  • Debora C. Azevedo
  • Adriana L. Oliveira
  • Frank J. Simeone
  • Connie Y. Chang
  • Allston J. Stubbs
  • Martin Torriani
Scientific Article



To assess MRI measures to quantify pelvic morphology that may predispose to ischiofemoral impingement (IFI). We hypothesized that patients with IFI have a wider interischial distance and an increased femoral neck angle compared with normal controls.

Materials and methods

The study was IRB-approved and complied with HIPAA guidelines. IFI was diagnosed based on clinical findings (hip or buttock pain) and ipsilateral edema of the quadratus femoris muscle on MRI. Control subjects did not report isolated hip/buttock pain and underwent MRI for surveillance of neoplasms or to exclude pelvic fractures. Two MSK radiologists measured the ischiofemoral (IF) and quadratus femoris (QF) distance, the ischial angle as a measure of inter-ischial distance, and the femoral neck angle. The quadratus femoris muscle was evaluated for edema. Groups were compared using ANOVA. Multivariate standard least-squares regression modeling was used to control for age and gender.


The study group comprised 84 patients with IFI (53 ± 16 years, 73 female, 11 male) and 51 controls (52 ± 16 years, 33 female, 18 male). Thirteen out of 84 patients (15 %) had bilateral IFI. Patients with IFI had decreased IF and QF distance (p < 0.0001), increased ischial angle (p = 0.004), and increased femoral neck angle (p = 0.02) compared with controls, independent of age and gender.


Patients with IFI have increased ischial and femoral neck angles compared with controls. These anatomical variations in pelvic morphology may predispose to IFI. MRI is a useful method of not only assessing the osseous and soft-tissue abnormalities associated with IFI, but also of quantifying anatomical variations in pelvic morphology that can predispose to IFI.


Ischiofemoral impingement Hip MRI Quadratus femoris muscle 


Conflict of interest

The authors declare that they have no conflict of interest.




  1. 1.
    Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;37:939–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193:186–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Taneja AK, Bredella MA, Torriani M. Ischiofemoral impingement. Magn Reson Imaging Clin N Am. 2013;21:65–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal Radiol. 2012;41:575–87.PubMedCrossRefGoogle Scholar
  5. 5.
    Sussman WI, Han E, Schuenke MD. Quantitative assessment of the ischiofemoral space and evidence of degenerative changes in the quadratus femoris muscle. Surg Radiol Anat. 2013;35:273–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Lenhard M, Johnson T, Weckbach S, Nikolaou K, Friese K, Hasbargen U. Three-dimensional pelvimetry by computed tomography. Radiol Med. 2009;114:827–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Salerno G, Daniels IR, Brown G, Heald RJ, Moran BJ. Magnetic resonance imaging pelvimetry in 186 patients with rectal cancer confirms an overlap in pelvic size between males and females. Colorectal Dis. 2006;8:772–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clin Orthop Relat Res. 2013;471:3774–80.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Unlu MC, Kesmezacar H, Kantarci F, Unlu B, Botanlioglu H. Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter. Arch Orthop Trauma Surg. 2011;131:1317–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Sugano N, Noble PC, Kamaric E. A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr. 1998;22:610–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59:268–9.PubMedGoogle Scholar
  12. 12.
    Kim WJ, Shin HY, Koo GH, Park HG, Ha YC, Park YH. Ultrasound-guided prolotherapy with polydeoxyribonucleotide sodium in ischiofemoral impingement syndrome. Pain Pract. 2014. doi: 10.1111/papr.12215.Google Scholar
  13. 13.
    Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skeletal Radiol. 2011;40:653–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Safran M, Ryu J. Ischiofemoral impingement of the hip: a novel approach to treatment. Knee Surg Sports Traumatol Arthrosc. 2014;22:781–5.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2014

Authors and Affiliations

  • Miriam A. Bredella
    • 1
    Email author
  • Debora C. Azevedo
    • 1
  • Adriana L. Oliveira
    • 1
  • Frank J. Simeone
    • 1
  • Connie Y. Chang
    • 1
  • Allston J. Stubbs
    • 2
  • Martin Torriani
    • 1
  1. 1.Department of Radiology, Musculoskeletal Imaging and InterventionMassachusetts General HospitalBostonUSA
  2. 2.Department of Orthopedic Surgery, Division of Sports MedicineWake Forest University School of MedicineWinston-SalemUSA

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