Femoroacetabular impingement: presence of FAI-like features on conventional radiography in young patients presenting to primary care with hip pain

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 prevalence of femoroacetabular impingement anatomy in Division 1 aquatic athletes who tread water

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa009 ◽

2020 ◽

Vol 7 (2) ◽

pp. 233-241

Author(s):

Joanna L Langner ◽

Marianne S Black ◽

James W MacKay ◽

Kimberly E Hall ◽

Marc R Safran ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Young Patients ◽

Hip Pain ◽

Water Polo ◽

Increased Risk ◽

Division 1 ◽

Mri Scans ◽

Asymptomatic Individuals ◽

Cam Morphology ◽

Pincer Morphology

Abstract Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The goal of this prospective cohort study was to use magnetic resonance imaging (MRI) to identify the prevalence of FAI anatomy in athletes who tread water and compare it to the literature on other sports. With university IRB approval, 20 Division 1 water polo players and synchronized swimmers (15 female, 5 male), ages 18–23 years (mean age 20.7 ± 1.4), completed the 33-item International Hip Outcome Tool and underwent non-contrast MRI scans of both hips using a 3 Tesla scanner. Recruitment was based on sport, with both symptomatic and asymptomatic individuals included. Cam and pincer morphology were identified. The Wilcoxon Signed-Rank/Rank Sum tests were used to assess outcomes. Seventy per cent (14/20) of subjects reported pain in their hips yet only 15% (3/20) sought clinical evaluation. Cam morphology was present in 67.5% (27/40) of hips, while 22.5% (9/40) demonstrated pincer morphology. The prevalence of cam morphology in water polo players and synchronized swimmers is greater than that reported for the general population and at a similar level as some other sports. From a clinical perspective, acknowledgment of the high prevalence of cam morphology in water polo players and synchronized swimmers should be considered when these athletes present with hip pain.

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A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

Clinics ◽

10.6061/clinics/2012(05)10 ◽

2012 ◽

Vol 67 (5) ◽

pp. 463-467 ◽

Cited By ~ 7

Author(s):

OF Miguel ◽

HB Cabrita ◽

MB Rodrigues ◽

AT Croci

Keyword(s):

Femoroacetabular Impingement ◽

Young Patients ◽

Hip Pain ◽

Radiographic Investigation

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A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

Pain Research and Treatment ◽

10.1155/2015/937431 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Vicente Sanchis-Alfonso ◽

Marc Tey ◽

Joan Carles Monllau

Keyword(s):

Conservative Treatment ◽

Pain Score ◽

Knee Pain ◽

Femoroacetabular Impingement ◽

Anterior Knee Pain ◽

Young Patients ◽

Hip Pain ◽

Functional Scores ◽

Novel Association ◽

Anterior Knee

Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment.

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Identification and Management of Psychosocial and Developmental Problems in Community-Based, Primary Care Pediatric Practices

PEDIATRICS ◽

10.1542/peds.89.3.480 ◽

1992 ◽

Vol 89 (3) ◽

pp. 480-485 ◽

Cited By ~ 3

Author(s):

Sarah McCue Horwitz ◽

Philip J. Leaf ◽

John M. Leventhal ◽

Brian Forsyth ◽

Kathy Nixon Speechley

Keyword(s):

Primary Care ◽

Child Behavior Checklist ◽

Social Issues ◽

Young Patients ◽

Well Being ◽

World Health ◽

Developmental Problems ◽

Active Intervention ◽

Health Organization ◽

New Morbidity

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity. The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychosocial and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problem in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P ≤ .05). The data suggest that, when asked to use a taxonomy appropriate for primary care, clinicians recognize problems in many 4- to 8-year-old children (515/1886; 27.3%). This rate is considerably higher than the rates previously reported. Further, many children with identified problems (56%) were reported by their clinicians to receive some form of active intervention. Characteristics of the visit (type of visit, clinician's knowledge of a child) that influence the recognition of problems were also identified. These results suggest that investigators must define what types of problems they are interested in and under what circumstances to determine accurately what pediatric practitioners know about psychosocial and developmental problems in their young patients and families.

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Current trends in sport and exercise hip conditions: Intra-articular and extra-articular hip pain, with detailed focus on femoroacetabular impingement (FAI) syndrome

Best Practice & Research Clinical Rheumatology ◽

10.1016/j.berh.2019.02.006 ◽

2019 ◽

Vol 33 (1) ◽

pp. 66-87 ◽

Cited By ~ 2

Author(s):

Joanne Kemp ◽

Alison Grimaldi ◽

Joshua Heerey ◽

Denise Jones ◽

Mark Scholes ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Pain ◽

Current Trends ◽

Sport And Exercise ◽

Fai Syndrome

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Resolving anterior hip pain in a young male footballer following arthroscopic surgery for Femoroacetabular Impingement Syndrome: A case report

Journal of Bodywork and Movement Therapies ◽

10.1016/j.jbmt.2019.05.027 ◽

2020 ◽

Vol 24 (1) ◽

pp. 63-68

Author(s):

Carl Todd ◽

Jon Karlsson ◽

Adad Baranto

Keyword(s):

Case Report ◽

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Young Male ◽

Hip Pain ◽

Impingement Syndrome ◽

Femoroacetabular Impingement Syndrome

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Do GPs accurately record date of death? A UK observational analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001514 ◽

2018 ◽

Vol 10 (3) ◽

pp. e24-e24 ◽

Cited By ~ 4

Author(s):

Amelia Harshfield ◽

Gary A Abel ◽

Stephen Barclay ◽

Rupert A Payne

Keyword(s):

Primary Care ◽

Young Patients ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Data Sets ◽

Factors Associated ◽

National Statistics ◽

Primary Care Data ◽

National Mortality ◽

General Practices

ObjectiveTo examine the concordance between dates of death recorded in UK primary care and national mortality records.MethodsUK primary care data from the Clinical Practice Research Datalink were linked to Office for National Statistics (ONS) data, for 118 571 patients who died between September 2010 and September 2015. Logistic regression was used to examine factors associated with discrepancy in death dates between data sets.ResultsDeath dates matched in 76.8% of cases with primary care dates preceding ONS date in 2.9%, and following in 20.3% of cases; 92.2% of cases differed by <2 weeks. Primary care date was >4 weeks later than ONS in 1.5% of cases and occurred more frequently with deaths categorised as ‘external’ (15.8% vs 0.8% for cancer), and in younger patients (15.9% vs 1% for 18–29 and 80–89 years, respectively). General practices with the greatest discrepancies (97.5th percentile) had around 200 times higher odds of recording substantially discordant dates than practices with the lowest discrepancies (2.5th percentile).ConclusionDates of death in primary care records often disagree with national records and should be treated with caution. There is marked variation between practices, and studies involving young patients, unexplained deaths and where precise date of death is important are particularly vulnerable to these issues.

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