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Ultraschall Med 2023; 44(02): 188-193
DOI: 10.1055/a-1663-6085
Original Article

Sonography-Based Determination of Hip Joint Anterior Alpha-Angle: A Reliable and Reproducible Method

Die sonografische Bestimmung des anterioren Alpha-Winkels des Hüftgelenks: eine verlässliche und reproduzierbare Methode
Christian T. Schamberger
1   Department of Orthopedics and Trauma Surgery, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)
,
Stephan Stein
1   Department of Orthopedics and Trauma Surgery, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)
2   Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
,
Gerd Gruber
3   Private Practice, for Orthopaedics and Trauma Surgery, Heidelberg, Germany
,
Arnold J. Suda 
4   Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, Salzburg, Austria
› Author Affiliations TRIAL REGISTRATION: Registration number (trial ID): DRKS00025175, Trial registry: Deutsches Register Klinischer Studien, Type of Study: Nicht-interventionell
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Abstract

Purpose Femoroacetabular impingement (FAI) is a known risk factor for hip osteoarthritis. The gold standard for diagnostics is X-ray and MRI. The accuracy of hip joint alpha angle measurements obtained using sonography is equal to measurements in MRI for patients with cam impingement of the hip joint.

Materials and Methods Patients with hip pain and MRI and sonography were evaluated between January 2015 and December 2019 in a single center. Musculoskeletal sonography was performed according to the DEGUM guidelines by ultrasound-certified specialists. Measurements were repeated three times by two independent investigators.

Results 285 patients were screened, and 110 patients (49 females, 61 males) met the inclusion criteria. The mean age at time of investigation of 54 left and 56 right hip joints was 54.2 years. 1320 measurements were performed. The mean alpha angle was 50.7° in MRI and 50.4° in sonography with a mean difference of 0.28° (p>0.05).

Conclusion Determining hip alpha angle using sonography is a safe and reproducible method. No statistically significant differences between results in MRI and sonography could be seen. Although this is a retrospective, single-center study including only Caucasian mid-Europeans and with the known limitations of ultrasound imaging, it nevertheless shows that sonography can be used as a simple, cheap, and fast technique to assess the hip alpha angle without losing diagnostic quality.

Zusammenfassung

Ziel Das femoroacetabuläre Impingement (FAI) ist ein bekannter Risikofaktor für eine Coxarthrose. Der Goldstandard in der Diagnostik sind Röntgen und MRT. Die Genauigkeit der sonografischen Bestimmung des Alpha-Winkels des Hüftgelenks entspricht bei Patienten mit Cam-Impingement des Hüftgelenks den Messungen in der MRT.

Material und Methoden Patienten mit Hüftschmerzen und MRT und Sonografie wurden zwischen Januar 2015 und Dezember 2019 in einem einzigen Zentrum untersucht. Die muskuloskelettale Sonografie wurde gemäß den DEGUM-Leitlinien von ultraschallzertifizierten Experten durchgeführt. Die Messungen wurden 3-mal von 2 unabhängigen Untersuchern wiederholt.

Ergebnisse 285 Patienten wurden untersucht, und 110 Patienten (49 Frauen, 61 Männer) erfüllten die Einschlusskriterien. Das Durchschnittsalter zum Zeitpunkt der Untersuchung von 54 linken und 56 rechten Hüftgelenken betrug 54,2 Jahre. Es wurden 1320 Messungen durchgeführt. Der mittlere Alpha-Winkel betrug 50,7° in der MRT und 50,4° in der Sonografie mit einer mittleren Differenz von 0,28° (p>0,05).

Schlussfolgerung Die sonografische Bestimmung des Alpha-Winkels der Hüfte ist eine sichere und reproduzierbare Methode. Es konnten keine statistisch signifikanten Unterschiede zwischen den Ergebnissen von MRT und Sonografie festgestellt werden. Obwohl es sich hier um eine retrospektive monozentrische Studie handelt mit ausschließlich kaukasischen Mitteleuropäern und den bekannten Einschränkungen der Ultraschallbildgebung, zeigt sie dennoch, dass die Sonografie als einfache, kostengünstige und schnelle Methode zur Beurteilung des Alpha-Winkels der Hüfte eingesetzt werden kann, ohne dass die diagnostische Qualität darunter leidet.

Keywords

sonography - alpha angle - hip joint - femoroacetabular impingement


Publication History

Received: 01 May 2021

Accepted after revision: 22 September 2021

Article published online:
01 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Letter to the Editor: “Sonography-Based Determination of Hip Joint Anterior Alpha-Angle: A Reliable and Reproducible Method”Ultraschall Med 2023; 44(02): 206-207
DOI: 10.1055/a-1795-2890

 

  • References

  • 1 Hale RF, Melugin HP, Zhou J. et al. Incidence of Femoroacetabular Impingement and Surgical Management Trends Over Time. Am J Sports Med 2021; 49: 35-41
    CrossrefPubMedSearch in Google Scholar
  • 2 Hoch A, Schenk P, Jentzsch T. et al. FAI morphology increases the risk for osteoarthritis in young people with a minimum follow-up of 25 years. Arch Orthop Trauma Surg 2021; 141: 1175-1181
    CrossrefPubMedSearch in Google Scholar
  • 3 Maupin JJ, Steinmetz G, Thakral R. Management of femoroacetabular impingement syndrome: current insights. Orthop Res Rev 2019; 11: 99-108
    CrossrefPubMedSearch in Google Scholar
  • 4 Wylie JD, Kim YJ. The Natural History of Femoroacetabular Impingement. J Pediatr Orthop 2019; 39: S28-S32
    CrossrefPubMedSearch in Google Scholar
  • 5 Heuck A, Dienst M, Glaser C. Femoroazetabuläres Impingement – Update 2019. Der Radiologe 2019; 59: 242-256
    CrossrefPubMedSearch in Google Scholar
  • 6 Waldt S. Bildgebung des Hüftgelenks beim femoroazetabulären Impingement. Arthroskopie 2019; 32: 86-94
    CrossrefPubMedSearch in Google Scholar
  • 7 Notzli HP, Wyss TF, Stoecklin CH. et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84: 556-560
    CrossrefPubMedSearch in Google Scholar
  • 8 Konermann W, Gruber G, Gaa J. Standardized sonographic examination of the hip joint. Ultraschall in Med 2000; 21: 137-141
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Gruber G, Schamberger C, Konermann W. Sonografie in Orthopädie, Unfallchirurgie und Rheumatologie. Berlin Heidelberg: Springer-Verlag; 2018.
    CrossrefSearch in Google Scholar
  • 10 Green SB. How Many Subjects Does It Take To Do A Regression Analysis. Multivariate Behavioral Research 1991; 26: 499-510
    CrossrefPubMedSearch in Google Scholar
  • 11 Barrientos C, Barahona M, Diaz J. et al. Is there a pathological alpha angle for hip impingement? A diagnostic test study. J Hip Preserv Surg 2016; 3: 223-228
    CrossrefPubMedSearch in Google Scholar
  • 12 Smith KM, Gerrie BJ, McCulloch PC. et al. Comparison of MRI, CT, Dunn 45 degrees and Dunn 90 degrees alpha angle measurements in femoroacetabular impingement. Hip Int 2018; 28: 450-455
    CrossrefPubMedSearch in Google Scholar
  • 13 Gollwitzer H, Suren C, Struwind C. et al. The natural alpha angle of the femoral head-neck junction: a cross-sectional CT study in 1312 femurs. Bone Joint J 2018; 100: 570-578
    CrossrefPubMedSearch in Google Scholar
  • 14 Lerch S, Kasperczyk A, Berndt T. et al. Ultrasound is as reliable as plain radiographs in the diagnosis of cam-type femoroacetabular impingement. Arch Orthop Trauma Surg 2016; 136: 1437-1443
    CrossrefPubMedSearch in Google Scholar
  • 15 Griffin DR, Dickenson EJ, Wall PDH. et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018; 391: 2225-2235
    CrossrefPubMedSearch in Google Scholar
  • 16 Hanke MS, Lerch TD, Schmaranzer F. et al. Complications of hip preserving surgery. EFORT Open Rev 2021; 6: 472-486
    CrossrefPubMedSearch in Google Scholar
  • 17 Kunze KN, Leong NL, Beck EC. et al. Hip Arthroscopy for Femoroacetabular Impingement Improves Sleep Quality Postoperatively. Arthroscopy 2019; 35: 461-469
    CrossrefPubMedSearch in Google Scholar
  • 18 Sonnenfeld JJ, Trofa DP, Mehta MP. et al. Hip Arthroscopy for Femoroacetabular Impingement. JBJS Essent Surg Tech 2018; 8: e23
    CrossrefPubMedSearch in Google Scholar
  • 19 Zhang D, Chen L, Wang G. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95: e5122
    CrossrefPubMedSearch in Google Scholar
  • 20 Clohisy JC, Baca G, Beaule PE. et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med 2013; 41: 1348-1356
    CrossrefPubMedSearch in Google Scholar
  • 21 Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular Impingement Syndrome. Curr Sports Med Rep 2020; 19: 360-366
    CrossrefPubMedSearch in Google Scholar
  • 22 Frank JM, Harris JD, Erickson BJ. et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy 2015; 31: 1199-1204
    CrossrefPubMedSearch in Google Scholar
  • 23 Maldonado DR, Chen JW, Walker-Santiago R. et al. Radiographic and Demographic Factors Can Predict the Need for Primary Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model Using 1398 Hips. Am J Sports Med 2020; 48: 173-180
    CrossrefPubMedSearch in Google Scholar
  • 24 Nakashima H, Tsukamoto M, Ohnishi Y. et al. Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. Am J Sports Med 2019; 47: 2029-2037
    CrossrefPubMedSearch in Google Scholar