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Hip shape is symmetric, non-dependent on limb dominance and gender-specific: implications for femoroacetabular impingement. A 3D CT analysis in asymptomatic subjects

  • Musculoskeletal
  • Published:
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Abstract

Objective

To determine the reference intervals (RefInt) of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in asymptomatic hips with computed tomography (CT) and determine their dependence on age, side, limb dominance and sex.

Methods

We prospectively included 590 patients and evaluated 1111 hips with semi-automated CT analysis. We calculated overall, side- and sex-specific parameters for imaging signs of cam [omega and alpha angle (α°)] and pincer-type morphology [acetabular version (ACvers), lateral centre-edge angle (LCEA) and cranio-caudal coverage].

Results

Hip shape was symmetrical and did not depend on limb dominance. The 95% RefInt limits were sex-different for all cam-type parameters and extended beyond current abnormal thresholds. Specifically, the upper limits of RefInt for α° at 12:00, 1:30 and 3:00 o’clock positions were 56°, 70° and 58°, respectively, and 45° for LCEA. Acetabular morphology varied between age groups, with a trend toward an LCEA/ACvers increase over time.

Conclusion

Our morphometric measurements can be used to estimate normal hip morphology in asymptomatic individuals. Notably they extended beyond current thresholds used for FAI imaging diagnosis, which was most pronounced for cam-type parameters. We suggest the need to reassess α° RefInt and consider a 60° threshold for the 12:00/3:00 positions and 65-70° for other antero-superior positions.

Key Points

• Hip shape is symmetrical regardless of limb dominance.

• Pincer/cam morphology is frequent in asymptomatic subjects (20 and 71%, respectively).

• LCEA and acetabular version increases with age (5-7° between opposite age groups).

• Femoral morphology is stable after physeal closure (in the absence of pathology).

• Alpha and omega angle thresholds should be set according to sex.

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Abbreviations

ACcov:

Acetabular cranio-caudal coverage

ACinc:

Acetabular inclination (Tönnis angle or Sourcil angle)

ACvers:

Acetabular version

Alpha angle:

α°

BMI:

Body mass index

CDA:

Cervico-diaphyseal angle

CT:

Computed tomography

DICOM:

Digital Imaging and Communications in Medicine

FAI:

Femoroacetabular impingement

FHN:

Femoral head-neck

LCEA:

Lateral centre-edge angle

MRI:

Magnetic resonance Imaging

Omega angle:

Ω°

OA:

Osteoarthritis

RefInt:

Reference intervals

SD:

Standard deviation

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Acknowledgements

The authors would like to thank José Roquette, João Sá, Isabel Vaz and Pedro Patrício for their continuing and enthusiastic support of clinical research at Hospital da Luz and Rúben Teixeira, Ana Filipa Graça, Rogério Lopes, Diogo Corrente, João Novo and Tiago Castela for their efforts toward optimising technical issues and providing patient care.

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Authors and Affiliations

  1. MSK imaging Unit (UIME), Imaging Centre, Hospital da Luz, Lisbon, Portugal

    Vasco V. Mascarenhas

  2. Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal

    Paulo Rego

  3. Hospital CUF Descobertas, Lisbon, Portugal

    Pedro Dantas

  4. Centro Hospitalar do Algarve, Faro, Portugal

    Miguel Castro

  5. Department of Radiology, Ghent University Hospital, Gent, Belgium

    Lennart Jans

  6. NOVA Medical School, Lisbon, Portugal

    Rui M. Marques, Nélia Gouveia & José G. Consciência

  7. Paediatric Hand Surgery and Microsurgery, Hospital Sant Joan De Deu, Universitat De Barcelona, Barcelona, Spain

    Francisco Soldado

  8. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

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  1. Vasco V. Mascarenhas
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Corresponding author

Correspondence to Vasco V. Mascarenhas.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. José Roquette.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Ninety-four of the 590 patients of the current cohort were previously studied and published [Mascarenhas VV, Rego PA, Dantas P, et al (2016) Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjects. Eur Radiol. doi: 10.1007/s00330-016-4530-0]. Substantially and important different objectives, statistical power and conclusions are therefore withdrawn from this cohort.

Methodology

• prospective

• cross-sectional study

• multicentre study

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Mascarenhas, V.V., Rego, P., Dantas, P. et al. Hip shape is symmetric, non-dependent on limb dominance and gender-specific: implications for femoroacetabular impingement. A 3D CT analysis in asymptomatic subjects. Eur Radiol 28, 1609–1624 (2018). https://doi.org/10.1007/s00330-017-5072-9

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