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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 4, 556-560.
doi: 10.1302/0301-620X.84B4.12014  
Copyright © 2002 by British Editorial Society of Bone and Joint Surgery
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The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement

H. P. Nötzli, MD, Head of Hip Surgery1; T. F. Wyss, MD, Resident1; C. H. Stoecklin, Assistant2; M. R. Schmid, MD, Staff Member3; K. Treiber, Radiology Technician4; and J. Hodler, MD, Professor, Chief of Section3

1 Department of Orthopaedic Surgery
2 ETH Zürich, Image Science Communication, Tech Laboratory, Zürich, Switzerland.
3 Department of Radiology, University of Zürich, Balgrist, Forchstrasse 340, CH-8008 Zürich, Switzerland.
4 Department of Radiology, University Hospital, Rämistrasse 100, Ch-8091 Zurich, Switzerland.

Correspondence should be sent to Dr H. Nötzli.

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination.

MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle ({alpha}). In addition, the width of the femoral head-neck junction was measured at two sites.

Repeated measurements showed good reproducibility among four observers. The angle {alpha} averaged 74.0° for the patients and 42.0° for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites.

Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips.

This test may be of value in patients with loss of internal rotation for which a cause is not found.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General