Characteristics of Hip Impingement Syndrome in patients with Multiple Hereditary Exostoses

Abstract BackgroundsThis study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome.Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Hip impingement symptoms were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. Alpha angle was evaluated to investigate the FAI. The minimum ischio-femoral distance was measured to evaluate for IFI using computed-tomographic study. Each measured morphometric study was compared according to gender, location and hip impingement symptom.Results Coxa valga and acetabular dysplasia were common with a mean femoral neck-shaft angle of 144.1°, mean CE angle of 27.9°, and mean Sharp’s acetabular angle of 42.0°. Each of the measured value for assessment of hip deformity was correlated significantly. Morphometric study on gender showed no significant difference except the alpha angle value. In addition, no significant difference was shown on comparison study by location of hip. On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. The number of hip joints with IFI symptom was higher than those with FAI symptom in this study. Furthermore, both the FAI and IFI symptom group showed significant differences from the non-symptom group in the morphometric study. In addition, the minimum ischio-femoral distance was significantly decreased in the IFI symptom group, which seems to be associated with coxa valga deformity.Conclusion The results suggest that the characteristic deformities that occur in the hip joint of MHE patients affect the appearance of impingement syndrome. Therefore, it is necessary to carefully evaluate the characteristic deformities of the hip joint in patients with MHE and to set up the treatment modality accordingly.Level of Evidence : Level III, retrospective comparative study

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Characteristics of hip impingement syndrome in patients with multiple hereditary exostoses

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04021-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yeong-Seub Ahn ◽

Sungmin Kim ◽

Woo-Jong Kim ◽

Jun-Hyuk Lim ◽

Sung-Taek Jung

Keyword(s):

Femoral Neck ◽

Alpha Angle ◽

Hip Joints ◽

Neck Shaft Angle ◽

Multiple Hereditary Exostoses ◽

Hip Impingement ◽

Morphometric Measure ◽

Shaft Angle ◽

Coxa Valga ◽

Symptom Group

Abstract Backgrounds This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. Results On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp’s angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp’s angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). Conclusion The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. Level of evidence Level III.

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Hip morphology predicts posterior hip impingement in a cadaveric model

Hip International ◽

10.1177/1120700018779906 ◽

2018 ◽

Vol 29 (3) ◽

pp. 322-327 ◽

Cited By ~ 7

Author(s):

William Z Morris ◽

Cody A Fowers ◽

Douglas S Weinberg ◽

Michael B Millis ◽

Leigh-Anne Tu ◽

...

Keyword(s):

Femoral Neck ◽

External Rotation ◽

Ischial Tuberosity ◽

Acetabular Version ◽

Lesser Trochanter ◽

Neck Shaft Angle ◽

Hip Impingement ◽

Hip Morphology ◽

Shaft Angle ◽

Coxa Valga

Introduction: Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Methods: Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. Results: External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from −0.39 to −0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta −0.35, p = 0.005). Discussion: Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

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Reconstruction of the Hip in Multiple Hereditary Exostoses

Children ◽

10.3390/children8060490 ◽

2021 ◽

Vol 8 (6) ◽

pp. 490

Author(s):

Dong Hoon Lee ◽

Dror Paley

Keyword(s):

Hip Joint ◽

Joint Involvement ◽

Neck Shaft Angle ◽

Multiple Hereditary Exostoses ◽

Femur Neck ◽

Radiographic Outcomes ◽

Surgical Dislocation ◽

Center Edge ◽

Shaft Angle ◽

Coxa Valga

The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

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Does hip morphology correlate with proximal femoral fracture type?

Hip International ◽

10.1177/1120700019859275 ◽

2019 ◽

Vol 30 (5) ◽

pp. 629-634

Author(s):

Gilad Rotem ◽

Zachary T Sharfman ◽

Ehud Rath ◽

Aviram Gold ◽

Gil Rachevsky ◽

...

Keyword(s):

Hip Fractures ◽

Alpha Angle ◽

Fracture Type ◽

Crossover Sign ◽

Hip Axis Length ◽

Neck Shaft Angle ◽

Hip Morphology ◽

Shaft Angle ◽

Axis Length ◽

Neck Diameter

Purpose: To determine if boney morphology influences the anatomic location of hip fractures in elderly patients. Methods: All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign. Results: 148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA ( p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures ( p = 0.013). Conclusions: Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.

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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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Standard Radiographic Assessment of Femoral Cam Morphology is Influenced by Neck-Shaft Angle and Femoral Version

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00392 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0039

Author(s):

Layla Haidar ◽

Ryan Warth ◽

Erinn Pemberton Annie Waite ◽

Alfred Mansour

Keyword(s):

Femoral Head ◽

Alpha Angle ◽

Three Dimensional ◽

Neck Shaft Angle ◽

Incremental Change ◽

Observer Reliability ◽

Angle Measurements ◽

Femoral Version ◽

Shaft Angle ◽

Head Neck

Objectives: Cam-type femoroacetabular impingement (FAI) is a three-dimensional (3D) deformity that is still difficult to assess using traditional two-dimensional (2D) radiographic views. While measurements of alpha angle and head-neck offset are used to estimate the likelihood of actual impingement, these 2D measurements do not account for z-axis variations in femoral version (FV) and neck-shaft angle (NSA). The purpose of this qualitative proof-of-concept study was to evaluate the potential variation in alpha angle and neck-shaft offset measurements with incremental changes in NSA and FV by simulating traditional radiographic views with software-generated Digitally-Reconstructed Radiographs (DRRs). We hypothesize that incremental changes in hip morphology will produce qualitative changes in alpha angle and neck-shaft offset. Methods: 3D-CT reconstruction images were obtained from one subject with symptomatic cam-type FAI. The 3D reconstruction was cleaned to include only the femoral head, neck and subtrochanteric region along with the ipsilateral hemipelvis. Using 3D medical image processing software (Mimics; Materialise, Inc.; Belgium), the pre-processed 3D model was manipulated in a standardized manner to simulate 5-degree incremental variations in FV and NSA (-15 degrees to +15 degrees for FV; -15 degrees to +10 degrees for NSA). Negative FV reflected external rotation of the femoral head-neck unit, whereas negative NSA reflected abduction of the femoral head-neck unit. Each modified 3D model was then used to generate DRRs corresponding to traditional 2D radiographic views used for assessment of cam-FAI (Anteroposterior [AP], False Profile [FP]), Cross Table Lateral [CTL], Frog Leg Lateral [FLL], 45- and 90-degree Dunn [45D and 90D, respectively]. Alpha angle and head-neck offset were measured on each radiographic view corresponding to each incremental change in FV and NSA. All measurements utilized the perfect circle technique and were made by two independent observers for assessment of inter-observer reliability. Two-way random effects ANOVA was used for statistical assessment of inter-observer reliability and reported as intra-class correlation coefficients (κ). Comparisons between groups were performed using two-tailed paired t-tests assuming unequal variance. P-values less than 0.05 were considered statistically significant. Results: Inter-observer reliability (κ) for head-neck offset and alpha angles were 0.46 (fair) and 0.88 (excellent), respectively. Variations in head-neck offset and alpha angle with incremental variations in FV and NSA are summarized in Figure 1. There were statistically significant changes in mean alpha angles when the NSA was adjusted from Neutral to -5 degrees (p=0.01) and from -5 degrees to -10 degrees (p<0.001). There were no statistically significant differences in alpha angles or head-neck offsets between each incremental change in FV (p<0.05). Alpha angle measurements were significantly more variable than head-neck offset measurements for all variations in FV (p<0.001) and NSA (p=0.02) (Figure 2). Conclusion: Two-dimensional evaluation of three-dimensional Cam morphology (alpha angle and head-neck offset) was found to be significantly affected by alterations in femoral version and head-neck offset. Head-neck offset measurements were significantly less variable than alpha angle measurements across all FVs and NSAs within each radiographic view. Future work should be done to develop standardized procedures for routine 3D radiographic assessment of cam-type FAI. [Figure: see text][Figure: see text]

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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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Influence of sex and age on sonographic infant hip indices

Caliphate Medical Journal ◽

10.47837/cmj.19770126.nma.20142410122 ◽

2014 ◽

Vol 2 (4) ◽

Author(s):

Kakale SB ◽

Tabari AM ◽

Isyaku K ◽

Yunusa A

Keyword(s):

Imaging Modality ◽

Alpha Angle ◽

Late Presentation ◽

Radiology Department ◽

Age Group ◽

Hip Joints ◽

Non Invasive ◽

Significant Difference ◽

Males And Females ◽

The Mean

Ultrasound is a non-invasive, cheap and readily available imaging modality for studying the infant hip. Early detection of developmental hip subluxation, acetabular dysplasia and the prevention of late presentation of a developmentally dislocated hip with consequent secondary premature degenerative arthritis are goals that all practitioners should strive for. Provision of axial indices of alpha and beta angles of the infant hip joint in Kano, Nigeria using ultrasonography to establish a normogram as reference values for further studies is the objective of this study. This descriptive prospective study was conducted at the Radiology Department of Aminu Kano Teaching Hospital, Kano state, Nigeria. Successive four hundred appropriately consented infants were recruited for this study. The axial angle relationships of both hip joints were measured using 7.5 MHz linear transducer of Mindray DP-8800 Digital plus ultrasound machine. The mean alpha and beta angles for both hips in females were 56.590 and 49.580 respectively while those for males were 56.730 and 50.530 respectively. Minimum and maximum alpha angle for both hips ranged from 380 to 780 while the beta angles ranged 290 to 660 respectively. The age group 1-3 months has the highest frequency of respondents (251) while age group 10 - 12 months has the lowest (22). There was no statistically significant difference in the alpha and beta angles between males and females hips and age of the infants did not affect the hip indices. The study showed no statistical significant difference in the measured alpha and beta angles between males and females. Age of measurement in infants did not affect the hip indices.

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A MORPHOMETRIC STUDY OF THE PROXIMAL END OF DRY ADULT FEMORA

International Journal of Anatomy and Research ◽

10.16965/ijar.2020.224 ◽

2020 ◽

Vol 8 (4.2) ◽

pp. 7799-7804

Author(s):

Ishita Sengupta ◽

◽

Madhumita Mahato ◽

Gairik Sengupta ◽

Jadab Chandra Chattopadhyay ◽

...

Keyword(s):

Proximal Femur ◽

Indian Population ◽

Traumatic Injury ◽

Morphometric Study ◽

Neck Of Femur ◽

Posterior Aspect ◽

Neck Shaft Angle ◽

East Indian ◽

Fracture Neck Femur ◽

Shaft Angle

Background: A good understanding of morphometric measurements of the proximal femur is essential in order to decrease the risk of complications associated with orthopedic surgeries performed in the proximal femur due to traumatic injury, metabolic or vascular causes, and to achieve proper alignment of prosthesis to be implanted. The purpose of this study is to evaluate morphometry of neck of femur in Eastern Indian population. Materials and Methods: The study was conducted on 50 dry adult femora [30 Right(R) and 20 Left(L)] available in the department of Anatomy of Medical College Kolkata, India. Results: a) Mean and Standard Deviation (SD) of Vertical length of Head of femur was Right side: 38.56±2.50mm and Left side: 38.07±3.43mm. b) Mean and SD of Width of neck of femur was Right side: 28.84±2.71mm and Left side:28.09±2.29mm. c) Mean and SD of length of Neck of femur on anterior aspect was Right side:26.37±2.92mm and Left side:26.12±3.42mm. d) Mean and SD of length of Neck of femur on posterior aspect was Right side:31.65±2.75mm and Left side:26.69±3.11mm. e) Neck-shaft angle on both sides were calculated. Conclusion: Indian dimensions of proximal end of femur are different as compared to that of the values in other parts of the world. Present study will be useful for crafting suitable implants used for surgical correction of fracture neck femur in East Indian population. KEYWORDS: Morphometry, Neck-shaft angle, Implant, Prosthesis, Width of neck, Vertical length of head of femur, Length of neck.

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