RESUMO
PURPOSE: This study was performed to evaluate the effects of age on the alpha angle and the incidence of asymptomatic cam morphology. METHODS: The radiographs of asymptomatic individuals between ages 8 and 22 were retrospectively collected. A total of 1417 individuals were included and grouped according to age: 8-12 (Group A), 13-18 (Group B), and 19-22 (Group C) years. Radiographic measurements of the alpha angles of the right hip were obtained from anteroposterior (AP) and frog-leg lateral (FL) radiographs. The correlations among alpha angles, the presence of cam morphology, and age were determined. RESULTS: The mean alpha angles of the three groups were statistically different (p < 0.001, each). The alpha angles on both radiographs were positively correlated with age. Intra-group analysis revealed that this correlation was only evident on the FL images of males in Group B. The presence of a radiographic cam morphology also positively correlated with age (p < 0.001 in both AP and FL images). The cam morphology on AP radiographs was 0 in Group A, 17(3.0%) in Group B, and 21(4.8%) in Group C; that on FL radiographs was 2(0.3%) in Group A, 45(7.9%) in Group B, and 103(23.6%) in Group C. Intra-group analysis revealed that the correlation was only significant in males in Group B. CONCLUSIONS: Higher alpha angles and the presence of cam morphology were positively correlated with age, particularly in males at or before the time of skeletal maturation. The prevalence of cam morphology did not differ from those in other ethnicities. LEVEL OF EVIDENCE: IV.
Assuntos
Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etnologia , Articulação do Quadril/diagnóstico por imagem , Adolescente , Fatores Etários , Povo Asiático , Criança , Feminino , Impacto Femoroacetabular/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Prevalência , Radiografia , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Adulto JovemRESUMO
INTRODUCTION: The restoration of range of motion after surgery in patients with femoroacetabular impingement syndrome is considered an important factor that improves clinical outcomes and determines the quality of life of patients, especially in the Asian population. METHODS: Arthroscopic femoroplasty was done in 109 Asian patients with cam impingement. The patients were retrospectively evaluated using range of motion and clinical outcomes (Harris Hip Score [HHS], visual analog scale score, Hip Outcome Score-Activity of Daily Living, and Hip Outcome Score-Sports subscales) between preoperative and postoperative conditions, with a follow-up period of >2 years. RESULTS: The increments of hip motion were an internal rotation of 10.1° (P < 0.05) at 3 postoperative months and an external rotation of 11.8° (P < 0.05) at approximately 6 postoperative months; both were maintained at 2 postoperative years. Mean clinical outcomes improved from 69.1 to 82.1 for HHS, from 6.0 to 2.1 for the visual analog scale score, and from 40.1 to 68.7 for the Hip Outcome Score-Sports Subscale at 6 postoperative months (P < 0.05) and were maintained at 2 years. Younger subjects (<45 years of age) displayed even greater improvements in the HHS and Hip Outcome Score-Activity of Daily Living/Sports Subscale than the other group (≥45 years of age) (P < 0.05). CONCLUSION: Patients who underwent arthroscopic femoroplasty showed improvements in internal rotation at 3 months postoperatively and external rotation at approximately 6 months postoperatively. In addition, younger age (<45 years and the restoration of rotational hip motion resulted in better clinical outcomes. LEVEL OF EVIDENCE: III a.
Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/fisiopatologia , Fêmur/cirurgia , Articulação do Quadril/fisiopatologia , Procedimentos de Cirurgia Plástica/métodos , Amplitude de Movimento Articular/fisiologia , Adulto , Povo Asiático , Feminino , Impacto Femoroacetabular/etnologia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , República da Coreia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports. PURPOSE: To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. RESULTS: A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% (P = .03). CONCLUSION: The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
Assuntos
Atletas , Impacto Femoroacetabular/etnologia , Ossos Pélvicos/anormalidades , Futebol , Adulto , Estudos Transversais , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/patologia , Humanos , Masculino , Ossos Pélvicos/diagnóstico por imagem , Prevalência , Adulto JovemRESUMO
BACKGROUND: Morphologic features of the proximal femur reminiscent of those seen in patients with femoroacetabular impingement (FAI) have been reported among asymptomatic individuals in Western populations, but whether this is the case in Asian populations is unknown. QUESTIONS/PURPOSES: The purpose of this study was to determine the prevalence of radiographic findings in the proximal femur that are consistent with FAI in asymptomatic Korean volunteers. METHODS: Two hundred asymptomatic volunteers with no prior hip surgery or childhood hip problems underwent three-view plain radiographs (pelvis AP view, Sugioka view, and 45° Dunn view) of both hips. There were 146 hips from male volunteers and 254 hips from female volunteers in the study. The mean age of all participants was 34.7 years (range, 21-49 years). Cam-type morphologic features were defined as the presence of the following on one or more of the three views: pistol-grip morphologic features, an osseous bump at the femoral head-neck junction, flattening of the femoral head-neck offset, or alpha angle greater than 55°. Pincer-type morphologic features were determined by radiographic signs, including crossover sign, deficient posterior wall sign, or lateral center-edge angle greater than 40°. RESULTS: The prevalence of cam-type morphologic features seen on at least one radiograph was 38% (male, 57%; female, 26%). The prevalence of cam-type features (at least one positive cam-type feature) was 2.0% (male, 6%; female, 0%) on the pelvic AP view, 24% (male, 36%; female, 17%) on the Sugioka view, and 30% (male, 47%; female, 20%) on the 45° Dunn view. The prevalence of pincer-type morphologic features (at least one positive pincer-type feature) was 23% (male, 27%; female, 21%) on the pelvic AP view. CONCLUSION: The prevalence of FAI-related morphologic features in asymptomatic Asian populations was comparable to the prevalence in Western populations. Considering the high prevalence of radiographic hip findings reminiscent of FAI in asymptomatic Asian populations, it will be important to determine whether FAI-related morphologic features are a cause of hip pain when considering surgery in Asian patients.
Assuntos
Povo Asiático , Impacto Femoroacetabular/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Adulto , Doenças Assintomáticas , Fenômenos Biomecânicos , Feminino , Impacto Femoroacetabular/etnologia , Impacto Femoroacetabular/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Amplitude de Movimento Articular , República da Coreia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Femoroacetabular impingement (FAI) deformity has been associated with posterior hip instability in adult athletes. PURPOSE: To determine if FAI deformity is associated with posterior hip instability in adolescents, the femoral head-neck junction or acetabular structure in a cohort of adolescent patients who sustained a low-energy, sports-related posterior hip dislocation was compared with that in a group of healthy age- and sex-matched controls with no history of hip injury or pain. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We identified 12 male patients (mean age, 13.9 years; range, 12-16 years) who sustained a sports-related posterior hip dislocation and underwent a computed tomography (CT) scan after closed reduction. For each patient, 3 age- and sex-matched healthy controls were identified. Femoral head-neck type was assessed by measurement of the alpha angle on the radially oriented CT images at the 12-, 1-, 2-, and 3-o'clock positions. Age, body mass index (BMI), alpha angle at each position, acetabular version, Tönnis angle, and lateral center-edge angle (LCEA) on the involved hip in the dislocation group were compared with those of the matched controls using a mixed-effects model. A logistic regression analysis using a generalized estimating equation was used to compare the percentage of subjects with cam-type FAI deformity (alpha angle >55°) in each group. RESULTS: The dislocation and control groups were similar in age distribution and BMI (P > .05). The mean alpha angles were statistically significantly higher in the dislocation group compared with the control group at the superior (46.3° ± 1.1° vs 42.7° ± 0.6°; P = .0213), superior-anterior (55.5° ± 1.9° vs 46.0° ± 1.3°; P = .0005), and anterior-superior (54.9° ± 1.5° vs 48.9° ± 1.0°; P = .0045) regions. Cam deformity was present in a larger proportion of patients in the dislocation group than in the control group (P < .0035). An alpha angle greater than 55° was present in 16.7% of the dislocation group and 0% of the control group at the 12-o'clock position (P = .1213), 41.7% versus 0% at the 1-o'clock position (P = .0034), 58% versus 6% at the 2-o'clock position (P = .0004), and 25% versus 2.8% at the 3-o'clock position (P = .0929). Acetabular anteversion was lower in the dislocation group (9.6° ± 1.4°) compared with the control group (15.1° ± 0.8°) (P = .0068). Mean acetabular LCEA was within a normal range in both groups. CONCLUSION: A significantly higher mean alpha angle from the superior to the anterior-superior regions of the femoral head-neck junction and lower acetabular version were found in adolescents who sustained low-energy, sports-related posterior hip dislocations.
Assuntos
Traumatismos em Atletas/epidemiologia , Impacto Femoroacetabular/epidemiologia , Cabeça do Fêmur/patologia , Colo do Fêmur/patologia , Luxação do Quadril/epidemiologia , Adolescente , Atletas/estatística & dados numéricos , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/patologia , Criança , Estudos de Coortes , Estudos Transversais , Impacto Femoroacetabular/etnologia , Impacto Femoroacetabular/patologia , Luxação do Quadril/etiologia , Luxação do Quadril/patologia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: We sought to describe the effect of alterations in hip morphology with respect to worsening hip OA in a community-based sample including African American (AA) and white men and women. METHODS: This nested case-control study defined case hips as Kellgren Lawrence grade (KLG) <3 on baseline supine pelvis radiographs and KLG ≥3 or THR for OA at the 1st or 2nd follow-up visit (mean 6 and 13 years, respectively); control hips had KLG <3 at both visits, with gender/race distribution similar to cases. Hip morphology was assessed using HipMorf software (Oxford, UK). Descriptive means and standard errors were obtained from generalized estimating equation (GEE) models. Sex-stratified GEE regression models (accounting for within-person correlation), adjusted for age, race, BMI, and side were then employed. RESULTS: A total of 120 individuals (239 hips; 71 case/168 control) were included (25% male, 26% AA, mean age 62 years, BMI 30 kg/m(2)). Case hips tended to have greater baseline AP alpha angles, smaller minimum joint space width (mJSW) and more frequent triangular index signs. Adjusted results among men revealed that higher AP alpha angle, Gosvig ratio, and acetabular index were positively associated with case hips; coxa profunda was negatively associated. Among women, greater AP alpha angle, smaller mJSW, protrusio acetabuli, and triangular index sign were associated with case hips. CONCLUSIONS: We confirmed an increased risk of worsening hip OA due to baseline features of cam deformity among men and women, as well as protrusio acetabuli among women, and provide the first estimates of these measures in AAs.
Assuntos
Impacto Femoroacetabular/patologia , Articulação do Quadril/patologia , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/patologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Progressão da Doença , Feminino , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etnologia , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etnologia , Osteoartrite do Quadril/etiologia , Radiografia/métodos , Índice de Gravidade de Doença , Fatores Sexuais , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Osteoarthritis of the hip is five to ten times more common in white people than in Chinese people. Little is known about the true prevalence of femoroacetabular impingement or its role in the development of osteoarthritis in the Chinese population. A cross-sectional study of both white and Chinese asymptomatic individuals was conducted to compare the prevalences of radiographic features posing a risk for femoroacetabular impingement in the two groups. It was hypothesized that that there would be proportional differences in hip anatomy between the white and Asian populations. METHODS: Pelvic computed tomography scans of 201 subjects (ninety-nine white Belgians and 102 Chinese; 105 men and ninety-six women) without hip pain who were eighteen to forty years of age were assessed. The original axial images were reformatted to three-dimensional pelvic models simulating standardized radiographic views. Ten radiographic parameters predisposing to femoroacetabular impingement were measured: alpha angle, anterior offset ratio, and caput-collum-diaphyseal angle on the femoral side and crossover sign, ischial spine projection, acetabular anteversion angle, center-edge angle, acetabular angle of Sharp, Tönnis angle, and anterior acetabular head index on the acetabular side. RESULTS: The white subjects had a less spherical femoral head than the Chinese subjects (average alpha angle, 56° compared with 50°; p<0.001). The Chinese subjects had less lateral acetabular coverage than the white subjects, with average center-edge angles of 35° and 39° (p<0.001) and acetabular angles of Sharp of 38° and 36° (p<0.001), respectively. A shallower acetabular configuration was predominantly present in Chinese women. CONCLUSIONS: Significant differences in hip anatomy were demonstrated between young asymptomatic Chinese and white subjects. However, the absolute size of the observed differences appears to contrast with the reported low prevalence of femoroacetabular impingement in Chinese individuals compared with the high prevalence in white populations.
Assuntos
Acetábulo/diagnóstico por imagem , Povo Asiático , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etnologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/diagnóstico por imagem , População Branca , Acetábulo/anatomia & histologia , Adolescente , Adulto , Causalidade , Comorbidade , Estudos Transversais , Feminino , Cabeça do Fêmur/anatomia & histologia , Cabeça do Fêmur/diagnóstico por imagem , Colo do Fêmur/anatomia & histologia , Colo do Fêmur/diagnóstico por imagem , Humanos , Masculino , Variações Dependentes do Observador , Osteoartrite/diagnóstico por imagem , Osteoartrite/epidemiologia , Exame Físico , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Femoroacetabular impingement (FAI) is one factor known to cause pain and osteoarthritis (OA) of the hips. Although secondary OA due to hip dysplasia is common among Japanese populations, primary OA is seldom observed. Concomitantly, FAI is also thought to be uncommon in Japan, but relatively few epidemiological studies have addressed this issue. This study aimed to clarify the prevalence of radiographic findings of FAI in a Japanese population and to evaluate whether FAI is a risk factor for the development of arthritic changes. METHODS: We retrospectively examined 87 patients who underwent unilateral hip osteotomy with a Charnley category A hip joint on the contralateral side. Anteroposterior-view radiographs of the non-operated hip joint were assessed for the presence of hip dysplasia, as well as pistol grip deformity and crossover sign indicative of cam-type and pincer-type impingement, respectively. The presence of arthritic changes in the non-operated hip joint was assessed in follow-up radiographs, and factors contributing to the development of arthritis were determined by survival analysis. RESULTS: Of the 87 hips examined, dysplasia was noted in 38 (43.6%). While no pistol grip deformity was observed, crossover sign, which is indicative of pincer-type impingement, was identified in 9 of 38 dysplastic hips (23.7%) and 15 of 49 non-dysplastic hips (30.6%). Arthritic changes were present in 13 of 38 dysplastic hips (34.2%) and 11 of 49 non-dysplastic hips (22.4%). Survival analysis revealed that the presence of the crossover sign in non-dysplastic hips was significantly associated with the development of arthritis. CONCLUSIONS: The prevalence of the crossover sign in hips in a Japanese population is similar to that reported in Western populations, despite the fact that FAI is believed to be less prevalent in the Japanese population. Furthermore, the presence of the crossover sign in non-dysplastic hip joints is associated with the development of arthritis. Based on our results, pincer-type impingement could be commonly associated with the development of arthritis in Japanese populations.
Assuntos
Povo Asiático/etnologia , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etnologia , Vigilância da População/métodos , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Radiografia , Estudos Retrospectivos , Adulto JovemRESUMO
The purpose of this study was to compare the acetabular version between male and female pelvises. We hypothesized that female acetabula would demonstrate more retroversion because Pincer-type femoroacetabular impingement (FAI) is associated with acetabular retroversion, which is more commonly observed in females. 120 bony pelvic specimens were randomly collected. The version was measured at three different axial sections of each acetabulum: cranial, central, and caudal. Males demonstrated significantly less anteversion than females in every section. The global version (the average of all three measurements) was also significantly different between males and females (16° ± 7° and 19° ± 8° respectively, P<0.001). Of the 240 examined acetabuli, 21 demonstrated cranial retroversion (16 males & 5 females). The data showed no significant difference (P=0.353) between global version of African Americans (18° ± 9°) and Caucasians (17° ± 7°). The results of this study suggest that symptomatic FAI in the female population likely reflects a complex interplay of femoral and acetabular dysmorphology and cannot be explained by differences in acetabular version alone.