Femoroacetabular impingement (FAI) may constrain hip articulation and cause chondrolabral damage, but to our knowledge, in vivo articulation and femur-labrum contact patterns have not been quantified.
In this exploratory study, we describe the use of high-speed dual-fluoroscopy and model-based tracking to dynamically measure in vivo hip articulation and estimate the location of femur-labrum contact in six asymptomatic hips and three hips with FAI during the impingement examination. We asked: (1) Does femur-labrum contact occur at the terminal position of impingement? (2) Could range of motion (ROM) during the impingement examination appear decreased in hips with FAI? (3) Does the location of femur-labrum contact coincide with that of minimum bone-to-bone distance? (4) In the patients with FAI, does the location of femur-labrum contact qualitatively correspond to the location of damage observed intraoperatively?
High-speed dual-fluoroscopy images were acquired continuously as the impingement examination was performed. CT arthrogram images of all subjects were segmented to generate three-dimensional (3-D) surfaces for the pelvis, femur, and labrum. Model-based tracking of the fluoroscopy images enabled dynamic kinematic observation of the 3-D surfaces. At the terminal position of the examination, the region of minimal bone-to-bone distance was compared with the estimated location of femur-labrum contact. Each patient with FAI underwent hip arthroscopy; the location of femur-labrum contact was compared qualitatively with damage found during surgery. As an exploratory study, statistics were not performed.
Femur-labrum contact was observed in both groups, but patterns of contact were subject-specific. At the terminal position of the impingement examination, internal rotation and adduction angles for each of the patients with FAI were less than the 95% confidence intervals (CIs) for the asymptomatic control subjects. The location of minimum bone-to-bone distance agreed with the region of femur-labrum contact in two of nine hips. The locations of chondrolabral damage identified during surgery qualitatively coincided with the region of femur-labrum contact.
Dual-fluoroscopy and model-based tracking provided the ability to assess hip kinematics in vivo during the entire impingement examination. The high variability in observed labrum-femur contact patterns at the terminal position of the examination provides evidence that subtle anatomic features could dictate underlying hip biomechanics. Although femur-labrum contact occurs in asymptomatic and symptomatic hips at the terminal position of the impingement examination, contact may occur at reduced adduction and internal rotation in patients with FAI. Use of minimum bone-to-bone distance may not appropriately identify the region of femur-labrum contact. Additional research, using a larger cohort and appropriate statistical tests, is required to confirm the findings of this exploratory study.
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We thank Blake Zimmerman, Department of Bioengineering, University of Utah, and Justine Goebel, Department of Bioengineering, University of Utah, for assistance with segmentation and model-based tracking.
The institution of one or more of the authors (ALK) has received, during the study period, funding from the LS Peery Discovery Program in Musculoskeletal Restoration. One of the authors certifies that he (SKA) has or may receive payments or benefits, during the study period, an amount of USD 10,000–USD 100,000 from Pivot Medical (Sunnyvale, CA, USA) and an amount of USD 10,000–USD 100,000 from Arthrocare Corp (Austin, TX, USA). One of the authors certifies that he (CLP) has or may receive payments or benefits, during the study period, an amount of USD 10,000–USD 100,000 from Biomet (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Kapron, A.L., Aoki, S.K., Peters, C.L. et al. Subject-specific Patterns of Femur-labrum Contact are Complex and Vary in Asymptomatic Hips and Hips With Femoroacetabular Impingement. Clin Orthop Relat Res 472, 3912–3922 (2014). https://doi.org/10.1007/s11999-014-3919-9
- Internal Rotation
- Terminal Position
- Femoroacetabular Impingement
- Bony Impingement
- Anatomic Coordinate System