Annals of Biomedical Engineering

, Volume 41, Issue 6, pp 1162–1171 | Cite as

Three-dimensional Quantification of Femoral Head Shape in Controls and Patients with Cam-type Femoroacetabular Impingement

  • Michael D. Harris
  • Shawn P. Reese
  • Christopher L. Peters
  • Jeffrey A. Weiss
  • Andrew E. AndersonEmail author


An objective measurement technique to quantify 3D femoral head shape was developed and applied to normal subjects and patients with cam-type femoroacetabular impingement (FAI). 3D reconstructions were made from high-resolution CT images of 15 cam and 15 control femurs. Femoral heads were fit to ideal geometries consisting of rotational conchoids and spheres. Geometric similarity between native femoral heads and ideal shapes was quantified. The maximum distance native femoral heads protruded above ideal shapes and the protrusion area were measured. Conchoids provided a significantly better fit to native femoral head geometry than spheres for both groups. Cam-type FAI femurs had significantly greater maximum deviations (4.99 ± 0.39 mm and 4.08 ± 0.37 mm) than controls (2.41 ± 0.31 mm and 1.75 ± 0.30 mm) when fit to spheres or conchoids, respectively. The area of native femoral heads protruding above ideal shapes was significantly larger in controls when a lower threshold of 0.1 mm (for spheres) and 0.01 mm (for conchoids) was used to define a protrusion. The 3D measurement technique described herein could supplement measurements of radiographs in the diagnosis of cam-type FAI. Deviations up to 2.5 mm from ideal shapes can be expected in normal femurs while deviations of 4–5 mm are characteristic of cam-type FAI.


Cam FAI Femur morphology Asphericity 



Funding for the recruitment and CT scanning of cam-type FAI patients was received through NIH grant #R01AR053344. Procurement and CT scanning of the control femurs was done with funds from a U.S. Department of the Army Award #W81XWH-06-1-0574.


  1. 1.
    Almoussa, S., C. Barton, A. D. Speirs, W. Gofton, and P. E. Beaule. Computer-assisted correction of cam-type femoroacetabular impingement: a sawbones study. J. Bone Joint Surg. Am. 93(Suppl 2):70–75, 2011.Google Scholar
  2. 2.
    Anda, S., T. Terjesen, K. A. Kvistad, and S. Svenningsen. Acetabular angles and femoral anteversion in dysplastic hips in adults: Ct investigation. J. Comput. Assist. Tomogr. 15:115–120, 1991.PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson, A. E., B. J. Ellis, S. A. Maas, and J. A. Weiss. Effects of idealized joint geometry on finite element predictions of cartilage contact stresses in the hip. J. Biomech. 43:1351–1357, 2010.PubMedCrossRefGoogle Scholar
  4. 4.
    Anderson, A. E., B. J. Ellis, C. L. Peters, and J. A. Weiss. Cartilage thickness: factors influencing multidetector ct measurements in a phantom study. Radiology 246:133–141, 2008.PubMedCrossRefGoogle Scholar
  5. 5.
    Anderson, A. E., C. L. Peters, B. D. Tuttle, and J. A. Weiss. Subject-specific finite element model of the pelvis: development, validation and sensitivity studies. J. Biomech. Eng. 127:364–373, 2005.PubMedCrossRefGoogle Scholar
  6. 6.
    Audenaert, E. A., N. Baelde, W. Huysse, L. Vigneron, and C. Pattyn. Development of a three-dimensional detection method of cam deformities in femoroacetabular impingement. Skeletal Radiol. 40:921–927, 2011.PubMedCrossRefGoogle Scholar
  7. 7.
    Audenaert, E. A., I. Peeters, S. Van Onsem, and C. Pattyn. Can we predict the natural course of femoroacetabular impingement? Acta Orthop. Belg. 77:188–196, 2011.PubMedGoogle Scholar
  8. 8.
    Barton, C., M. J. Salineros, K. S. Rakhra, and P. E. Beaule. Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin. Orthop. Relat. Res. 469:464–469, 2011.PubMedCrossRefGoogle Scholar
  9. 9.
    Beaule, P. E., E. Zaragoza, K. Motamedi, N. Copelan, and F. J. Dorey. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J. Orthop. Res. 23:1286–1292, 2005.PubMedGoogle Scholar
  10. 10.
    Byrd, J. W., and K. S. Jones. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin. Orthop. Relat. Res. 467:739–746, 2009.PubMedCrossRefGoogle Scholar
  11. 11.
    Carlisle, J. C., L. P. Zebala, D. S. Shia, D. Hunt, P. M. Morgan, H. Prather, R. W. Wright, K. Steger-May, and J. C. Clohisy. Reliability of various observers in determining common radiographic parameters of adult hip structural anatomy. Iowa Orthop. J. 31:52–58, 2011.PubMedGoogle Scholar
  12. 12.
    Cerveri, P., A. Manzotti, and G. Baroni. Patient-specific acetabular shape modelling: comparison among sphere, ellipsoid and conchoid parameterisations. Comput. Methods Biomech. Biomed. Eng. 2012. doi: 10.1080/10255842.2012.702765
  13. 13.
    Clohisy, J. C., J. C. Carlisle, R. Trousdale, Y. J. Kim, P. E. Beaule, P. Morgan, K. Steger-May, P. L. Schoenecker, and M. Millis. Radiographic evaluation of the hip has limited reliability. Clin. Orthop. Relat. Res. 467:666–675, 2009.PubMedCrossRefGoogle Scholar
  14. 14.
    Clohisy, J. C., J. C. Carlisle, P. E. Beaule, Y. J. Kim, R. T. Trousdale, R. J. Sierra, M. Leunig, P. L. Schoenecker, and M. B. Millis. A systematic approach to the plain radiographic evaluation of the young adult hip. J. Bone Joint Surg. Am. 90(Suppl 4):47–66, 2008.Google Scholar
  15. 15.
    Clohisy, J. C., L. P. Zebala, J. J. Nepple, and G. Pashos. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J. Bone Joint Surg. Am. 92:1697–1706, 2010.Google Scholar
  16. 16.
    Clohisy, J. C., R. M. Nunley, R. J. Otto, and P. L. Schoenecker. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin. Orthop. Relat. Res. 462:115–121, 2007.PubMedCrossRefGoogle Scholar
  17. 17.
    Domayer, S. E., K. Ziebarth, J. Chan, S. Bixby, T. C. Mamisch, and Y. J. Kim. Femoroacetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI. Eur. J. Radiol. 80(3):805–810, 2011.PubMedCrossRefGoogle Scholar
  18. 18.
    Dudda, M., C. Albers, T. C. Mamisch, S. Werlen, and M. Beck. Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin. Orthop. Relat. Res. 467:651–659, 2009.PubMedCrossRefGoogle Scholar
  19. 19.
    Eijer, H., M. Leunig, N. Mahomed, and R. Ganz. Cross table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int. 11:37–41, 2001.Google Scholar
  20. 20.
    Ganz, R., J. Parvizi, M. Beck, M. Leunig, H. Notzli, and K. A. Siebenrock. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin. Orthop. Relat. Res. 417:112–120, 2003.PubMedGoogle Scholar
  21. 21.
    Ganz, R., T. J. Gill, E. Gautier, K. Ganz, N. Krugel, and U. Berlemann. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J. Bone Joint Surg. Br. 83(8):1119–1124, 2001.PubMedCrossRefGoogle Scholar
  22. 22.
    Harris, W. H. Etiology of osteoarthritis of the hip. Clin. Orthop. Relat. Res. 213:20–33, 1986.PubMedGoogle Scholar
  23. 23.
    Ito, K., M. A. Minka, 2nd, M. Leunig, S. Werlen, and R. Ganz. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J. Bone Joint Surg. Br. 83:171–176, 2001.Google Scholar
  24. 24.
    Kapron, A. L., A. E. Anderson, S. K. Aoki, L. G. Phillips, D. J. Petron, R. Toth, and C. L. Peters. Radiographic prevalence of femoroacetabular impingement in collegiate football players: Aaos exhibit selection. J. Bone Joint Surg. Am. 93:e111(111-110), 2011.Google Scholar
  25. 25.
    Konan, S., F. Rayan, and F. S. Haddad. Is the frog lateral plain radiograph a reliable predictor of the alpha angle in femoroacetabular impingement? J. Bone Joint Surg. Br. 92:47–50, 2010.PubMedGoogle Scholar
  26. 26.
    Lavigne, M., J. Parvizi, M. Beck, K. A. Siebenrock, R. Ganz, and M. Leunig. Anterior femoroacetabular impingement: part i. Techniques of joint preserving surgery. Clin. Orthop. Relat. Res. 418:61–66, 2004.PubMedCrossRefGoogle Scholar
  27. 27.
    Lavigne, M., M. Kalhor, M. Beck, R. Ganz, and M. Leunig. Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip. Orthop. Clin. N. Am. 36(2):171–176, viii, 2005.Google Scholar
  28. 28.
    Mardones, R. M., C. Gonzalez, Q. Chen, M. Zobitz, K. R. Kaufman, and R. T. Trousdale. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique. J. Bone Joint Surg. Am. 88(Suppl 1 Pt 1):84–91, 2006.Google Scholar
  29. 29.
    Matsuda, D. K. The case for cam surveillance: the arthroscopic detection of cam femoroacetabular impingement missed on preoperative imaging and its significance. Arthroscopy 27:870–876, 2011.PubMedCrossRefGoogle Scholar
  30. 30.
    Meermans, G., S. Konan, F. S. Haddad, and J. D. Witt. Prevalence of acetabular cartilage lesions and labral tears in femoroacetabular impingement. Acta Orthop. Belg. 76:181–188, 2010.PubMedGoogle Scholar
  31. 31.
    Menschik, F. The hip joint as a conchoid shape. J. Biomech. 30:971–973, 1997.PubMedCrossRefGoogle Scholar
  32. 32.
    Metz, C. T. Digitally Reconstructed Radiographs. Utrecht: Utrecht University, p. 79, 2005.Google Scholar
  33. 33.
    Meyer, D. C., M. Beck, T. Ellis, R. Ganz, and M. Leunig. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin. Orthop. Relat. Res. 445:181–185, 2006.PubMedGoogle Scholar
  34. 34.
    Nepple, J. J., J. C. Carlisle, R. M. Nunley, and J. C. Clohisy. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am. J. Sports Med. 39:296–303, 2011.PubMedCrossRefGoogle Scholar
  35. 35.
    Notzli, H. P., T. F. Wyss, C. H. Stoecklin, M. R. Schmid, K. Treiber, and J. Hodler. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J. Bone Joint Surg. Br. 84:556–560, 2002.Google Scholar
  36. 36.
    Pfirrmann, C. W., B. Mengiardi, C. Dora, F. Kalberer, M. Zanetti, and J. Hodler. Cam and pincer femoroacetabular impingement: characteristic mr arthrographic findings in 50 patients. Radiology 240:778–785, 2006.PubMedCrossRefGoogle Scholar
  37. 37.
    Philippon, M. J., R. B. Maxwell, T. L. Johnston, M. Schenker, and K. K. Briggs. Clinical presentation of femoroacetabular impingement. Knee Surg. Sports Traumatol. Arthrosc. 15:1041–1047, 2007.PubMedCrossRefGoogle Scholar
  38. 38.
    Philippon, M. J., M. L. Schenker, K. K. Briggs, D. A. Kuppersmith, R. B. Maxwell, and A. J. Stubbs. Revision hip arthroscopy. Am. J. Sports Med. 35:1918–1921, 2007.PubMedCrossRefGoogle Scholar
  39. 39.
    Pollard, T. C., R. N. Villar, M. R. Norton, E. D. Fern, M. R. Williams, D. J. Simpson, D. W. Murray, and A. J. Carr. Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips. Acta orthopaedica. 81:134–141, 2010.PubMedCrossRefGoogle Scholar
  40. 40.
    Rakhra, K. S., A. M. Sheikh, D. Allen, and P. E. Beaule. Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin. Orthop. Relat. Res. 467:660–665, 2009.PubMedCrossRefGoogle Scholar
  41. 41.
    Rasquinha, B. J., J. Sayani, J. F. Rudan, G. C. Wood, and R. E. Ellis. Articular surface remodeling of the hip after periacetabular osteotomy. Int. J. Comput. Assist. Radiol. Surg. 7:241–248, 2012.PubMedCrossRefGoogle Scholar
  42. 42.
    Ruff, C. B., and W. C. Hayes. Sex differences in age-related remodeling of the femur and tibia. J. Orthop. Res. 6:886–896, 1988.PubMedCrossRefGoogle Scholar
  43. 43.
    Siebenrock, K. A., K. H. Wahab, S. Werlen, M. Kalhor, M. Leunig, and R. Ganz. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin. Orthop. Relat. Res. 418:54–60, 2004.PubMedCrossRefGoogle Scholar
  44. 44.
    Tannast, M., D. Goricki, M. Beck, S. B. Murphy, and K. A. Siebenrock. Hip damage occurs at the zone of femoroacetabular impingement. Clin. Orthop. Relat. Res. 466:273–280, 2008.PubMedCrossRefGoogle Scholar
  45. 45.
    Tannast, M., M. Kubiak-Langer, F. Langlotz, M. Puls, S. B. Murphy, and K. A. Siebenrock. Noninvasive three-dimensional assessment of femoroacetabular impingement. J. Orthop. Res. 25:122–131, 2007.PubMedCrossRefGoogle Scholar
  46. 46.
    Tannast, M., K. A. Siebenrock, and S. E. Anderson. Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. Radiologia 50:271–284, 2008.PubMedCrossRefGoogle Scholar

Copyright information

© Biomedical Engineering Society 2013

Authors and Affiliations

  • Michael D. Harris
    • 1
    • 2
  • Shawn P. Reese
    • 2
  • Christopher L. Peters
    • 1
  • Jeffrey A. Weiss
    • 1
    • 2
    • 3
  • Andrew E. Anderson
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  2. 2.Department of BioengineeringUniversity of UtahSalt Lake CityUSA
  3. 3.Scientific Computing and Imaging Institute, University of UtahSalt Lake CityUSA
  4. 4.Department of Physical TherapyUniversity of UtahSalt Lake CityUSA

Personalised recommendations