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Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

  • Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Three-dimensional imaging (CT and MRI) is the gold standard for detecting femoral head-neck junction malformations in femoroacetabular impingement, yet plain radiographs are used for initial diagnostic evaluation. It is unclear, however, whether the plain radiographs accurately reflect the findings on three-dimensional imaging.

Questions/Purposes

We therefore: (1) investigated the correlation of alpha angle measurements on plain radiographs and radial reformats of CT scans; (2) determined which radiographic views are most sensitive and specific in detecting head-neck deformities present on CT scans; and (3) determined if specific radiographic views correlated with specific locations on the radial oblique CT scan.

Methods

We retrospectively reviewed 41 surgical patients with preoperative CT scans (radial oblique reformats) and plain radiographs (AP pelvis, 45° Dunn, frog lateral, and crosstable lateral). Alpha angles were measured on plain radiographs and CT reformats.

Results

The complete radiographic series was 86% to 90% sensitive in detecting abnormal alpha angles on CT. The maximum alpha angle on plain radiographs was greater than that of CT reformats in 61% of cases. Exclusion of the crosstable lateral did not affect the sensitivity (86%–88%). The Dunn view was most sensitive (71%–80%). The frog lateral showed the best specificity (91%–100%). Substantial correlations (intraclass correlation coefficients, 0.64–0.75) between radiograph and radial oblique CT position were observed, including AP/12:00 (superior), Dunn/1:00 (anterolateral), frog/3:00 (anterior), and crosstable/3:00 (anterior).

Conclusions

For diagnostic and treatment purposes, a three-view radiographic hip series (AP pelvis, 45° Dunn, and frog lateral) effectively characterizes femoral head-neck junction malformations.

Level of Evidence

Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Karen Steger-May for assistance with statistical analyses as well as Dr Daniel Wessel and Tim Keys for assistance in determining radiation exposure.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid, 11300 West Pavilion, Campus Box 8233, St Louis, MO, USA

    Jeffrey J. Nepple MD & John C. Clohisy MD

  2. University of Chicago, Chicago, IL, USA

    John M. Martel MD

  3. Department of Orthopaedic Surgery, Children’s Hospital, Boston, MA, USA

    Young-Jo Kim MD

  4. William Beaumont Hospital, Royal Oak, MI, USA

    Ira Zaltz MD

Authors
  1. Jeffrey J. Nepple MD
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  2. John M. Martel MD
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  3. Young-Jo Kim MD
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  4. Ira Zaltz MD
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  5. John C. Clohisy MD
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Consortia

ANCHOR Study Group

Corresponding author

Correspondence to John C. Clohisy MD.

Additional information

ANCHOR Study Group: J. C. Clohisy, H. S. Hosalkar, Y.-J. Kim, J. M. Martel, M. B. Millis, J. J. Nepple, D. Podeszwa, D. Sucato, E. Sink, I. Zaltz

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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.

All investigations were conducted in conformity with ethical principles of research and informed consent for participation in the study was obtained.

This work was performed at Washington University School of Medicine, St Louis, MO, USA, and various centers of the ANCHOR Study Group.

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Nepple, J.J., Martel, J.M., Kim, YJ. et al. Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?. Clin Orthop Relat Res 470, 3313–3320 (2012). https://doi.org/10.1007/s11999-012-2510-5

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  • DOI: https://doi.org/10.1007/s11999-012-2510-5

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