Skip to main content
SpringerLink
Log in

Femoroacetabular impingement: normal values of the quantitative morphometric parameters in asymptomatic hips

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the means and the reference intervals of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in normal hips with high-resolution computed tomography (CT).

Methods

We prospectively included 94 adult individuals who underwent CT for thoracic, abdominal or urologic pathologies. Patients with a clinical history of hip pathology and/or with osteoarthritis on CT were excluded. We calculated means and 95 % reference intervals for imaging signs of cam-type (alpha angle at 90° and 45° and femoral head–neck offset) and pincer-type impingement (acetabular version angle, lateral centre-edge angle and acetabular index).

Results

The 95 % reference interval limits were all far beyond the abnormal thresholds found in the literature for cam-type and to a lesser extent for pincer-type FAI. The upper limits of the reference intervals for the alpha angles (at 90°/45°) were 68°/83° (men) and 69°/84° (women), compared to thresholds from the literature (50°, 55° or 60°). Reference intervals were similar between genders for cam-type parameters, and slightly differed for pincer-type.

Conclusion

The 95 % reference intervals of morphometric measurements of FAI in asymptomatic hips were beyond the abnormal thresholds, which was especially true for cam-type FAI. Our results suggest the need for redefining the current morphometric parameters used in the diagnosis of FAI.

Key Points

• 95 % reference intervals limits of FAI morphotype were beyond currently defined thresholds.

• Reference intervals of pincer-type morphotype measurements were close to current definitions.

• Reference intervals of cam-type morphotype measurements were far beyond the current definitions.

• Current morphometric definitions of cam-type morphotype should be used with care.

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

Abbreviations

CT:

computed tomography

FAI:

femoroacetabular impingement

ICC:

intraclass correlation coefficients

MPR:

multiplanar reformatting

MRI:

magnetic resonance imaging

OA:

osteoarthritis

PACS:

picture archiving and storage system

References

  1. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

  2. Ito K, Leunig M, Ganz R (2004) Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 429:262–271

  3. Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, Siebenrock KA (2003) Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthr Cartil 11:508–518

    Article  CAS  PubMed  Google Scholar 

  4. Byrd JWT (2014) Femoroacetabular impingement in athletes: current concepts. Am J Sports Med 42:737–751

    Article  PubMed  Google Scholar 

  5. Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol 188:1540–1552

    Article  PubMed  Google Scholar 

  6. Kassarjian A, Brisson M, Palmer WE (2007) Femoroacetabular impingement. Eur J Radiol 63:29–35

    Article  PubMed  Google Scholar 

  7. Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ (2011) Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy 27:252–269

    Article  PubMed  Google Scholar 

  8. Ng VY, Arora N, Best TM, Pan X, Ellis TJ (2010) Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med 38:2337–2345

    Article  PubMed  Google Scholar 

  9. Parvizi J, Leunig M, Ganz R (2007) Femoroacetabular impingement. J Am Acad Orthop Surg 15:561–570

    PubMed  Google Scholar 

  10. Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ (2005) Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res 23:1286–1292

    Article  PubMed  Google Scholar 

  11. Clohisy JC, Carlisle JC, Beaulé PE et al (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 Central  PubMed  Google Scholar 

  12. James SLJ, Ali K, Malara F, Young D, O'Donnell J, Connell DA (2006) MRI findings of femoroacetabular impingement. AJR Am J Roentgenol 187:1412–1419

    Article  PubMed  Google Scholar 

  13. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, 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 (Br) 84:556–560

    Article  Google Scholar 

  14. Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240:778–785

    Article  PubMed  Google Scholar 

  15. Ecker TM, Tannast M, Puls M, Siebenrock KA, Murphy SB (2007) Pathomorphologic alterations predict presence or absence of hip osteoarthrosis. Clin Orthop Relat Res 465:46–52

    PubMed  Google Scholar 

  16. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A (2010) Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am 92:1162–1169

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA (2012) How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers? Radiology 264:514–521

    Article  PubMed  Google Scholar 

  20. Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770

    PubMed  Google Scholar 

  21. Pollard TCB, Villar RN, Norton MR et al (2010) Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips. Acta Orthop 81:134–141

    Article  PubMed Central  PubMed  Google Scholar 

  22. Chakraverty JK, Sullivan C, Gan C, Narayanaswamy S, Kamath S (2013) Cam and pincer femoroacetabular impingement: CT findings of features resembling femoroacetabular impingement in a young population without symptoms. Am J Roentgenol 200:389–395

    Article  Google Scholar 

  23. Laborie LB, Lehmann TG, Engesæter I, Eastwood DM, Engesæter LB, Rosendahl K (2011) Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiology 260:494–502

    Article  PubMed  Google Scholar 

  24. Reichenbach S, Jüni P, Werlen S et al (2010) Prevalence of cam-type deformity on hip magnetic resonance imaging in young males: a cross-sectional study. Arthr Care Res (Hoboken) 62:1319–1327

    Article  Google Scholar 

  25. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, Peters CL (2011) Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am 93:e111(1-e1110)

    Article  Google Scholar 

  26. Omoumi P, Thiery C, Michoux N, Malghem J, Lecouvet FE, Vande Berg BC (2014) Anatomic features associated with femoroacetabular impingement are equally common in hips of old and young asymptomatic individuals without CT signs of osteoarthritis. AJR Am J Roentgenol. doi:10.2214/AJR.12.10083

  27. Horowitz GL, Altaie S, Boyd JC et al (2008) Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline–third edition CLSI document C28-A3. Clinical and Laboratory Standards Institute, Wayne

    Google Scholar 

  28. Collins JA, Ward JP, Youm T (2013) Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med. doi:10.1177/0363546513499227

    PubMed Central  Google Scholar 

  29. de Bruin F, Reijnierse M, Farhang-Razi V, Bloem JL (2013) Radiographic signs associated with femoroacetabular impingement occur with high prevalence at all ages in a hospital population. Eur Radiol 23:3131–3139

    Article  PubMed  Google Scholar 

  30. Altman DG (1990) Practical statistics for medical research. Chapman & Hall/CRC, Boca Raton

    Google Scholar 

  31. Rakhra KS, Sheikh AM, Allen D, Beaulé PE (2009) Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res 467:660–665

    Article  PubMed Central  PubMed  Google Scholar 

  32. Harris-Hayes M, Royer NK (2011) Relationship of acetabular dysplasia and femoroacetabular impingement to hip osteoarthritis: a focused review. PM R 3:1055–1067.e1

    Article  PubMed Central  PubMed  Google Scholar 

  33. Werner CM, Ramseier LE, Ruckstuhl T et al (2012) Normal values of Wiberg’s lateral center-edge angle and Lequesne’s acetabular index-a coxometric update. Skelet Radiol 41:1273–1278

    Article  Google Scholar 

  34. Palmer WE (2010) Femoroacetabular impingement: caution is warranted in making imaging-based assumptions and diagnoses. Radiology 257:4–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Dr. Patrick Omoumi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. We received approval from the institutional ethical committee of our institution: Commission d'Éthique Biomédicale Hospitalo-Facultaire, Cliniques Universitaires Saint Luc - Université Catholique de Louvain. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Cliniques Universitaires Saint Luc - Université Catholique de Louvain, Woluwe-Saint-Lambert, Belgium

    Marianne Lepage-Saucier, Cécile Thiéry, Ahmed Larbi, Frédéric E. Lecouvet, Bruno C. Vande Berg & Patrick Omoumi

  2. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Patrick Omoumi

  3. Hôpital Notre-Dame - Centre hospitalier de l’Université de Montréal, 1560, rue Sherbrooke Est Montréal, H2L 4M1, Québec, Canada

    Marianne Lepage-Saucier

Authors
  1. Marianne Lepage-Saucier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cécile Thiéry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed Larbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frédéric E. Lecouvet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno C. Vande Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Omoumi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Omoumi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lepage-Saucier, M., Thiéry, C., Larbi, A. et al. Femoroacetabular impingement: normal values of the quantitative morphometric parameters in asymptomatic hips. Eur Radiol 24, 1707–1714 (2014). https://doi.org/10.1007/s00330-014-3171-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3171-4

Keywords

Search

Navigation