Cam Morphology is Associated with Increased Femoral Version: Findings from a Collection of 1,321 Cadaveric Femurs

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

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Correction to: Clinical and radiological hip parameters do not precede, but develop simultaneously with cam morphology: a 5-year follow-up study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06374-x ◽

2021 ◽

Vol 29 (5) ◽

pp. 1411-1412

Author(s):

P. van Klij ◽

M. P. Heijboer ◽

A. Z. Ginai ◽

J. A. N. Verhaar ◽

J. H. Waarsing ◽

...

Keyword(s):

Follow Up Study ◽

Cam Morphology

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The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

Hip International ◽

10.1177/11207000211013029 ◽

2021 ◽

pp. 112070002110130

Author(s):

Leigh-Anne Tu ◽

Douglas S Weinberg ◽

Raymond W Liu

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Hip Osteoarthritis ◽

Volume Ratio ◽

Femoral Head Coverage ◽

Neck Shaft Angle ◽

Hip Arthritis ◽

Femoral Version ◽

Shaft Angle ◽

The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

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The relationship between cam morphology and hip and groin symptoms and signs in young male football players

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13660 ◽

2020 ◽

Vol 30 (7) ◽

pp. 1221-1231 ◽

Cited By ~ 2

Author(s):

Pim Klij ◽

Abida Z. Ginai ◽

Marinus P. Heijboer ◽

Jan A. N. Verhaar ◽

Jan H. Waarsing ◽

...

Keyword(s):

Young Male ◽

Football Players ◽

The Relationship ◽

Cam Morphology ◽

Symptoms And Signs

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BORDERLINE ACETABULAR DYSPLASIA: THREE-DIMENSIONAL DEFORMITY PREDICTORS OF THE DIAGNOSIS OF SYMPTOMATIC INSTABILITY TREATED WITH PERIACETABULAR OSTEOTOMY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00160 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0016

Author(s):

Elizabeth Graesser ◽

Maria Schwabe ◽

Cecilia Pascual Garrido ◽

John C. Clohisy ◽

Jeffrey J. Nepple

Keyword(s):

Low Dose ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Alpha Angle ◽

Three Dimensional ◽

Acetabular Coverage ◽

Low Dose Ct ◽

Femoral Version ◽

Center Edge ◽

Hip Morphology

Introduction: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia. Summary: This study attempts to define 3D CT characteristics to help distinguish between patients with impingement-based vs instability-based symptoms of borderline acetabular dysplasia.

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Cam morphology is associated with radiographic hip osteoarthritis and hip pain in men but not in women: findings from a cross-sectional study in UK biobank

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2021.02.385 ◽

2021 ◽

Vol 29 ◽

pp. S291-S292

Author(s):

B. Faber ◽

R. Ebsim ◽

F. Saunders ◽

M. Frysz ◽

C. Lindner ◽

...

Keyword(s):

Hip Osteoarthritis ◽

Cross Sectional Study ◽

Hip Pain ◽

Uk Biobank ◽

Sectional Study ◽

Cross Sectional ◽

Cam Morphology

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Femoral Version, Neck-Shaft Angle, and Acetabular Anteversion in Chinese Han Population

Medicine ◽

10.1097/md.0000000000000891 ◽

2015 ◽

Vol 94 (21) ◽

pp. e891 ◽

Cited By ~ 12

Author(s):

Nan Jiang ◽

Lin Peng ◽

Mohammed Al-Qwbani ◽

Guo-Ping Xie ◽

Qin-Meng Yang ◽

...

Keyword(s):

Chinese Han Population ◽

Acetabular Anteversion ◽

Chinese Han ◽

Han Population ◽

Neck Shaft Angle ◽

Femoral Version ◽

Shaft Angle

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Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06643-3 ◽

2021 ◽

Author(s):

Zaki Arshad ◽

Henry David Maughan ◽

Karadi Hari Sunil Kumar ◽

Matthew Pettit ◽

Arvind Arora ◽

...

Keyword(s):

Clinical Decision Making ◽

Clinical Decision ◽

Original Research ◽

Distribution Analysis ◽

Inclusion Criteria ◽

Acetabular Version ◽

Level Of Evidence ◽

Femoral Version ◽

Normal Mean ◽

The Relationship

Abstract Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

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