Paper # 48: Radiographic Predictors of Femoroacetabular Impingement

Paper # 48: Radiographic Predictors of Femoroacetabular Impingement

e100 ABSTRACTS study is to correlate clinical factors such as age, pain symptom duration, and Wiberg angle with the severity of acetabular chondroma...

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e100

ABSTRACTS

study is to correlate clinical factors such as age, pain symptom duration, and Wiberg angle with the severity of acetabular chondromalacia. The hypothesis is increased duration of hip pain symptoms will correlate with severity of acetabular chondromalacia. Methods: 46 consecutive subjects (48 hips) 18 to 40 years old (20 males and 26 females) were identified as athletes with nonarthritic hip pain (Tonnis 0 or 1) and no history of hip injury who had undergone hip arthroscopy. A retrospective review of prospectively collected data including age, duration of pain symptoms, Wiberg angle, and intraoperative acetabular chondromalacia assessment by Outerbridge grade (I-IV) and lesion surface area (mm2) was performed. The degree of acetabular chondromalacia was a product of the Outerbridge grade and lesion surface area. Pearson correlations with regressions were performed on two cohorts of patients, male and female, to compare the influence of age, duration of pain, and Wiberg angle on the degree of chondomalacia. Results: The male cohort had an average age of 26.8 years (18-39 years), pain duration of 32.5 months (2-156 months), Wiberg angle of 30.5° (22-41), and degree of chondromalacia of 453.4 (40-2040). The female cohort had an average age of 26.5 years (19-40), pain duration of 19.1 months (2-63 months), Wiberg angle of 28.8° (19-40), and degree of chondromalacia of 180.1 (40930). The Pearson correlations for the male cohort were r⫽0.43 for age (p⫽0.049), r⫽0.85 for pain duration (p⫽0.000), and r⫽0.13 for Wiberg angle (p⫽0.573). The Pearson correlations for the female cohort were r⫽0.34 for age (p⫽0.083), r⫽0.02 for pain duration (p⫽0.941), and r⫽0.10 for Wiberg angle (p⫽0.619). Conclusions: In male athletes with atraumatic, nonarthritic hip pain, age has a medium positive correlation and the duration of pain symptoms has a large positive correlation with the degree of acetabular chondromalacia noted at hip arthroscopy. In similar female athletes, there was a trend toward age correlation, but pain symptom duration did not correlate. Wiberg angle had no correlation with acetabular chondromalacia severity in this population. These findings support early identification of male athletes with atraumatic hip pain to limit the severity of acetabular chondromalacia, a precursor of hip osteoarthritis.

Paper # 48: Radiographic Predictors of Femoroacetabular Impingement MORTEZA MEFTAH, MD, USA ANIL S. RANAWAT, MD, USA MICHAEL LEUNIG, MD, SWITZERLAND · Hospital for Special Surgery New York, NY, USA

Summary: Although we found a few radiographic findings of FAI unique to symptomatic hips, none was a single strong predictor of symptoms. Abstract: Introduction: Due to the number of abnormal radiographic findings in femoroacetabular impingement (FAI), identification of the most important findings is challenging. The objective of this study was to determine the radiographic measurements most predictive of the symptomatic hip in unilateral FAI patients when compared to their asymptomatic side. Our secondary objectives were to find if any of these radiographic findings correlate with pain scores and assess gender differences among them. Material and Methods: One hundred and one consecutive patients with unilateral FAI symptoms were included in this study. All patients filled out a WOMAC pain questionnaire. Thirty-three radiographic parameters were measured for each hip from antero-posterior and lateral radiographs. Two independent blinded physicians performed all the measurements. Findings were compared between symptomatic and non- symptomatic hips. Correlation between WOMAC pain scores and the radiographic findings was calculated for each gender. Results: Symptomatic hips present with smaller Neck Shaft Angles, greater distances from the ilioischial line to the acetabular fossa and longer lengths of cross over compared to the non-symptomatic side. We found positive correlations between increasing pain scores with more medial posterior wall relative to the center of femoral head, a more lateral acetabular fossa relative to the Ilioichial Line (AceF-IIL) and presence of a posterior wall sign. Symptomatic hips in males had more joint space narrowing, femoral osteophytes, higher alpha angles and larger, more incongruent femoral heads. Females had more medial AceF-IIL and smaller Femoral Head Extrusion Index. Discussion and Conclusion: Although we found a few radiographic findings of FAI unique to symptomatic hips, none was a single strong predictor of symptoms. Our data showed that varus hips, length of cross over sign and shallower sockets were correlated with more pain. Men present with more cam-type radiographic findings and women showed more pincer-type characteristics. Paper # 49: 3D and 4D Computer Tomography Video Evaluation In Hip Arthroscopy CHRISTOPH GEORG GEBHART, MD, AUSTRIA · Orthopädie St. Pölten St. Poelten, AUSTRIA