Clinical Orthopaedics and Related Research®

, Volume 471, Issue 2, pp 478–485 | Cite as

The Shape of the Proximal Femur Influences Acetabular Wear Patterns Over Time

  • Jonathan J. Streit
  • Ari Levine
  • Ian J. Barrett
  • Daniel R. Cooperman
  • Victor Goldberg
Symposium: Papers Presented at the Annual Meetings of The Hip Society



Femoroacetabular impingement has been proposed as a cause of early osteoarthritis, but it is not known how this develops over time or whether the shape of the proximal femur influences this risk.


(1) Which areas of the acetabulum are worn more frequently by individuals with a cam deformity of the proximal femur? (2) Do observed acetabular wear patterns differ based on the etiology of the cam deformity? (3) Do wear patterns of individuals with a cam deformity differ based on an individual’s age?


We examined 645 corresponding femora and acetabuli from the Hamann-Todd Osteological Collection and determined the offset and alpha angle using photographs; 370 specimens met inclusion criteria and were examined for signs of wear and the locations of wear were recorded. Specimens were separated into eight subgroups based on age either younger than 40 years or older than 60 years, alpha angle greater or less than 55°, and degree of anterior head-neck offset. We compared the prevalence of wear between groups in each location.


Individuals with abnormal geometry of the proximal femur demonstrated different wear patterns from individuals with normal geometry. There were few differences in wear patterns identified based on the etiology of the femoral deformity. Abnormal femoral geometry was associated with more frequent wear primarily at the anterosuperior acetabulum for individuals younger than 40 years of age and globally for individuals older than 60 years of age.


Femoral geometry appears to influence the pattern of acetabular wear occurring over time.



We thank Lyman Jellema and the Cleveland Museum of Natural History for their assistance in the completion of this study. We acknowledge the contributions of Sean Waldron MD, for making femoral measurements. We also recognize our artist, Matt Streit (, for his contributions to the article.


  1. 1.
    Beall DP, Sweet CF, Martin HD, Lastine CL, Grayson DE, Ly JQ, Fish JR. Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol. 2005;34:691–701.PubMedCrossRefGoogle Scholar
  2. 2.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.PubMedCrossRefGoogle Scholar
  3. 3.
    Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop Relat Res. 1983;175:79–85.PubMedGoogle Scholar
  4. 4.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRefGoogle Scholar
  5. 5.
    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMedGoogle Scholar
  6. 6.
    Goodman DA, Feighan JE, Smith AD, Latimer BL, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997;79:1489–1497.PubMedGoogle Scholar
  7. 7.
    Hack K, Di Primio G, Rakhra K, Beaule P. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010;92:2436–2444.PubMedCrossRefGoogle Scholar
  8. 8.
    Jung KA, Restrepo C, Hellman M, AbdelSalam H, Morrison W, Parvizi J. The prevalence of cam-type femoroacetabular deformity in asymptomatic adults. J Bone Joint Surg Br. 2011;93:1303–1307.PubMedCrossRefGoogle Scholar
  9. 9.
    Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;236:588–592.PubMedCrossRefGoogle Scholar
  10. 10.
    Notzli H, Wyss T, Stoecklin C, Schmid M, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.PubMedCrossRefGoogle Scholar
  11. 11.
    Odgers PNB. Two details about the neck of the femur: (1) the eminentia, (2) the empreinte. J Anat. 1931;45:352–362.Google Scholar
  12. 12.
    Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;15:561–570.PubMedGoogle Scholar
  13. 13.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.PubMedCrossRefGoogle Scholar
  14. 14.
    Philippon M, Stubbs A, Schenker M, Maxwell R, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.PubMedCrossRefGoogle Scholar
  15. 15.
    Sudeck P. [For anatomy and etiology of coxa vara adolescentium: at the same time a contribution to the teaching of the architectural construction of the femur coxalen] [in German]. Arch Clin Chirurg. 1899;59:504–524.Google Scholar
  16. 16.
    Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthritis. Acta Orthop Scand. 1939;83(Suppl 58):1–135.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Jonathan J. Streit
    • 1
  • Ari Levine
    • 1
  • Ian J. Barrett
    • 1
  • Daniel R. Cooperman
    • 1
  • Victor Goldberg
    • 1
  1. 1.Orthopaedic SurgeryUniversity Hospitals Case Medical CenterClevelandUSA

Personalised recommendations