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Femoroacetabular impingement in ancient Nubia 1400-656 BC

  • Orthopaedic Surgery
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Abstract

Introduction

There is significant recent interest in femoroacetabular impingement (FAI) in orthopaedics. The etiology of the cam deformity is unknown but has been hypothesized to be due to stresses from sporting activities in our modern society. Few archeological studies exist of femora and FAI. This study reviewed proximal femoral anatomy in a skeletal collection from the ancient Nile valley archeological site at Tombos 1400-656 BC.

Methods

Digital photographs of the femora were used to obtain angular measurements of the apparent neck shaft, true neck shaft, version, inclination, and α and β angles of Nötzli. All photographs were reviewed by two orthopaedic surgeons for cam and pincer lesions. Sex and age of the specimens was determined when possible. A cam lesion was defined as any femur demonstrating an α angle > 50° or when a cam deformity was seen on visual inspection by both orthopaedic surgeons. Pincer lesions were identified upon visual inspection by both orthopaedic surgeons, when the femoral neck demonstrated impaction lesions, as pelvis radiographs could not be obtained.

Results

There were 126 unique femora; 69 female and 57 male. Age estimates were possible in 100 and was 15–24 years in 14, 25–34 years in 33, 35–49 years in 28, 50–69 years in 17, and ≥ 70 years in 8. There were nine femora (seven individuals) with cam lesions (7%) and five femora (four individuals) with pincer lesions (4%). One demonstrated a combined lesion.

Conclusion

FAI existed in ancient Nile valley inhabitants and is thus not only a product of modern day life style athletics. This contrasts with Native Americans living in Ohio 700–1000 AD where no FAI was identified. This difference is likely due to combinations of different types of activity, diet, and genetics. Further research of ancient populations is needed to further answer this question.

Level of evidence

IV—cohort study.

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Acknowledgements

The modern community of Tombos welcomed the archaeological team and assisted with excavations each season. The Department of Anthropology at Purdue University provided the curation facilities for the specimens in this study.

Funding

Excavations at the Tombos site were primarily funded by the National Science Foundation (Grants BCS-0917824, 0907815, 0313247) and the National Geographic Society.

Author information

Authors and Affiliations

  1. Department of Anthropology, Purdue University, West Lafayette, IN, USA

    Sarah N. Coon & Michele R. Buzon

  2. Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, CT, USA

    Kristin E. Yu, William M. McLaughlin & Daniel R. Cooperman

  3. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Raghav Badrinath

  4. Department of Orthopaedic Surgery, Riley Children’s Hospital, Indiana University School of Medicine, Phase 1, Suite 1100, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA

    Randall T. Loder

Authors
  1. Sarah N. Coon
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  5. Michele R. Buzon
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Contributions

SNC: methodology, investigation, data curation, writing—original draft, writing—review and editing. KEY: data curation, investigation, formal analysis, writing—original draft, writing—review and editing. WMM: data curation, investigation, writing—review and editing. RB: data curation, investigation, writing—review and editing. MRB: grant funding, resources, methodology, data curation, writing—original draft, writing—review and editing, project administration. DC: conceptualization, methodology, investigation, writing—original draft, writing—review and editing, project administration. RTL: conceptualization, methodology, investigation, data curation, formal analysis, writing—original draft, writing—review and editing, project administration.

Corresponding author

Correspondence to Randall T. Loder.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The Sudanese National Corporation for Antiquities and Museums permitted the excavation and exportation of human remains.

Informed consent

The specimens studied are from 3000 years ago making informed consent impossible, and Institutional Board Review approval does not apply as per Purdue University, curator of the specimens.

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Coon, S.N., Yu, K.E., McLaughlin, W.M. et al. Femoroacetabular impingement in ancient Nubia 1400-656 BC. Arch Orthop Trauma Surg 143, 3909–3917 (2023). https://doi.org/10.1007/s00402-022-04649-1

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