Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients

Canella, Richard Prazeres; Adam, Guilherme Pradi; Castillo, Roberto André Ulhôa de; Codonho, Daniel; Ganev, Gerson Gandhi; Vicenzi, Luiz Fernando de

doi:10.1016/j.rboe.2016.02.001

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Revista Brasileira de Ortopedia

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Original Article • Rev. bras. ortop. 51 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.rboe.2016.02.001 copy

Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients^☆ ☆ Work performed in the Imperial Hospital de Caridade, Florianópolis, SC, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI), using computed tomography (CT).

METHODS:

We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third), femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient.

RESULTS:

There were inverse correlations between the following angles: (1) acetabular coverage versus alpha angle (p = 0.019); (2) acetabular version (supraequatorial) versus alpha angle (p = 0.049). For patients with femoral anteversion lower than 15 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.026); (2) acetabular version (middle third) versus alpha angle (p = 0.02). For patients with acetabular version (supraequatorial) lower than 10 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.004); (2) acetabular version (middle third) versus alpha angle (p = 0.009).

CONCLUSION:

There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was) in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases.

Hip; Femoroacetabular impingement; X-ray computed tomography

	Center-edge angle (Chen)	Acetabular depth	Cranial acetabular version	Middle-third acetabular version	Cervicodiaphyseal angle	Alpha angle	Femoral version angle
Center-edge angle (Chen)
Pearson's correlation	1	-0.159	0.45	0.097	-0.046	-0.231	-0.029
p		0.109	0	0.328	0.646	0.019	0.775
n	103	103	103	103	103	103	103

Acetabular depth
Pearson's correlation	-0.159	1	-0.352	-0.377	0.274	0.14	0.025
p	0.109		0	0	0.005	0.159	0.8
n	103	103	103	103	103	103	103

Cranial acetabular version
Pearson's correlation	0.45	-0.352	1	0.493	-0.103	-0.194	-0.001
p	0	0		0	0.302	0.049	0.989
n	103	103	103	103	103	103	103

Middle-third acetabular version
Pearson's correlation	0.097	-0.377	0.493	1	0.06	-0.183	0.089
p	0.328	0	0		0.547	0.065	0.372
n	103	103	103	103	103	103	103

Cervicodiaphyseal angle
Pearson's correlation	-0.046	0.274	-0.103	0.06	1	0.099	-0.019
p	0.646	0.005	0.302	0.547		0.318	0.846
n	103	103	103	103	103	103	103

Alpha angle
Pearson's correlation	-0.231	0.14	-0.194	-0.183	0.099	1	0.104
p	0.019	0.159	0.049	0.065	0.318		0.294
n	103	103	103	103	103	103	103

Femoral version angle
Pearson's correlation	-0.029	0.025	-0.001	0.089	-0.019	0.104	1
p	0.775	0.8	0.989	0.372	0.846	0.294
n	103	103	103	103	103	103	103

	Center-edge angle (Chen)	Acetabular depth	Cranial acetabular version	Middle-third acetabular version	Cervicodiaphyseal angle	Alpha angle	Femoral version angle
Center-edge angle (Chen)
Pearson's correlation	1	-0.187	0.333	0.067	0.054	-0.176	-0.212
p		0.219	0.025	0.661	0.727	0.248	0.161
n	45	45	45	45	45	45	45

Acetabular depth
Pearson's correlation	-0.187	1	-0.443	-0.409	0.164	0.238	0.017
p	0.219		0.002	0.005	0.282	0.116	0.911
n	45	45	45	45	45	45	45

Cranial acetabular version
Pearson's correlation	0.333	-0.443	1	0.49	-0.003	-0.331	0.018
p	0.025	0.002		0.001	0.983	0.026	0.906
n	45	45	45	45	45	45	45

Middle-third acetabular version
Pearson's correlation	0.067	-0.409	0.49	1	-0.003	-0.346	0.04
p	0.661	0.005	0.001		0.984	0.02	0.794
n	45	45	45	45	45	45	45

Cervicodiaphyseal angle
Pearson's correlation	0.054	0.164	-0.003	-0.003	1	-0.009	-0.034
p	0.727	0.282	0.983	0.984		0.954	0.827
n	45	45	45	45	45	45	45

Alpha angle
Pearson's correlation	-0.176	0.238	-0.331	-0.346	-0.009	1	0.002
p	0.248	0.116	0.026	0.02	0.954		0.992
n	45	45	45	45	45	45	45

Femoral version angle
Pearson's correlation	-0.212	0.017	0.018	0.04	-0.034	0.002	1
p	0.161	0.911	0.906	0.794	0.827	0.992
n	45	45	45	45	45	45	45

	Center-edge angle (Chen)	Acetabular depth	Cranial acetabular version	Middle-third acetabular version	Cervicodiaphyseal angle	Alpha angle	Femoral version angle
Center-edge angle (Chen)
Pearson's correlation	1	-0.236	0.25	0.14	0.043	-0.151	-0.334
p		0.172	0.148	0.423	0.807	0.387	0.05
n	35	35	35	35	35	35	35

Acetabular depth
Pearson's correlation	-0.236	1	-0.305	-0.266	0.146	0.227	0.051
p	0.172		0.074	0.122	0.402	0.189	0.769
n	35	35	35	35	35	35	35

Cranial acetabular version
Pearson's correlation	0.25	-0.305	1	0.146	-0.043	-0.477	-0.175
p	0.148	0.074		0.402	0.807	0.004	0.314
n	35	35	35	35	35	35	35

Middle-third acetabular version
Pearson's correlation	0.14	-0.266	0.146	1	0.038	-0.434	-0.007
p	0.423	0.122	0.402		0.828	0.009	0.967
n	35	35	35	35	35	35	35

Cervicodiaphyseal angle
Pearson's correlation	0.043	0.146	-0.043	0.038	1	0.053	-0.135
p	0.807	0.402	0.807	0.828		0.764	0.439
n	35	35	35	35	35	35	35

Alpha angle
Pearson's correlation	-0.151	0.227	-0.477	-0.434	0.053	1	0.045
p	0.387	0.189	0.004	0.009	0.764		0.799
n	35	35	35	35	35	35	35

Femoral version angle
Pearson's correlation	-0.334	0.051	-0.175	-0.007	-0.135	0.045	1
p	0.05	0.769	0.314	0.967	0.439	0.799
n	35	35	35	35	35	35	35

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E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: rpcanella@md.aaos.org (R.P. Canella).

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Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients☆ ☆ Work performed in the Imperial Hospital de Caridade, Florianópolis, SC, Brazil.

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients^☆ ☆ Work performed in the Imperial Hospital de Caridade, Florianópolis, SC, Brazil.