Arthroscopic Analysis of the Radiologic Abnormalities of the Hip Associated with Anterior Femoroacetabular Impingement

Pil-Sung Kim; Deuk-Soo Hwang; Chan Kang; Jung-Bum Lee; Jun-Yeong Park

doi:10.5371/jkhs.2011.23.1.15

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Kim, Hwang, Kang, Lee, and Park: Arthroscopic Analysis of the Radiologic Abnormalities of the Hip Associated with Anterior Femoroacetabular Impingement

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(1): 15-24.

Published online: 31 March 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.1.15

Arthroscopic Analysis of the Radiologic Abnormalities of the Hip Associated with Anterior Femoroacetabular Impingement

Pil-Sung Kim, MD^*, Deuk-Soo Hwang, MD, Chan Kang, MD, Jung-Bum Lee, MD^†, Jun-Yeong Park, MD

Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

^*Department of Orthopedic Surgery, Bumin Seoul Hospital, Seoul, Korea.

^†Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea.

Address reprint request to Deuk-Soo Hwang, MD. Department of Orthopedic Surgery, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. TEL: +82-42-280-7350, FAX: +82-42-252-7098, dshwang@cnu.ac.kr

Received 5 July 2010 Revised 24 February 2011 Accepted 24 February 2011

Abstract

Purpose

We wanted to arthroscopically analyze the femoral osseous abnormalities (bumps) in hips with anterior femoroacetabular impingement (FAI) and the other radiologic abnormalities of the hip joint associated with this.

Materials and Methods

We retrospectively reviewed the radiographs of 45 patients (51 hips) who underwent arthroscopic treatment under the impression of FAI from January to August, 2008. The indications for surgery included persistent hip pain, the absence of advanced osteoarthritis, physical examination or MRA findings consistent with an acetabualr labral tear. Preoperative and postoperative plain radiographs (pelvis AP, frog-leg lateral, cross table lateral and the false profile view) were taken. As the occasion demanded, 3D-CT or MRA were performed.

Results

For the radiologic findings, a decreased head-neck offset (<8 mm) was seen in 15 hips. Femoral bumps were seen in 26 hips and among them, 11 hips were associated with acetabular retroversion, 5 hips were associated with a prominent acetabular rim and 13 hips were located on the flattening of the neck due to a decreased offset. Pistol grip deformity was found in 21 hips and acetabular retroversion was done in 32 hips. Regarding the secondary changes, spurs on the acetabulum of the femur were found in 14 hips and femoral bony cysts were found in 23 hips. Arthroscopically, all the hips had acetabular degenerative labral tear and the acetabular cartilage was injured in 32 hips (62.7%). Among them, 25 hips underwent acetabular retroversion.

Conclusion

Femoral osseous abnormalities are seen in various locations and these abnormalities have various shapes. A considerable number were associated with pincer impingement and they could produce a 'kissing lesion' between the acetabulum and femur. Identification of these abnormalities on radiographs aids confirming FAI in hips with symptomatic early osteoarthritis.

Keywords: Femoroacetabular impingement, Femoral focal elevation, Radiologic abnormality, Arthroscopy

Figures and Tables

Fig. 1

Hip plain radiographies. (A) Hip AP. (B) Frog-leg lateral view. (C) Cross-table lateral view. (D) False profile view.

Fig. 2

Flattening of femoral neck with a retroversion. (A) Right hip: decreased curvature of femoral neck. (B) Acetabular labral tear. (C) Flattening of femoral neck.

Fig. 3

Bump associated with acetabular retroversion. (A) Acetabular retroversion: Crossover sign (figure of eight) are positive on both hip joint. (B) CT: We found out bump formation (yellow arrow) on femoral neck. Arthroscopic findings: (C) Acetabular labral tear. (D) We could find out bump on femoral neck under arthroscopy.

Fig. 4

Bump associated with prominent acetabular rim. (A, B) Both acetabula have a prominent acetabular rim and we can find bump (yellow arrow) on femoral neck at cross table lateral view. (C) Under arthroscopy, femoral bump (yellow arrow) was revealed on femoral neck consistent with prominent acetabular rim.

Fig. 5

Bump on flattening of femoral neck. (A) X-ray. (B) Arthroscopic finding.

Fig. 6

Pistol grip deformity.

Fig. 7

Hook-shaped spur on head-neck junction. (A) Hook-shaped spur (yellow arrow) on femoral head-neck junction. (B) We check the hook on MR angiography. (C) 3 Dimensional CT image. (D) Arthroscopic image of spur (yellow arrow).

Fig. 8

Femoral bony cyst on femoral neck. (A) CT image: femoral bony cyst (yellow arrow) on femoral neck. (B) After bumpectomy, a hollow suggestive with cyst was revealed.

Fig. 9

Contrecoup lesion: arthroscopy showed a lesion (yellow arrow) on posteroinferior acetabular cartilage.

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