Is there a relationship between femoral neck-shaft angle and ischiofemoral impingement in patients with hip pain?

Abstract Ischiofemoral impingement (IFI) is a cause of deep gluteal space syndrome. The prevalence of radiographic findings in patients with hip pain is unknown. To assess if there is a correlation between femoral neck-shaft angle (NSA) and the distance of the ischiofemoral space (IFS) and quadratus femoris space (QFS) and to determine the prevalence of quadratus femoris (QF) edema in patients with hip pain. A retrospective case series was conducted involving 100 consecutive hip or pelvis magnetic resonance imaging scans on patients presenting with hip pain. NSA, IFS and QFS distances were measured and presence of QF edema was noted. Analysis of the groups (QF edema vs no edema) was performed using two-tailed t-test and Pearson correlation. There were 18 hips in the edema group (mean age 51.11 years ± 10.5) and 82 hips in the non-edema group (mean age 40.79 years ± 15.9). Within the edema group, there was a moderate positive correlation between NSA and QFS (r = 0.498, P = 0.036) and a weak positive correlation between NSA and IFI (0.312, P = 0.208). The prevalence of QF edema in this study was 18% with only 28% of those subjects having clinical symptoms of IFI. Patients with QF edema had significantly narrower QFS and IFS distances (P < 0.001). The prevalence of QF edema is 18% in a consecutive sample of adults with hip pain. In patients with QF edema, only 28% have symptoms of IFI. In patients with QF edema, there was a moderate positive correlation between NSA and QFS.

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ISCHIOFEMORAL IMPINGEMENT IN ADOLESCENTS: FROM CLINICAL PRESENTATION TO RETURN TO SPORTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00020 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0002

Author(s):

Javier Besomi ◽

Alan Garin ◽

Cristhian Herrera ◽

Pedro Salgado ◽

Selim Abara ◽

...

Keyword(s):

Clinical Presentation ◽

Hip Pain ◽

Return To Sports ◽

X Rays ◽

Imaging Findings ◽

Duration Of Symptoms ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Ischiofemoral Impingement ◽

Quadratus Femoris

Background: Ischiofemoral impingement is an often unrecognized cause of hip pain in adolescents. It is caused by abnormal contact between the proximal femur and the ischium. The aim of our work is to describe clinical presentation, imaging findings and functional outcomes of ischiofemoral impingement in adolescents. Methods: We performed a retrospective study. Clinical files were reviewed (age, sex, type and duration of symptoms and hip physical examination). Imaging findings were evaluated in pelvis radiographs (presence of coxa profunda, acetabular protrusio, Wiberg angle, femoral neck shaft angle and acetabular retroversion) and in MRI (quadratus femoris edema, measurement of ischiofemoral and quadratus femoris space). Lower extremity functional scale (LEFS) were used to measured response to a physiotherapy protocol. Also relapse and time to sports return were recorded. Results: 24 hips, two bilateral in 20 female patients and 2 male patients, with 13 years-old on average (9-18) were obtained. Main symptom was hip pain with latency to consultant of 9 days on average (2-14). All patients practiced school sports, the most frequent was gymnastics. Positive FADIR test, ischiofemoral impingement test and pain on palpation of the ischium and gluteus medius were found in everyone. The median of Wiberg angle was 37º (25-48), femoral shaft angle 138º (128-144), and coxa profunda was present in 5 hips. MRI showed 13 hips with quadratus femoris edema, one with muscle atrophy, ischiofemoral space was 20 mm on average (16-25) and quadratus femoris space 17 mm on average (13-21). Our physiotherapy protocol was followed for all patients with a median of 18 sessions (10-30). LEFS improved from 56.4% (30-93) to 92% (80-100) (p=0,02). Time to turn asymptomatic was 6 months on average (3-13). With 2 years follow up, 2 hips had recurrence of symptoms. Time to sports return was 5 months on average (3-7). Conclusions: Ischiofemoral impingement is cause of hip pain in active female adolescents. X-rays are inespecific and MRI shows typically quadratus femoris edema. Conservative treatment with physiotherapy is an effective method that allows sports return in few months. This is the first report in the literature regards ischiofemoral impingement in pediatric population including results of treatment and return to sports.

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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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Simultaneous Morscher’s osteotomy and arthroscopic debridement in the management of Legg–Calvé–Perthes disease: a case report and literature review

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab017 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i4-i8

Author(s):

Batool Bosakhar ◽

Hassan Baldawi ◽

Kathy Liu ◽

Olufemi R Ayeni ◽

Waleed Kishta

Keyword(s):

Case Report ◽

Literature Review ◽

Femoral Neck ◽

Perthes Disease ◽

Labral Repair ◽

Coxa Vara ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Outcome Tool

Abstract There is a lack of consensus around optimal surgical management for Legg–Calvé–Perthes Disease (LCPD). This case report discusses the benefits of combining arthroscopic femoral neck osteochondroplasty and labral repair with Morscher’s Osteotomy (MO) for LCPD. S.A. is a 17-year-old female diagnosed with LCPD at the age of 6 years and has long-standing right hip symptoms. An arthroscopic femoral neck osteochondroplasty and labral repair followed by MO was performed. The pre-operative and 8 months post-operative International Hip Outcome Tool (iHOT-12) scores were 16.3 and 79.8 out of 100, respectively, indicating better quality-of-life. Also, the femoral neck-shaft-angle (NSA) changed from 120 pre-operative to 138.7 post-operative to represent the correction of coxa vara. The literature review revealed no published reports describing combined MO with hip arthroscopic interventions in managing LCPD. Combined arthroscopic femoral neck osteochondroplasty (with labral repair) and MO provides high patient satisfaction and improves radiographic parameters in patients with LCPD.

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Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/293 ◽

2021 ◽

Vol 10 (19) ◽

pp. 1387-1390

Author(s):

Rajeev Kumar Kanchan ◽

Sonali Subhadarsini ◽

Dharma Niranjan Mishra ◽

Chinmayi Mohapatra

Keyword(s):

Femoral Neck ◽

Ventral Surface ◽

Cross Sectional Study ◽

Cross Sectional ◽

Legal Cases ◽

Male And Female ◽

Neck Shaft Angle ◽

Femur Neck ◽

Shaft Angle ◽

The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

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Morphometric Study of Femoral Neck-Shaft Angle in Kolar Population and Its Clinical Importance

Indian Journal of Anatomy ◽

10.21088/ija.2320.0022.8319.16 ◽

2019 ◽

Vol 8 (3) ◽

pp. 226-232

Author(s):

Suresh NM ◽

◽

Sunitha R ◽

Aruna N ◽

Nalini JP ◽

...

Keyword(s):

Femoral Neck ◽

Clinical Importance ◽

Morphometric Study ◽

Neck Shaft Angle ◽

Shaft Angle

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The Association Between Femoral Neck-Shaft Angle and Aging and Its Influence on the Performance of Functional Activity: A Cross-Sectional Investigation

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0008 ◽

2020 ◽

Vol 28 (2) ◽

pp. 250-254

Author(s):

Ibrahim M. Altubasi

Keyword(s):

Femoral Neck ◽

Regression Models ◽

Walking Speed ◽

Functional Performance ◽

Hierarchical Regression ◽

Performance Tests ◽

Cross Sectional ◽

Neck Shaft Angle ◽

Functional Activities ◽

Shaft Angle

The purposes of this study were first to examine the association between aging and both the magnitude and asymmetry in the femoral neck-shaft angle (NSA). The second purpose was to determine the effects of both the magnitude and NSA asymmetry on the performance of functional activities in healthy individuals. Fifty-one subjects participated in this study. The femoral NSA was measured on computed tomography scout images. The participants performed four performance tests. Four hierarchical regression models were constructed to explore the effect of each predictor on the outcomes. Aging was associated with NSA asymmetry, but not with the degree of NSA. Age contributed significantly to the variability of all functional performance tests except the 10-m walking speed. The degree of the NSA did not contribute to the prediction of the functional performance tests. However, asymmetry in the NSA added significantly to the prediction of all functional performance tests except the 10-m walking speed.

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Femoral neck-shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side

Journal of Anatomy ◽

10.1111/joa.12073 ◽

2013 ◽

Vol 223 (2) ◽

pp. 133-151 ◽

Cited By ~ 37

Author(s):

Ian Gilligan ◽

Supichya Chandraphak ◽

Pasuk Mahakkanukrauh

Keyword(s):

Femoral Neck ◽

Neck Shaft Angle ◽

Shaft Angle

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Etiological importance of training frequency, age and prevalance of Femoroacetabular İmpingement(FAİ) in pediatric male athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00067 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0006

Author(s):

Gökhan Polat ◽

Ufuk Arzu ◽

Engin Dinç ◽

Bülent Bayraktar

Keyword(s):

Femoroacetabular Impingement ◽

Alpha Angle ◽

Statistical Relationship ◽

Male Athletes ◽

Positive Correlation ◽

Morphological Abnormalities ◽

Neck Shaft Angle ◽

Weekly Training ◽

Training Frequency ◽

Shaft Angle

Femoroacetabular impingement (FAİ) is a prearthrozic disease that causes hip pain in adolescent-adult patients. The aim of the study is, determining the prevalence of asymptomatic radiographic findings of FAİ, to examine the evaluation of prevalence difference according to age groups and the impact of the levels of physical activity at developmental period on the development of asymptomatic FAİ. Materials-Methods: In our study, we included 214 pediatric athletes from 8 football teams operating in Istanbul between 11-18 years of age in September 2015- January 2016. Ethics Committee approval was obtained for our study. AP pelvis and Frog-leg radiographs, curriculum vitae of the athletes, their injuries, and their realtime complaints have been questioned. The alpha angle, CE angle, Tonnis angle, collodiaphyseal angle is measured from the resulting AP and Frog leg radiographs and terms of morphological abnormalities (FAİ, dysplasia and coxa vara…) was noted. Also athletes dominant feet, weekly training period and the years they play soccer was noted. The obtained data were analyzed by one-way ANOVA and Student-T test. Results: The average age of the 214 pediatric male athletes that included was 15(10-18). Asymptomatic FAİ prevalence of all ages was %29.9, % 0 in the range of 10-12 years, %13.1 in the range of 13-15 years, %45.7 in the 15-18 age range. These findings showed that significantly increased prevalence of FAİ in line with age in pediatric athletes statistically (p <0.05). The mean right hip alpha angle of all athletes was 50.7, left alpha angle was 50.3, right-CE angle was 28.6, left CE angle was 29.5, right Tönnis Angle 6.6, left Tönnis angle 5.0, right neck-shaft angle 133.9, left neck-shaft angle 134.7 degrees found. There was 7 acetabular dysplasia, 56 athletes with CAM type FAS, 4 athletes Pincer type FAS, and 4 combined FAS was found. There was no significant statistical relationship in the prevalences of FAİ between the number of years he worked as an athlete or the side which they hit the ball. However a positive correlation was found between weekly training hours (p <0.05). There were no statistical relationship between morphological abnormalities and previous injuries. Discussion: Among the etiology oriented researches, investigation for developmental factors still continues. İn our study, it is found that the sports activities in the pediatric period that are accused can be a factor in FAİ development due to the positive correlation between pediatric athletes age ang training frequency.

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