Skip to main content

Advertisement

SpringerLink
Log in

Modified head-neck offset for diagnosing anterior femoro-acetabular impingement

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The head-neck offset described by Eijer et al. (eHNO), which is used to diagnose anterior femoro-acetabular impingement (FAI), can be difficult to measure. The aim of this study was to verify if a modified head-neck offset (mHNO) provides more accurate and reproducible values than those of the eHNO.

Methods

The eHNO, mHNO, cephalic radius and alpha angle were measured on frog-leg radiographs of a group of patients with FAI and a control group (T); three independent reviewers measured the 50 hips in each group twice. The comparison of the two HNOs focused on reproducibility (intraclass correlation coefficient), validity (correlation with alpha angle), practical utility (difference between means in the FAI and control groups) and accuracy of the diagnostic thresholds.

Results

The mHNO had better reproducibility (p < 0.05) within and between observers in all study subjects than that of the eHNO (0.938 and 0.979 vs 0.881 and 0.904). The correlation with the alpha angle was also better (p < 0.05) for the mHNO than that for the eHNO. The diagnostic performances of the mHNO and mAOR thresholds were higher than those of the eHNO, eAOR and alpha angle.

Conclusions

The new HNO is easier to measure, more reproducible and more accurate. A modified HNO <5 mm and a modified AOR <0.100 on the frog-leg view argued in favour of a pathological cam-type head-neck junction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Eijer H, Leunig M, Mahomed M (2001) Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabulat impingement. Hip Int 11:37–41

    Google Scholar 

  2. Cavaignac E, Chiron P, Espié A, Reina N, Lepage B, Laffosse JM (2012) Experimental study of an original radiographic view for diagnosis of cam-type anterior femoro-acetabular impingement. Int Orthop 36(9):1783–1788

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chiron P, Laffosse J (2009) Les lésions du labrum de la hanche: signes, imagerie, traitement. Rev Rhum 76(2):202–207

    Article  Google Scholar 

  4. Espié A, Chaput B, Murgier J, Bayle-Iniguez X, Elia F, Chiron P (2014) 45°-45°-30° frog-leg radiograph for diagnosing cam-type anterior femoro-acetabular femoro-acetabular impingement: reproducibility and thresholds. Orthop Traumatol Surg Res 100(8):843–848

    Article  PubMed  Google Scholar 

  5. Chiron P, Espié A, Reina N, Cavaignac E, Molinier F, Laffosse JM (2012) Surgery for femoro-acetabular impingement using a minimally invasive anterolateral approach: analysis of 118 cases at 2.2-year follow-up. Orthop Traumatol Surg Res 98(1):30–38

    Article  CAS  PubMed  Google Scholar 

  6. Notzli H, Wyss T, Stoecklin C, Schmid M, 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 Am 84(B):556–560

    Article  CAS  Google Scholar 

  7. CLSI (2008) Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline, 3rd edn. CLSI document C28-A3. Clinical and Laboratory Standards Institute, Wayne

    Google Scholar 

  8. Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R (2004) Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 418:54–60

    Article  PubMed  Google Scholar 

  9. Bixby S, Kienle K, Nasreddine A, Zurakowski D, Kim Y, Yen Y (2013) Reference values for proximal femoral anatomy in adolescents based on sex, physis, and imaging plane. Am J Sports Med 41(9):2074–2082

    Article  PubMed  Google Scholar 

  10. Lerch S, Kasperczyk A, Berndt T, Ruhmann O (2015) Ultrasonography can quantify the extent of osteochondroplasty after treatment of Cam-type femoro-acetabular impingement. Int Orthop 39(5):853–858

    Article  PubMed  Google Scholar 

  11. Nepple J, Martell J, Kim Y, Zaltz I, Millis M, Podeszwa D, Sucato D, Sink E, Clohisy J, ANCHOR Study Group (2014) Interobserver and intraobserver reliability of the radiographic analysis of femoro-acetabular impingement and dysplasia using computer-assisted measurements. Am J Sports Med 42(10):2393-2401

  12. Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL (2007) The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res 462:115–121

    Article  PubMed  Google Scholar 

  13. Beaule PE, Harvey N, Zaragoza E, Le Duff MJ, Dorey FJ (2007) The femoral head/neck offset and hip resurfacing. J Bone Joint Surg (Br) 89(1):9–15

    Article  CAS  Google Scholar 

  14. Fraitzl CR, Kappe T, Pennekamp F, Reichel H, Billich C (2013) Femoral head-neck offset measurements in 339 subjects: distribution and implications for femoro-acetabular impingement. Knee Surg Sports Traumatol Arthrosc 21(5):1212–1217

    Article  PubMed  Google Scholar 

  15. Wensaas A, Gunderson RB, Svenningsen S, Terjesen T (2012) Femoro-acetabular impingement after slipped upper femoral epiphysis: the radiological diagnosis and clinical outcome at long-term follow-up. J Bone Joint Surg (Br) 94(11):1487–1493

    Article  CAS  Google Scholar 

  16. Carlisle J, Zebala L, Shia D, Hunt D, Morgan P, Prather H, Wright R, Steger-May K, Clohisy J (2011) Reliability of various observers in determining common radiographic parameters oh adult hip structural anatomy. Iowa Ortho J 31:52–58

    Google Scholar 

  17. Murgier J, Chiron P, Cavaignac E, Espié A, Bayle-Iniguez X, Lepage B (2013) The lateral view head-neck index (LVHNI): a diagnostic tool for the sequelae of slipped capital femoral epiphysis. Orthop Traumatol Surg Res 99(5):501–508

    Article  CAS  PubMed  Google Scholar 

  18. Murgier J, Espie A, Bayle-Iniguez X, Cavaignac E, Chiron P (2013) Frequency of radiographic signs of slipped capital femoral epiphysiolysis sequelae in hip arthroplasty candidates for coxarthrosis. Orthop Traumatol Surg Res 99(7):791–797

    Article  CAS  PubMed  Google Scholar 

  19. Murgier J, Reina N, Cavaignac E, Espie A, Bayle-Iniguez X, Chiron P (2014) The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoro-acetabular impingement. Bone Joint J 96-B(6):724–729

    Article  CAS  PubMed  Google Scholar 

  20. Clohisy J, Carlisle J, Beaule P (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 90(Suppl 4):47-66

    Article  PubMed  PubMed Central  Google Scholar 

  21. Harris MD, Kapron AL, Peters CL, Anderson AE (2014) Correlations between the alpha angle and femoral head asphericity: implications and recommendations for the diagnosis of cam femoro-acetabular impingement. Eur J Radiol 83(5):788–796

    Article  PubMed  PubMed Central  Google Scholar 

  22. Audenaert EA, Mahieu P, Pattyn C (2010) Three-dimensional assessment of cam engagement in femoro-acetabular impingement. Arthroscopy 27(2):167–171

    Article  PubMed  Google Scholar 

  23. Bedi A, Dolan M, Magennis E, Lipman J, Buly R, Kelly BT (2012) Computer-assisted modeling of osseous impingement and resection in femoro-acetabular impingement. Arthroscopy 28(2):204–210

    Article  PubMed  Google Scholar 

  24. Domayer SE, Ziebarth K, Chan J, Bixby S, Mamisch TC, Kim YJ (2011) Femoro-acetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI. Eur J Radiol 80:805–810

    Article  CAS  PubMed  Google Scholar 

  25. Dudda M, Albers C, Mamisch TC, Werlen S, Beck M (2009) Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin Orthop Relat Res 467(3):651–659

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hack K, Di Primio G, Rakhra K, Beaule PE (2010) Prevalence of cam-type femoro-acetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92(14):2436–2444

    Article  PubMed  Google Scholar 

  27. Rakhra KS, Sheikh AM, Allen D, Beaule PE (2009) Comparison of MRI alpha angle measurement planes in femoro-acetabular impingement. Clin Orthop Relat Res 467(3):660–665

    Article  PubMed  PubMed Central  Google Scholar 

  28. Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P, Steger-May K, Schoenecker PL, Millis M (2009) Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res 467(3):666–675

    Article  PubMed  PubMed Central  Google Scholar 

  29. Malhotra R, Kannan A, Kancherla R, Khatri D, Kumar V (2012) Femoral head-neck offset in the Indian population: a CT based study. Indian J Orthop 46(2):212–215

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kang AC, Gooding AJ, Coates MH, Goh TD, Armour P, Rietveld J (2010) Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoro-acetabular impingement. Am J Sports Med 38(6):1160–1165

    Article  PubMed  Google Scholar 

  31. Pollard TC, Villar RN, Norton MR, Fern ED, Williams MR, Simpson DJ, Murray DW, Carr AJ (2010) Femoro-acetabular impingement and classification of the cam deformity: the reference interval in normal hips. Acta Orthop 81(1):134–141

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

P. Chiron is a consultant for Zimmer, Sanofi and Smith & Nephew, and has received royalties from Zimmer and Integra. The other authors declare that they have no conflicts of interest related or unrelated to this article.

Author information

Authors and Affiliations

  1. Clinique Saint Jean du Languedoc, 20 route de Revel, 31400, Toulouse, France

    Aloїs Espié

  2. Service de Chirurgie Orthopédique, Secteur A, 5ème étage, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, Place du Docteur Baylac, TSA 40 031, 31059, Toulouse CEDEX 9, France

    Fanny Elia, Jérôme Murgier, Philippe Chiron & Benoit Chaput

Authors
  1. Aloїs Espié
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fanny Elia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jérôme Murgier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Chiron
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benoit Chaput
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aloїs Espié.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

Head-neck offset (red arrow) as Eijer et al. [1]. Line A neck axis, line B parallel to A and tangent to the cortex of the femoral neck, line C parallel to A and tangent to the head. (GIF 91 kb)

High Resolution (TIFF 799 kb)

ESM 2

Example of a radiograph with an Eijer’s offset difficult to measure: Eijer’s HNO = 8.6 mm; modified HNO = 0.8 mm.h (GIF 108 kb)

High Resolution (TIFF 1592 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Espié, A., Elia, F., Murgier, J. et al. Modified head-neck offset for diagnosing anterior femoro-acetabular impingement. International Orthopaedics (SICOT) 40, 687–695 (2016). https://doi.org/10.1007/s00264-015-2834-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2834-3

Keywords

Search

Navigation