Prevalence of Cam and Pincer Deformities in the X-Rays of Asymptomatic Individuals

Objective. The presence of radiological signs of femoroacetabular impingement (FAI) is not necessarily associated with symptoms. Hence, the prevalence of cam and pincer deformities in the overall population may be underestimated. The purpose of this study was to screen an unselected cohort of people without hip symptoms for native radiological signs of cam and pincer deformities to determine their actual prevalence. Materials and Methods. 110 asymptomatic patients had AP pelvis X-rays and cross-table hip X-rays performed. We evaluated the images for the presence of cross-over signs and measured lateral center edge (LCE) angles, alpha angles (α-angles), and femoral offset ratios. Results. Positive cross-over signs were seen in 34%; LCE angles > 40° in 13%; and femoral offset ratios < 0.18 in 43%. In 41% of the patients, α-angles were >50°. Male patients showed significantly higher α-angles, lower offset ratios, and a higher prevalence of cross-over signs. In contrast, female patients had significantly higher LCE angles. Conclusion. According to our data, radiological signs of cam and pincer deformities are common in asymptomatic people. In clinical practice, patients presenting with hip pain and radiological signs of FAI should undergo further diagnostic evaluation. However, in asymptomatic patients, no further evaluation is recommended.

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The prevalence of femoroacetabular impingement in asymptomatic hips in Indian population: a radiomorphometric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213177 ◽

2021 ◽

Author(s):

Mohammed Fawas Namboodikandy ◽

Jojo Inassi ◽

Balaji Zacharia

Keyword(s):

Femoroacetabular Impingement ◽

Indian Population ◽

Tertiary Care ◽

Cross Sectional Study ◽

X Rays ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Secondary Osteoarthritis ◽

Asymptomatic Patients ◽

Asymptomatic Individuals

Background: Femoroacetabular impingement (FAI) is a common cause of secondary osteoarthritis of the hip. There are no much studies about the occurrence of FAI in asymptomatic individuals in Indian population. Our objective was to find out the radiological prevalence of FAI in asymptomatic adult Indian population.Methods: A cross sectional study was carried out in our institution, which is a tertiary care centre, between September 2016 and September 2018 in which in which we studied radiographs of 1600 hips from 800 pelvic x-rays of asymptomatic patients.Results: Out of 1600 radiographs of the hips studied 1353 were found to be normal and the remaining 247(15.4%), had features of FAI. 61 hip radiographs (3.8%) showed cam lesions and 9.2 % showed pincer type of lesion.38 hips (2.4%) showed mixed type of FAI.Conclusions: Significant number of radiographs of asymptomatic patients showed features of FAI. Further long-term studies are needed to see the proportion of these patients with FAI progressing to secondary osteoarthritis of hip.

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Abstract 2663: How Do Cardiologists and Cardiothoracic Surgeons Treat Asymptomatic Mitral Regurgitation in Clinical Practice? An International Survey

Circulation ◽

10.1161/circ.116.suppl_16.ii_590-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kevin M Harris ◽

Catherine A Pastorius ◽

Eileen M Harwood ◽

Sue Duval ◽

Alan T Hirsch ◽

...

Keyword(s):

Clinical Practice ◽

Mitral Regurgitation ◽

Practice Patterns ◽

Geographical Location ◽

Lv Function ◽

Asymptomatic Patients ◽

The Usa ◽

Asymptomatic Individuals ◽

Regurgitant Orifice Area ◽

Cardiac Surgeons

Background: Severe mitral regurgitation (MR) is known to be associated with adverse clinical outcomes. Thus, consensus-derived, evidence-based practice standards (e.g., ACC/AHA Guidelines for Management of Valvular Heart Disease) have been published. Yet, no data exist to describe whether physicians follow such standards in clinical practice for asymptomatic pts with MR. Methods: A random sample of cardiovascular specialists were surveyed by email and asked to complete 26 items that encompassed MR-related practice patterns. Results: 1035 physicians completed the survey (68% response rate) and the sample included adult cardiologists (95%) and cardiac surgeons (5%) who practice in the USA (84%), Canada (6%), and other nations (10%). When asked ``Do you refer asymptomatic patients with severe MR and normal LV function for MV repair?”, 28% responded yes/almost always, and 11% responded no/ rarely. There was geographic & specialty-dependent variation in practice (Table ). Patient referral for mitral surgery was based on risk markers, such as atrial fibrillation (18%) and pulmonary hypertension (17%) and anatomic factors (e.g., flail valve, 18%) and clinical variables (e.g., increased likelihood of repair, 19%). Most physicians (65%) use medications to delay progression of MR, with ACE-inhibitors utilized by 57%. Isolated posterior prolapse repair was repaired successfully >85% at their hospital by 61% (60% for cardiologists vs. 82% for surgeons, p=0.004). 28% of respondents almost always quantitate MR using effective regurgitant orifice area, while 30% rarely or never do so. Conclusions: Cardiologists frequently refer asymptomatic MR patients for mitral reparative surgery, but referral is often prompted by factors beyond those included in current guidelines. Practice patterns vary by physician type and by geographical location. Medications are frequently used to treat asymptomatic individuals with MR, in the absence of documented evidence of efficacy.

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Prevalence of radiographic parameters on CT associated with femoroacetabular impingement in a Chinese asymptomatic population

Acta Radiologica ◽

10.1177/0284185119898661 ◽

2020 ◽

Vol 61 (9) ◽

pp. 1213-1220

Author(s):

Jing Chen ◽

Lei Xu ◽

Zhe-feng Chen ◽

Yue-fen Zou

Keyword(s):

Femoroacetabular Impingement ◽

Elderly Women ◽

Alpha Angle ◽

Ct Images ◽

Chinese Patients ◽

Predisposing Factor ◽

Imaging Evaluation ◽

Center Edge ◽

Asymptomatic Patients ◽

Sector Angle

Background Imaging evaluation of femoroacetabular impingement (FAI) plays a major role in early diagnosis and treatment, preventing irreversible degenerative changes in hip joints. Purpose To investigate the anatomical parameters associated with FAI in a Chinese asymptomatic population by computed tomography (CT) and to evaluate the prevalence of the radiographic features of cam and pincer types in Chinese patients. Material and Methods We reviewed the CT images of 470 hips in 235 Chinese patients who underwent abdominal and pelvic CT scans for reasons unrelated to hip symptoms at our hospital between February and October 2017. The following measurements were made on each hip joint: acetabular version angle (AV); anterior acetabular sector angle (AASA); posterior acetabular sector angle (PASA); the lateral center edge angle (LCE); the alpha angle (AA); and femoral head-neck offset (FHNO). Results Significant differences in all parameters were seen between men and women. Young men and elderly women showed more retroversion in our study. LCE, AA, and FHNO were all larger in men than women. The data showed 25% of female joints and 34.5% of male joints had at least one predisposing factor for FAI using measurement parameters by CT images in Chinese asymptomatic patients, and the prevalence of pincer lesion (19.1%) was larger than cam lesion (9.1%). Conclusion Morphological features associated with FAI are also present in Chinese asymptomatic patients. The threshold values for abnormal parameters should be reconsidered based on gender, age, and other factors in order to improve the accuracy of diagnosis.

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Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977892 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712097789

Author(s):

Rodolfo Morales-Avalos ◽

Adriana Tapia-Náñez ◽

Mario Simental-Mendía ◽

Guillermo Elizondo-Riojas ◽

Michelle Morcos-Sandino ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Alpha Angle ◽

Cross Sectional Study ◽

Level Of Evidence ◽

Crossover Sign ◽

Cross Sectional ◽

Radiographic Findings ◽

Morphological Variations ◽

Pelvic Radiographs ◽

Center Edge

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

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IDENTIFICATION OF FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN THE CONTRALATERAL HIP OF PATIENTS WITH SYMPTOMATIC FEMOROACETABULAR IMPINGEMENT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00145 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0014

Author(s):

Adam Khan ◽

Craig R. Louer ◽

Wahid Abu-Amer ◽

Gail Pashos ◽

Cecilia Pascual Garrido ◽

...

Keyword(s):

Disease Progression ◽

Femoroacetabular Impingement ◽

External Rotation ◽

Univariate Analysis ◽

Alpha Angle ◽

Hip Osteoarthritis ◽

Symptom Development ◽

Ucla Activity Score ◽

Center Edge ◽

Imaging Characteristics

Introduction: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. Hypothesis/Purpose: The purpose of this study was to (1) investigate rates of initial and subsequent symptom development in the contralateral hip of patients with FAI, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included a minimum 5 year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) were monitored over the study course. Univariate analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: 146 patients (146 hips, 81.5%) were included (min 5 year, mean 6.7 years). Thirty-nine (26%) presented with symptoms in the contralateral hip while 34 (23%) developed symptoms. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.164 vs. 0.153 p=0.025). Maximum alpha angle (p=0.413), lateral center edge angle (p=0.704), and crossover sign (p=0.115) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in extension (35.740 vs 45.140, p=0.012) and 900 of flexion (40.00 vs 50.800, p=0.009) as well as external rotation at 900 of flexion (28.940 vs 36.590, p=0.020) were decreased in hips developing symptoms. Internal Rotation in flexion was not significantly decreased in symptomatic patients (11.060 vs 14.20, p=0.113). Conclusions: We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.

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The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients With Hip Pain

The American Journal of Sports Medicine ◽

10.1177/0363546519896355 ◽

2020 ◽

Vol 48 (3) ◽

pp. 647-653 ◽

Cited By ~ 1

Author(s):

Jun Zhou ◽

Heath P. Melugin ◽

Rena F. Hale ◽

Devin P. Leland ◽

Christopher D. Bernard ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Mixed Type ◽

Imaging Modality ◽

Alpha Angle ◽

Young Patients ◽

Radiographic Finding ◽

Hip Pain ◽

Radiographic Findings ◽

Protrusio Acetabuli ◽

Center Edge

Background: Radiography is the initial imaging modality used to evaluate femoroacetabular impingement (FAI), and diagnostic radiographic findings are well-established. However, the prevalence of these radiographic findings in patients with hip pain is unknown. Purpose: The purpose was 3-fold: (1) to determine the overall prevalence of radiographic FAI deformities in young patients presenting with hip pain, (2) to identify the most common radiographic findings in patients with cam-type FAI, and (3) to identify the most common radiographic findings in patients with pincer-type FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A geographic database was used to identify patients aged 14 to 50 years with hip pain between the years 2000 to 2016. The following were evaluated on radiographs: cam type: typical pistol grip deformity, alpha angle >55°; pincer type: crossover sign (COS), coxa profunda or protrusio acetabuli, lateral center edge angle (LCEA) ≥40°, Tönnis angle <0°; and mixed type: both cam- and pincer-type features. Posterior wall sign (PWS) and ischial spine sign (ISS) were also evaluated. The prevalence of each was determined. Descriptive statistics were performed on all radiographic variables. Results: There were 1893 patients evaluated, and 1145 patients (60.5%; 1371 hips; 374 male and 771 female; mean age, 28.8 ± 8.4 years) had radiographic findings consistent with FAI. Of these hips, 139 (10.1%) had cam type, 245 (17.9%) had pincer type, and 987 (72.0%) had mixed type. The prevalence of a pistol grip deformity and an alpha angle >55° was 577 (42.1%) and 1069 (78.0%), respectively. The mean alpha angle was 66.9°± 10.5°. The prevalence of pincer-type radiographic findings was the following: COS, 1062 (77.5%); coxa profunda, 844 (61.6%); ISS, 765 (55.8%); PWS, 764 (55.7%); Tönnis angle <0°, 312 (22.8%); LCEA ≥40°, 170 (12.4%); and protrusio acetabuli, 7 (0.5%). Conclusion: The overall prevalence of radiographic findings consistent with FAI in young patients with hip pain was 60.5%. Radiographic findings for mixed-type FAI were the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°. The most common radiographic finding for pincer-type FAI was the COS.

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The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients

Cardiology Research and Practice ◽

10.1155/2018/5128626 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Chi-Wei Chang ◽

Kuo-meng Liao ◽

Yi-Ting Chang ◽

Sheng-Hung Wang ◽

Ying-chun Chen ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Hazard Ratio ◽

Radial Pulse ◽

Cardiac Events ◽

Asymptomatic Patients ◽

Adverse Cardiac Events ◽

Silent Coronary Artery Disease ◽

Artery Disease ◽

Asymptomatic Individuals

Background. It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives. To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods. 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results. Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P<0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P<0.001 for trend) and for coronary disease (P<0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions. This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.

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Differential Kinetics of Cycle Threshold Values during Admission by Symptoms among Patients with Mild COVID-19: A Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158181 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8181

Author(s):

Teppei Sakano ◽

Mitsuyoshi Urashima ◽

Hiroyuki Takao ◽

Kohei Takeshita ◽

Hiroe Kobashi ◽

...

Keyword(s):

Cohort Study ◽

Viral Load ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Polymerase Chain Reaction Test ◽

Cycle Threshold ◽

Viral Loads ◽

Asymptomatic Patients ◽

Asymptomatic Individuals ◽

Chain Reaction Test

In the coronavirus disease 2019 (COVID-19) pandemic, more than half of the cases of transmission may occur via asymptomatic individuals, which makes it difficult to contain. However, whether viral load in the throat during admission is different between asymptomatic and symptomatic patients is not well known. By conducting a prospective cohort study of patients with asymptomatic or mild COVID-19, cycle threshold (Ct) values of the polymerase chain reaction test for COVID-19 were examined every other day during admission. The Ct values during admission increased more steadily in symptomatic patients and febrile patients than in asymptomatic patients, with significance (p = 0.01 and p = 0.004, respectively), although the Ct values as a whole were not significantly different between the two groups. Moreover, the Ct values as a whole were higher in patients with dysosmia/dysgeusia than in those without it (p = 0.02), whereas they were lower in patients with a headache than those without (p = 0.01). Patients who were IgG-positive at discharge maintained higher Ct values, e.g., more than 35, during admission than those with IgG-negative (p = 0.03). Assuming that viral load and Ct values are negatively associated, the viral loads as a whole and their changes by time may be different by symptoms and immune reaction, i.e., IgG-positive at discharge.

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Simulations of the spread of COVID-19 and control policies in Tunisia

10.1101/2020.05.02.20088492 ◽

2020 ◽

Author(s):

Slimane BenMiled ◽

Amira Kebir

Keyword(s):

Epidemiological Model ◽

Tunisian Population ◽

Control Policies ◽

Asymptomatic Patients ◽

Asymptomatic Individuals ◽

And Control

AbstractWe develop and analyze in this work an epidemiological model for COVID-19 using Tunisian data. Our aims are first to evaluate Tunisian control policies for COVID-19 and secondly to understand the effect of different screening, quarantine and containment strategies and the rule of the asymptomatic patients on the spread of the virus in the Tunisian population. With this work, we show that Tunisian control policies are efficient in screening infected and asymptomatic individuals and that if containment and curfew are maintained the epidemic will be quickly contained.

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Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice

Physical Therapy ◽

10.1093/ptj/pzz189 ◽

2020 ◽

Vol 100 (5) ◽

pp. 788-797 ◽

Cited By ~ 2

Author(s):

Jordan Cannon ◽

Alexander E Weber ◽

Seol Park ◽

Erik N Mayer ◽

Christopher M Powers

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

Femoroacetabular Impingement ◽

Time History ◽

Theoretical Framework ◽

Impingement Syndrome ◽

Future Research ◽

Appropriate Treatment ◽

Femoroacetabular Impingement Syndrome

Abstract Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.

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