Semin Musculoskelet Radiol 2013; 17(03): 229-247
DOI: 10.1055/s-0033-1348090
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Normal Anatomy and Imaging of the Hip: Emphasis on Impingement Assessment

Mary Kristen Jesse
1   Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
,
Brian Petersen
2   Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, University of Colorado, Aurora, Colorado
,
Colin Strickland
1   Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado, Aurora, Colorado
,
Omer Mei-Dan
3   Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
20 June 2013 (online)

Abstract

A comprehensive knowledge of normal hip anatomy and imaging techniques is essential in the evaluation and assessment of the patient with hip pain. This article reviews the osseous, soft tissue, and vascular components of the hip and the normal anatomical variants encountered in routine hip imaging. Basic and advanced hip imaging is discussed with particular emphasis on radiographic and computed tomography measurements and their utility in evaluating patients with developmental hip dysplasia and femoroacetabular impingement syndrome.

 
  • References

  • 1 Brückl R, Tönnis D. The growth of the juvenile hip joint. A planimetric study of x-ray films (author's transl) [in German]. Arch Orthop Trauma Surg 1979; 93 (2) 149-159
  • 2 Wierusz-Kozłowska M, Ziemiański A, Kruczyński J, Borkowski W. Development of the normal infantile hip joints assessed by MRI [in Polish]. Chir Narzadow Ruchu Ortop Pol 2000; 65 (1) 25-32
  • 3 Wyler A, Bousson V, Bergot C , et al. Comparison of MR-arthrography and CT-arthrography in hyaline cartilage-thickness measurement in radiographically normal cadaver hips with anatomy as gold standard. Osteoarthritis Cartilage 2009; 17 (1) 19-25
  • 4 Dietrich TJ, Suter A, Pfirrmann CW, Dora C, Fucentese SF, Zanetti M. Supraacetabular fossa (pseudodefect of acetabular cartilage): frequency at MR arthrography and comparison of findings at MR arthrography and arthroscopy. Radiology 2012; 263 (2) 484-491
  • 5 Hergan K, Oser W, Moriggl B. Acetabular ossicles: normal variant or disease entity?. Eur Radiol 2000; 10 (4) 624-628
  • 6 Arho AO. Accessory bones of extremities in roentgen picture. Duodecim 1940; 56: 399-410
  • 7 Martinez AE, Li SM, Ganz R, Beck M. Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim?. Hip Int 2006; 16 (4) 281-286
  • 8 Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 2005; 236 (2) 588-592
  • 9 Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991; 73 (3) 423-429
  • 10 Cooke WR, Gill HS, Murray DW, Ostlere SJ. Discrete mineralisation of the acetabular labrum: a novel marker of femoroacetabular impingement?. Br J Radiol 2013; 86 (1021) 20120182
  • 11 Smith MV, Panchal HB, Ruberte Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med 2011; 39 (Suppl): 103S-110S
  • 12 Edwards DJ, Lomas D, Villar RN. Diagnosis of the painful hip by magnetic resonance imaging and arthroscopy. J Bone Joint Surg Br 1995; 77 (3) 374-376
  • 13 Petersilge CA, Haque MA, Petersilge WJ, Lewin JS, Lieberman JM, Buly R. Acetabular labral tears: evaluation with MR arthrography. Radiology 1996; 200 (1) 231-235
  • 14 Cotten A, Boutry N, Demondion X , et al. Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr 1998; 22 (1) 1-7
  • 15 Gerhardt M, Johnson K, Atkinson R , et al. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int 2012; 22 (1) 75-81
  • 16 Petersilge C. Imaging of the acetabular labrum. Magn Reson Imaging Clin N Am 2005; 13 (4) 641-652 , vi
  • 17 Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009; 2 (2) 105-117
  • 18 Lecouvet FE, Vande Berg BC, Malghem J , et al. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 1996; 167 (4) 1025-1028
  • 19 Hodler J, Yu JS, Goodwin D, Haghighi P, Trudell D, Resnick D. MR arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers. AJR Am J Roentgenol 1995; 165 (4) 887-891
  • 20 Czerny C, Hofmann S, Urban M , et al. MR arthrography of the adult acetabular capsular-labral complex: correlation with surgery and anatomy. AJR Am J Roentgenol 1999; 173 (2) 345-349
  • 21 Aydingöz U, Oztürk MH. MR imaging of the acetabular labrum: a comparative study of both hips in 180 asymptomatic volunteers. Eur Radiol 2001; 11 (4) 567-574
  • 22 Studler U, Kalberer F, Leunig M , et al. MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 2008; 249 (3) 947-954
  • 23 DuBois DF, Omar IM. MR imaging of the hip: normal anatomic variants and imaging pitfalls. Magn Reson Imaging Clin N Am 2010; 18 (4) 663-674
  • 24 Saddik D, Troupis J, Tirman P, O'Donnell J, Howells R. Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review. AJR Am J Roentgenol 2006; 187 (5) W507-W11
  • 25 Dinauer PA, Murphy KP, Carroll JF. Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears. AJR Am J Roentgenol 2004; 183 (6) 1745-1753
  • 26 Smith MV, Costic RS, Allaire R, Schilling PL, Sekiya JK. A biomechanical analysis of the soft tissue and osseous constraints of the hip joint. Knee Surg Sports Traumatol Arthrosc 2012; ; October 30 (Epub ahead of print)
  • 27 Fuss FK, Bacher A. New aspects of the morphology and function of the human hip joint ligaments. Am J Anat 1991; 192 (1) 1-13
  • 28 Wagner FV, Negrão JR, Campos J , et al. Capsular ligaments of the hip: anatomic, histologic, and positional study in cadaveric specimens with MR arthrography. Radiology 2012; 263 (1) 189-198
  • 29 Martin RL, Kivlan BR, Clemente FR. A cadaveric model for ligamentum teres function: a pilot study. Knee Surg Sports Traumatol Arthrosc 2012; ; November 2 (Epub ahead of print)
  • 30 Keene GS, Villar RN. Arthroscopic anatomy of the hip: an in vivo study. Arthroscopy 1994; 10 (4) 392-399
  • 31 Gray AJ, Villar RN. The ligamentum teres of the hip: an arthroscopic classification of its pathology. Arthroscopy 1997; 13 (5) 575-578
  • 32 Armfield DR, Towers JD, Robertson DD. Radiographic and MR imaging of the athletic hip. Clin Sports Med 2006; 25 (2) 211-239 , viii
  • 33 Demange M. Influence of the femoral head ligament on hip mechanical function. Acta Ortop Bras. 2007; 15 (4) 187-190
  • 34 Remes V, Tervahartiala P, Helenius I, Peltonen J. Magnetic resonance imaging analysis of hip joint development in patients with diastrophic dysplasia. J Pediatr Orthop 2002; 22 (2) 212-216
  • 35 Fu Z, Peng M, Peng Q. Anatomical study of the synovial plicae of the hip joint. Clin Anat 1997; 10 (4) 235-238
  • 36 Bencardino JT, Kassarjian A, Vieira RL, Schwartz R, Mellado JM, Kocher M. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain. Skeletal Radiol 2011; 40 (4) 415-421
  • 37 Bartonícek J. Weitbrecht's retinacula of the hip joint [in Czech]. Acta Chir Orthop Traumatol Cech 1990; 57 (5) 385-391
  • 38 Blankenbaker DG, Davis KW, De Smet AA, Keene JS. MRI appearance of the pectinofoveal fold. AJR Am J Roentgenol 2009; 192 (1) 93-95
  • 39 Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat 2001; 23 (6) 371-374
  • 40 Guillin R, Cardinal E, Bureau NJ. Sonographic anatomy and dynamic study of the normal iliopsoas musculotendinous junction. Eur Radiol 2009; 19 (4) 995-1001
  • 41 Shu B, Safran MR. Case report: Bifid iliopsoas tendon causing refractory internal snapping hip. Clin Orthop Relat Res 2011; 469 (1) 289-293
  • 42 Spratt JD, Logan BM, Abrahams PH. Variant slips of psoas and iliacus muscles, with splitting of the femoral nerve. Clin Anat 1996; 9 (6) 401-404
  • 43 Chander S. The iliopsoas bursa in man. Anat Rec 1934; 36: 235-240
  • 44 Varma DG, Richli WR, Charnsangavej C, Samuels BI, Kim EE, Wallace S. MR appearance of the distended iliopsoas bursa. AJR Am J Roentgenol 1991; 156 (5) 1025-1028
  • 45 Woodley SJ, Mercer SR, Nicholson HD. Morphology of the bursae associated with the greater trochanter of the femur. J Bone Joint Surg Am 2008; 90 (2) 284-294
  • 46 Kassarjian A, Llopis E, Schwartz RB, Bencardino JT. Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms. Eur Radiol 2009; 19 (11) 2779-2782
  • 47 Troelsen A, Jacobsen S, Rømer L, Søballe K. Weightbearing anteroposterior pelvic radiographs are recommended in DDH assessment. Clin Orthop Relat Res 2008; 466 (4) 813-819
  • 48 Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 2007; 188 (6) 1540-1552
  • 49 Clohisy JC, Carlisle JC, Beaulé PE , et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 2008; 90 (Suppl. 04) 47-66
  • 50 Barton C, Salineros MJ, Rakhra KS, Beaulé PE. Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 2011; 469 (2) 464-469
  • 51 Lequesne M , de SEZE. False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies. [in French]. Rev Rhum Mal Osteoartic 1961; 28: 643-652
  • 52 Chan YS, Lien LC, Hsu HL , et al. Evaluating hip labral tears using magnetic resonance arthrography: a prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis. Arthroscopy 2005; 21 (10) 1250
  • 53 Czerny C, Hofmann S, Neuhold A , et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996; 200 (1) 225-230
  • 54 Leunig M, Werlen S, Ungersböck A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br 1997; 79 (2) 230-234
  • 55 Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP. Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol 2006; 186 (2) 449-453
  • 56 Plötz GM, Brossmann J, von Knoch M, Muhle C, Heller M, Hassenpflug J. Magnetic resonance arthrography of the acetabular labrum: value of radial reconstructions. Arch Orthop Trauma Surg 2001; 121 (8) 450-457
  • 57 Yoon LS, Palmer WE, Kassarjian A. Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography. Skeletal Radiol 2007; 36 (11) 1029-1033
  • 58 Zlatkin MB, Pevsner D, Sanders TG, Hancock CR, Ceballos CE, Herrera MF. Acetabular labral tears and cartilage lesions of the hip: indirect MR arthrographic correlation with arthroscopy—a preliminary study. AJR Am J Roentgenol 2010; 194 (3) 709-714
  • 59 Vahlensieck M, Peterfy CG, Wischer T , et al. Indirect MR arthrography: optimization and clinical applications. Radiology 1996; 200 (1) 249-254
  • 60 Pozzi G, Stradiotti P, Parra CG, Zagra L, Sironi S, Zerbi A. Femoro-acetabular impingement: can indirect MR arthrography be considered a valid method to detect endoarticular damage? A preliminary study. Hip Int 2009; 19 (4) 386-391
  • 61 Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res 2011; 469 (3) 831-838
  • 62 Jin W, Kim KI, Rhyu KH , et al. Sonographic evaluation of anterosuperior hip labral tears with magnetic resonance arthrographic and surgical correlation. J Ultrasound Med 2012; 31 (3) 439-447
  • 63 Robben SG, Lequin MH, Diepstraten AF, den Hollander JC, Entius CA, Meradji M. Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology 1999; 210 (2) 499-507
  • 64 Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?. Acta Orthop 2009; 80 (3) 314-318
  • 65 Fredensborg N, Nilsson BE. The joint space in normal hip radiographs. Radiology 1978; 126 (2) 325-326
  • 66 Ogata S, Moriya H, Tsuchiya K, Akita T, Kamegaya M, Someya M. Acetabular cover in congenital dislocation of the hip. J Bone Joint Surg Br 1990; 72 (2) 190-196
  • 67 Omeroglu H, Biçimoglu A, Aguş H, Tümer Y. Measurement of center-edge angle in developmental dysplasia of the hip: a comparison of two methods in patients under 20 years of age. Skeletal Radiol 2002; 31 (1) 25-29
  • 68 Jacobsen S, Sonne-Holm S, Søballe K, Gebuhr P, Lund B. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Acta Orthop 2005; 76 (2) 149-158
  • 69 Pedersen DR, Lamb CA, Dolan LA, Ralston HM, Weinstein SL, Morcuende JA. Radiographic measurements in developmental dysplasia of the hip: reliability and validity of a digitizing program. J Pediatr Orthop 2004; 24 (2) 156-160
  • 70 Umer M, Sepah YJ, Asif S, Azam I, Jawad MU. Acetabular morphometry and prevalence of hip dysplasia in the South Asian population. Orthop Rev (Pavia) 2009; 1 (1) e10
  • 71 Sharp I. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br 1961; 43-B (2) 268-272
  • 72 Jamali AA, Mladenov K, Meyer DC , et al. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res 2007; 25 (6) 758-765
  • 73 Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 1999; 81 (2) 281-288
  • 74 Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 1999; 81 (12) 1747-1770
  • 75 Reikerås O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand 1983; 54 (1) 18-23
  • 76 McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br 1970; 52 (1) 148-159
  • 77 Li PL, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted. Clin Orthop Relat Res 2003; (416) 245-253
  • 78 Salter RB. The classic. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip by Robert B. Salter, J. Bone Joint Surg. (Brit) 43B:3:518, 1961. Clin Orthop Relat Res 1978; 137 (137) 2-14
  • 79 Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis : a new sign for acetabular retroversion. Clin Orthop Relat Res 2008; 466 (3) 677-683
  • 80 Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84 (4) 556-560
  • 81 Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res 2006; 445: 181-185
  • 82 Nepple JJ, Martel JM, Kim YJ, Zaltz I, Clohisy JC. ANCHOR Study Group. Do plain radiographs correlate with CT for imaging of cam-type femoroacetabular impingement?. Clin Orthop Relat Res 2012; 470 (12) 3313-3320
  • 83 Pollard TC, Villar RN, Norton MR , et al. Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips. Acta Orthop 2010; 81 (1) 134-141
  • 84 Ito K, Minka II MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001; 83 (2) 171-176
  • 85 Gelberman RH, Cohen MS, Shaw BA, Kasser JR, Griffin PP, Wilkinson RH. The association of femoral retroversion with slipped capital femoral epiphysis. J Bone Joint Surg Am 1986; 68 (7) 1000-1007
  • 86 Tönnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop 1991; 11 (4) 419-431
  • 87 Saikia KC, Bhuyan SK, Rongphar R. Anthropometric study of the hip joint in northeastern region population with computed tomography scan. Indian J Orthop 2008; 42 (3) 260-266
  • 88 Mesgarzadeh M, Revesz G, Bonakdarpour A. Femoral neck torsion angle measurement by computed tomography. J Comput Assist Tomogr 1987; 11 (5) 799-803
  • 89 Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CW. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012; 263 (2) 475-483
  • 90 Maheshwari AV, Zlowodzki MP, Siram G, Jain AK. Femoral neck anteversion, acetabular anteversion and combined anteversion in the normal Indian adult population: a computed tomographic study. Indian J Orthop 2010; 44 (3) 277-282
  • 91 Kim HD, Lee DS, Eom MJ, Hwang JS, Han NM, Jo GY. Relationship between physical examinations and two-dimensional computed tomographic findings in children with intoeing gait. Ann Rehabil Med 2011; 35 (4) 491-498
  • 92 Schneider B, Laubenberger J, Jemlich S, Groene K, Weber HM, Langer M. Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol 1997; 70 (834) 575-579
  • 93 Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ. MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. AJR Am J Roentgenol 1997; 168 (3) 791-794
  • 94 Coleman SS. Diagnosis of congenital dysplasia of the hip in the newborn infant. J Am Med Assoc 1956; 162 (6) 548-554
  • 95 Eckhoff DG. Variation in femoral anteversion. Clin Anat 1994; 7 (2) 72-75
  • 96 Wiberg G. Studies on dyspastic acetabula and congenital subluxation of the hip joint. With special reference to the complication of osteoarthritis. Acta Chir Scand 1939; 83 (Suppl. 58) 28-38
  • 97 Maruyama M, Feinberg JR, Capello WN, D'Antonio JA. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res 2001; (393) 52-65
  • 98 Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res 2009; 467 (4) 876-885
  • 99 Buller LT, Rosneck J, Monaco FM, Butler R, Smith T, Barsoum WK. Relationship between proximal femoral and acetabular alignment in normal hip joints using 3-dimensional computed tomography. Am J Sports Med 2012; 40 (2) 367-375
  • 100 Hetsroni I, Dela Torre K, Duke G, Lyman S, Kelly BT. Sex differences of hip morphology in young adults with hip pain and labral tears. Arthroscopy 2013; 29 (1) 54-63