European Radiology

, 18:1869 | Cite as

CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement

  • Stephanie PanzerEmail author
  • Peter Augat
  • Ulrich Esch
Computer Tomography


The purpose of this study was to evaluate whether there is a correlation between the presence of herniation pits (HPs) and morphological indicators of cam and pincer femoroacetabular impingement (FAI) based on computed tomography (CT) examinations. CT studies of the pelvis obtained from 200 patients were retrospectively analysed for the presence of HPs and morphological abnormalities of the femoral head and acetabulum. As an indicator for cam FAI, we used the angle α, describing the anterior femoral head-neck junction. As an indicator for pincer FAI, we measured the acetabular coverage and the acetabular orientation. Student’s t-test was used for statistical analysis. HPs were identified in 85 of the 200 patients. HPs were predominantly found in the superior portion of the proximal anterior femoral neck; some were located in the inferior portion. The angle α was significantly larger by 10% in the group with HPs. A correlation between the presence of HPs and morphological indicators of pincer FAI was not found. In conclusion HPs are not only located in the superior portion of the proximal anterior femoral neck, but also in the inferior portion. There is an association between the presence of HPs and a high value of angle α.


Spiral computed tomography Hip joint Femur neck Osteoarthritis 


  1. 1.
    Pitt MJ, Graham AR, Shipman JH, Birkby W (1982) Herniation pit of the femoral neck. AJR 138:1115–1121PubMedGoogle Scholar
  2. 2.
    Angel JL (1964) The reaction area of the femoral neck. Clin Orthop 32:130–142PubMedGoogle Scholar
  3. 3.
    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 236:237–246PubMedCrossRefGoogle Scholar
  4. 4.
    Nokes SR, Vogler JB, Spritzer CE, Martinez S, Herfkens RJ (1989) Herniation pits of the femoral neck: appearance at MR imaging. Radiology 172:231–234PubMedGoogle Scholar
  5. 5.
    Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240(3):778–785PubMedCrossRefGoogle Scholar
  6. 6.
    Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE (2006) Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 236:588–592CrossRefGoogle Scholar
  7. 7.
    Sundberg TP, Toomayan GA, Major NM (2006) Evaluation of the acetabular labrum at 3.0-T MR imaging compared with 1.5-T MR arthrography: preliminary experience. Radiology 238(2):706–711PubMedCrossRefGoogle Scholar
  8. 8.
    Bredella MA, Stoller DW (2005) MR imaging of femoroacetabular impingement. Magn Reson Imaging Clin N Am 13:653–664. DOI  10.1016/j.mric.2005.08.001 Google Scholar
  9. 9.
    Kassarjian A (2006) Hip MR arthrography and femoroacetabular impingement. Semin Musculoskelet Radiol 10:208–219. DOI  10.1055/s-2006–957174
  10. 10.
    Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the articular cartilage. Femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018. DOI  10.1302/0301–620X.87B7 Google Scholar
  11. 11.
    Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement. Part II. Midterm results of surgical treatment. Clin Orthop 418:67–74PubMedCrossRefGoogle Scholar
  12. 12.
    Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR (1997) Subclinical slipped capital femoral epiphysis. Relationship to osteoarthritis of the hip. J Bone Joint Surg Am 79:1489–1497PubMedGoogle Scholar
  13. 13.
    Leunig M, Casillas MM, Hamlet M et al (2000) Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 71(4):370–375PubMedCrossRefGoogle Scholar
  14. 14.
    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120. DOI  10.1097/01.blo.0000096804.78689.c2 Google Scholar
  15. 15.
    Wagner S, Hofstetter W, Chiquet M et al (2003) Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage 11:508–518PubMedCrossRefGoogle Scholar
  16. 16.
    Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770PubMedGoogle Scholar
  17. 17.
    Tanzer M, Noiseux N (2004) Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 429:170–177PubMedCrossRefGoogle Scholar
  18. 18.
    Eijer H, Myers SR, Ganz R (2001) Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 15:475–481PubMedCrossRefGoogle Scholar
  19. 19.
    Eijer H, Leunig M, Mahomed N, Ganz R (2001) Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int 11:37–41Google Scholar
  20. 20.
    Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176PubMedCrossRefGoogle Scholar
  21. 21.
    Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA (2007) Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res 25:122–131. DOI  10.1002/jor.20309 Google Scholar
  22. 22.
    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560PubMedCrossRefGoogle Scholar
  23. 23.
    Anda S, Svenningsen S, Groøntvedt T, Benum P (1990) Pelvic inclination and spatial orientation of the acetabulum: a radiographic, computed tomographic and clinical investigation. Acta Radiol 31:389–394PubMedCrossRefGoogle Scholar
  24. 24.
    Siebenrock KA, Kalbermatten DF, Ganz R (2003) Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res 407:241–248. DOI  10.1097/01.blo.0000030508.43495.79 Google Scholar
  25. 25.
    McKibbin B (1970) Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br 52:148–159PubMedGoogle Scholar
  26. 26.
    Anda S, Svenningsen S, Dale LG, Benum P (1986) The acetabular sector angle of the adult hip determined by computed tomography. Acta Radiol Diag 27:443–447Google Scholar
  27. 27.
    Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br 81:281–288PubMedCrossRefGoogle Scholar
  28. 28.
    Daenen B, Preidler KW, Padmanabhan S et al (1997) Symptomatic herniation pits of the femoral neck: anatomic and clinical study. AJR 168:149–153PubMedGoogle Scholar
  29. 29.
    Hedvabny Z, Zidkova H, Kofranek I (1993) Herniation pit. Acta Chir Orthop Traumatol Cech 60:351–353PubMedGoogle Scholar
  30. 30.
    Murray RO (1965) The aetiology of primary osteoarthritis of the hip. Brit J Radiol 38:810–824PubMedCrossRefGoogle Scholar
  31. 31.
    Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD (1975) Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The hip. Proceedings of the third open scientific meeting of The Hip Society. Mosby, St. Louis, pp 212–228Google Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  1. 1.Department of RadiologyTrauma Center MurnauMurnauGermany
  2. 2.Biomechanics LaboratoryParacelsus Medical University Salzburg and Trauma Center MurnauMurnauGermany

Personalised recommendations