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Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI

  • Symposium: 2012 International Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI).

Questions/purposes

We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI.

Methods

Surface models based on CT scan reconstructions of 13 valgus hips with increased antetorsion, 22 hips with FAI, and 27 normal hips were included. Validated three-dimensional collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and the femoral sides.

Results

Hips with coxa valga and antetorsion showed decreased extension, external rotation, and adduction, whereas internal rotation in 90° of flexion was increased. Impingement zones were more anteroinferior on the femur and posteroinferior on the acetabular (pelvic) side; and the zones were more frequently extraarticular, posterior, or to a lesser degree anterior against the inferior iliac spine. We found a higher prevalence of extraarticular impingement for valgus hips with increased antetorsion.

Conclusions

Valgus hips with increased antetorsion predispose to posterior extraarticular FAI and to a lesser degree anteroinferior spine impingement.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Klaus A. Siebenrock MD, Simon Damian Steppacher MD, Pascal Cyrill Haefeli MD & Moritz Tannast MD

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Joseph Michael Schwab MD

Authors
  1. Klaus A. Siebenrock MD
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  2. Simon Damian Steppacher MD
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  3. Pascal Cyrill Haefeli MD
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  4. Joseph Michael Schwab MD
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  5. Moritz Tannast MD
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Corresponding author

Correspondence to Klaus A. Siebenrock MD.

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Each author certifies that he or she, or a member of their immediate family, 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.

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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Siebenrock, K.A., Steppacher, S.D., Haefeli, P.C. et al. Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI. Clin Orthop Relat Res 471, 3774–3780 (2013). https://doi.org/10.1007/s11999-013-2895-9

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  • DOI: https://doi.org/10.1007/s11999-013-2895-9

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