Abstract
Most patients presenting with loss of hip motion secondary to FAI have a combination of cam and pincer morphology. In this study, we present a composite index for predicting joint ROM based on anatomic parameters derived from both the femur and acetabulaum using a single reformatted CT slice.
Computer models of the hip joint were reconstructed from CT scans of 31 patients with mixed-type FAI (Average alpha angle: 73.6±11.1°, average LCE: 38.9±7.2°). The internal rotation of the hip at impingement was measured at 90° flexion using custom software. With the joint in neutral, a single slice perpendicular to the acetabular rim was taken at the 2 o'clock position. A set of 11 femoral and acetabular parameters measured from this slice were correlated with hip ROM using stepwise logistic regression.
Three anatomic parameters provided significant discrimination of cases impinging at <15 and >15 degrees IR: femoral anteversion (28%, p=0.026), the arc of anterior femoral head sphericity (10%, p=0.040), and the LCE in the 2 o'clock plane (10%, p=0.048). This led to the following definition of the Impingement Index: 0.16*(fem version) +0.11*(ant arc)−0.17*(LCE) which correctly classified 82% of cases investigated. None of the traditional parameters (e.g. alpha angle) were significantly correlated with ROM.
Our study has identified alternative morphologic parameters that could act as strong predictors of FAI in preoperative assessments. Using this information, each patient's individual risk of impingement may be estimated, regardless of the relative contributions of deformities of the femur and the acetabulum.
