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Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement?

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Abstract
Femoroacetabular impingement (FAI) presupposes a dynamic interaction of the proximal femur and acetabulum producing clinical symptoms and chondrolabral damage. Currently, FAI classification is based on alpha angle and center-edge angle measurements in a single plane. However, acetabular and femoral version and neck-shaft angle also influence FAI. Furthermore, each of these parameters has a reciprocal interaction with the others; for example, a shallow acetabulum delays impingement of the femoral head with the acetabular rim. We introduce the new parameter "omega zone," which combines five parameters into one: the alpha and center-edge angles, acetabular and femoral version, and neck-shaft angle. We sought to determine whether the omega zone could differentiate patients with FAI from (1) normal control subjects (alpha < 55A degrees), but also from (2) control subjects with elevated alpha angles (a parts per thousand yenA 55A degrees). We evaluated CT data of 20 hips of male patients with symptomatic cam-type FAI and of 35 male hips extracted from 110 anonymized CT scans for vascular diagnosis. We excluded hips with osteoarthritis, developmental dysplasia, or coxa profunda (center-edge angle 20A degrees-45A degrees on AP pelvic view or corresponding coronal CT views). With dedicated software, femoral and pelvic orientation was standardized; we tested the omega zone in four hip positions in three distinct groups: patients with cam-type FAI (alpha > 60A degrees) and control subjects with normal (< 55A degrees) and high alpha angles (a parts per thousand yenA 55A degrees). The omega zone was smaller in patients with cam-type FAI than normal control subjects (alpha angle < 55A degrees) at 60A degrees and 90A degrees of flexion (mean, 12%; 95% confidence interval [CI], 7-17; p = 0.008; Cohen's d = 9%; 95% CI, 4-13; p = 0.003). Furthermore, the omega zone was smaller in all positions in patients with cam-type FAI than control subjects with high alpha angles (0A degrees p = 0.017, 30A degrees p = 0.004, 60A degrees p = 0.004, 90A degrees p = 0.007). In contrast, the omega zone did not differ between control subjects with normal or high alpha angles. In all hips, the omega zone decreased with flexion, corresponding to a decrease in remaining impingement-free motion with flexion. The omega zone visualizes and quantifies the interaction of the proximal femur and acetabulum. The omega zone differed between patients with cam-type FAI and control subjects with high alpha angles (a parts per thousand yen 55A degrees), who could not be distinguished based on alpha angle alone. For hip-preserving surgery, it can help surgeons decide whether to address the femur, the acetabulum, or both.
Keywords
INTERNAL-ROTATION, OSTEOARTHRITIS, TOTAL HIP-REPLACEMENT, ASSOCIATION, DYSPLASIA, MOTION, RANGE, HEAD

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MLA
Bouma, Heinse W et al. “Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?” CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 473.4 (2015): 1396–1403. Print.
APA
Bouma, H. W., Hogervorst, T., Audenaert, E., Krekel, P., & van Kampen, P. M. (2015). Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement? CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 473(4), 1396–1403. Presented at the Bernese Hip Symposium.
Chicago author-date
Bouma, Heinse W, Tom Hogervorst, Emmanuel Audenaert, Peter Krekel, and Paulien M van Kampen. 2015. “Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?” Clinical Orthopaedics and Related Research 473 (4): 1396–1403.
Chicago author-date (all authors)
Bouma, Heinse W, Tom Hogervorst, Emmanuel Audenaert, Peter Krekel, and Paulien M van Kampen. 2015. “Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?” Clinical Orthopaedics and Related Research 473 (4): 1396–1403.
Vancouver
1.
Bouma HW, Hogervorst T, Audenaert E, Krekel P, van Kampen PM. Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement? CLINICAL ORTHOPAEDICS AND RELATED RESEARCH. 2015;473(4):1396–403.
IEEE
[1]
H. W. Bouma, T. Hogervorst, E. Audenaert, P. Krekel, and P. M. van Kampen, “Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement?,” CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, vol. 473, no. 4, pp. 1396–1403, 2015.
@article{8082132,
  abstract     = {{Femoroacetabular impingement (FAI) presupposes a dynamic interaction of the proximal femur and acetabulum producing clinical symptoms and chondrolabral damage. Currently, FAI classification is based on alpha angle and center-edge angle measurements in a single plane. However, acetabular and femoral version and neck-shaft angle also influence FAI. Furthermore, each of these parameters has a reciprocal interaction with the others; for example, a shallow acetabulum delays impingement of the femoral head with the acetabular rim. 
We introduce the new parameter "omega zone," which combines five parameters into one: the alpha and center-edge angles, acetabular and femoral version, and neck-shaft angle. We sought to determine whether the omega zone could differentiate patients with FAI from (1) normal control subjects (alpha < 55A degrees), but also from (2) control subjects with elevated alpha angles (a parts per thousand yenA 55A degrees). 
We evaluated CT data of 20 hips of male patients with symptomatic cam-type FAI and of 35 male hips extracted from 110 anonymized CT scans for vascular diagnosis. We excluded hips with osteoarthritis, developmental dysplasia, or coxa profunda (center-edge angle 20A degrees-45A degrees on AP pelvic view or corresponding coronal CT views). With dedicated software, femoral and pelvic orientation was standardized; we tested the omega zone in four hip positions in three distinct groups: patients with cam-type FAI (alpha > 60A degrees) and control subjects with normal (< 55A degrees) and high alpha angles (a parts per thousand yenA 55A degrees). 
The omega zone was smaller in patients with cam-type FAI than normal control subjects (alpha angle < 55A degrees) at 60A degrees and 90A degrees of flexion (mean, 12%; 95% confidence interval [CI], 7-17; p = 0.008; Cohen's d = 9%; 95% CI, 4-13; p = 0.003). Furthermore, the omega zone was smaller in all positions in patients with cam-type FAI than control subjects with high alpha angles (0A degrees p = 0.017, 30A degrees p = 0.004, 60A degrees p = 0.004, 90A degrees p = 0.007). In contrast, the omega zone did not differ between control subjects with normal or high alpha angles. In all hips, the omega zone decreased with flexion, corresponding to a decrease in remaining impingement-free motion with flexion. 
The omega zone visualizes and quantifies the interaction of the proximal femur and acetabulum. The omega zone differed between patients with cam-type FAI and control subjects with high alpha angles (a parts per thousand yen 55A degrees), who could not be distinguished based on alpha angle alone. For hip-preserving surgery, it can help surgeons decide whether to address the femur, the acetabulum, or both.}},
  author       = {{Bouma, Heinse W and Hogervorst, Tom and Audenaert, Emmanuel and Krekel, Peter and van Kampen, Paulien M}},
  issn         = {{0009-921X}},
  journal      = {{CLINICAL ORTHOPAEDICS AND RELATED RESEARCH}},
  keywords     = {{INTERNAL-ROTATION,OSTEOARTHRITIS,TOTAL HIP-REPLACEMENT,ASSOCIATION,DYSPLASIA,MOTION,RANGE,HEAD}},
  language     = {{eng}},
  location     = {{Berne, Switzerland}},
  number       = {{4}},
  pages        = {{1396--1403}},
  title        = {{Can combining femoral and acetabular morphology parameters improve the characterization of femoroacetabular impingement?}},
  url          = {{http://dx.doi.org/10.1007/s11999-014-4037-4}},
  volume       = {{473}},
  year         = {{2015}},
}

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