Prevalence Of Cam Deformity Research Articles

Iliopsoas Pathology: Game-changing Findings from a Large Hip Arthroscopy Study Group

Report the prevalence, associated findings, rendered arthroscopic surgical procedures, and outcomes of hips with iliopsoas-related pathology. Enrolled patients that underwent isolated hip arthroscopy that reached 2-year minimum PRO follow-up were assigned to Iliopsoas group, defined as pre-operative diagnosis of iliopsoas tendonitis, internal snapping hip symptoms, history of psoas injection, and/or intra-operative anteroinferior labral bruising or tear or the control group. The prevalence of iliopsoas-related pathology, radiographic and intra-operative findings, and rendered procedures between study and control groups were compared using Chi square analysis. Minimum 2-year outcomes were compared using analysis of variance (a priori alpha set at 0.05). 629 patients met the inclusion criteria of which 69 patients (11%) comprised the iliopsoas group and 560 patients (89%), the control group. Iliopsoas tenotomy was performed in 5 patients, all via the transcapsular approach. Demographics did not differ between groups (p>0.05). There was no significant difference in the prevalence of cam deformity, global pincer deformity, or dysplasia between cohorts but there was a lower incidence of focal pincer impingement among patients with iliopsoas involvement (22 % vs 37%,p=0.001). Labral repair and debridement was more commonly performed in the group of patients without iliopsoas involvement and relatively more labral reconstructions in the iliopsoas group (p<0.05). Post-operative iHOT-12 scores similarly improved to 70.2 (SD:26.7) for the iliopsoas group and 73.0 (SD:25.1) for the control group (p=0.68). Post-operative pain scores similarly reduced to 21.9 (SD 23.0) for the iliopsoas group and 20.2 (SD: 22) for the control group (p=0.74). The most significant finding from this large multicenter study is the extremely low incidence of arthroscopic iliopsoas tenotomies despite the not uncommon prevalence of iliopsoas-related pathology. The incidence of iliopsoas tenotomy has significantly decreased in patients undergoing hip arthroscopy and the presence of iliopsoas–related pathology even untreated with tenotomy is not a predictor of poorer outcomes.

CAM-type femoroacetabular impingement in male elite junior cross-country skiers and non-athlete controls: a cross-sectional MRI study

ObjectivesCross-country (CC) skiing consists of two main techniques: classic and skating. Hip motion during the skating technique is similar to that in ice skating and is considered a risk factor...

Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head.

Osteonecrosis of the femoral head (ONFH) and CAM-type femoroacetabular impingement (FAI) present two different pathologies of the hip joint. The aim of this study is to describe the prevalence of CAM-FAI in a collective of ONFH hips and to evaluate its influence on ONFH therapy outcome. A cohort of 86 ONFH hips with a mean follow-up of 46.7months (±20.5) after advanced core decompression (ACD) was evaluated regarding CAM deformity by measuring the alpha angle (α) and head-neck offset. The influence of CAM-type FAI was investigated using the Kaplan-Meier estimator and the Cox regression model. The mean α was 60.4° (±13.8) with 41 hips (47.7%) being ≥60°. The mean head-neck offset was 4.5mm (±3.2), with 78 hips (90.7%) being ≤9mm. Survival analysis indicated noticeably better ACD results for α<60° versus α≥60° (p=0.07). Treatment failure within the first 2years was statistically estimated as 27.7% for α<60° versus 40.7% for α≥60°: The hazard ratio for α≥60° was 1.94. Head-neck offset-dependent survival showed better, though not significant, results for offset >9mm (p=0.38, hazard ratio 1.89 for offsets ≤9mm). The prevalence of CAM-type deformity is greatly increased in patients with concomitant ONFH. There is a strong indication that CAM-type FAI has a negative influence on ONFH therapy outcome. The risk that ONFH treatment will fail seems to be twice as high for α≥60° as for α<60°. We recommend cotreatment of pathological head-neck offset in patients with ONFH.

CORR Insights®: What Is the Prevalence of Cam Deformity After Prophylactic Pinning of the Contralateral Asymptomatic Hip in Unilateral Slipped Capital Femoral Epiphysis? A 10-year Minimum Followup Study.

CORR Insights®: What Is the Prevalence of Cam Deformity After Prophylactic Pinning of the Contralateral Asymptomatic Hip in Unilateral Slipped Capital Femoral Epiphysis? A 10-year Minimum Followup Study.

What Is the Prevalence of Cam Deformity After Prophylactic Pinning of the Contralateral Asymptomatic Hip in Unilateral Slipped Capital Femoral Epiphysis? A 10-year Minimum Followup Study.

Prophylactic pinning of the asymptomatic and normal-appearing contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) remains controversial. Understanding the minimal 10-year clinical, functional, and radiographic outcomes of the contralateral asymptomatic hip in unilateral SCFE may be helpful in the decision regarding whether the benefits associated with potentially preventing a SCFE are outweighed by the risk of additional surgery. Among patients with SCFE treated with prophylactic pinning of the asymptomatic and contralateral hip, we sought (1) to determine the complications and reoperations; (2) to evaluate the development of cam deformities and the frequency and severity of osteoarthritis progression; and (3) to characterize hip pain and function as measured by the Harris hip score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) at minimal 10-year followup. Between 1998 and 2005 all patients with SCFE seen at our institution were treated with the modified Dunn procedure and all were offered prophylactic pinning of the contralateral asymptomatic hip. Of the 41 patients who underwent the unilateral modified Dunn procedure and who had an asymptomatic contralateral hip, 37 patients (90%) underwent pinning of that contralateral hip. Of those, 33 patients (80%) were available for clinical and radiographic evaluation for this retrospective study at a minimum of 10 years (mean followup 12 ± 2 years) after surgery. Three patients of the 37 patients only had 10-year clinical followup, including questionnaires sent by mail and telephone, because they refused further radiographic followup and one patient was lost to followup. The group included 19 males and 17 females whose age at surgery was a mean of 13 ± 2 years. Medical charts were reviewed and patients were asked about complications and additional surgical procedures. Most recent postoperative radiographs were evaluated for measurement of the alpha angle, head-neck offset, epiphysis orientation, and osteoarthritis grading according to Tönnis classification and minimum joint space width. The presence of a cam deformity was defined by an alpha angle measurement > 60° on the AP radiograph and/or > 55° on the lateral radiograph. Hip function and pain were assessed by the HHS and HOOS outcome measures. No complications with prophylactic in situ pinning were recorded. Four of 36 (11%) patients underwent subsequent surgical treatment for cam-type femoroacetabular impingement (FAI), and hardware removal was performed in four hips (11%). The mean alpha angle was 53° ± 8° on the AP radiograph and 49° ± 8° on the lateral view at followup. In total, 10 of 33 hips (30%) had a cam morphology at the femoral head-neck junction and four (12%) were symptomatic and underwent FAI surgery. Six of 33 patients (18%) developed an asymptomatic cam morphology at the femoral head-neck junction; in three of 33 hips (9%), the cam deformity instead of lesion were visible only on the lateral projection, and 9% were visible on both the AP and lateral projections. The preoperative offset of the femoral head-neck junction was 10 ± 3 mm on the AP view and 11 ± 4 mm on the lateral view. At followup, the AP offset was 7 ± 3 mm and the lateral offset was 6 ± 3 mm, and on the lateral view, the offset was < 10 mm in eight hips (22%). No patient had radiographic signs of hip osteoarthritis (Tönnis Grade 0). The mean minimum joint space width was 4 ± 0.4 mm. The mean HHS for the 32 patients who did not undergo subsequent surgery was 97 ± 5 at latest followup. The mean postoperative HOOS was 94 ± 8 for the 32 patients at latest followup. At a minimum followup of 10 years after prophylactic pinning of a contralateral asymptomatic hip, most patients achieve excellent hip scores; however, a substantial proportion will develop a symptomatic cam deformity despite prophylactic pinning. No patient had signs of osteoarthritis at a minimum of 10 years, but almost one-third of the patients who underwent prophylactic pinning developed a cam deformity. Level IV, therapeutic study.

Prevalence of Cam Deformity with Associated Femoroacetabular Impingement Syndrome in Hip Joint Computed Tomography of Asymptomatic Adults

PurposeFemoroacetabular impingement (FAI) is considered an important cause of early degenerative arthritis development. Although three-dimensional (3D) imaging such as computed tomography (CT) and magnetic resonance imaging are considered precise imaging modalities for 3D morphology of FAI, they are associated with several limitations when used in out-patient clinics. The paucity of FAI morphologic data in Koreans makes it difficult to select the most effective radiographical method when screening for general orthopedic problems. We postulate that there might be an individual variation in the distribution of cam deformity in the asymptomatic Korean population.Materials and MethodsFrom January 2011 to December 2015, CT images of the hips of 100 subjects without any history of hip joint ailments were evaluated. A computer program which generates 3D models from CT scans was used to provide sectional images which cross the central axis of the femoral head and neck. Alpha angles were measured in each sectional images. Alpha angles above 55° were regarded as cam deformity.ResultsThe mean alpha angle was 43.5°, range 34.7–56.1°(3 o'clock); 51.24°, range 39.5–58.8°(2 o'clock); 52.45°, range 43.3–65.5°(1 o'clock); 44.09°, range 36.8–49.8°(12 o'clock); 40.71, range 33.5–45.8°(11 o'clock); and 39.21°, range 34.1–44.6°(10 o'clock). Alpha angle in 1 and 2 o'clock was significantly larger than other locations (P<0.01). The prevalence of cam deformity was 18.0% and 19.0% in 1 and 2 o'clock, respectively.ConclusionCam deformity of FAI was observed in 31% of asymptomatic hips. The most common region of cam deformity was antero-superior area of femoral head-neck junction (1 and 2 o'clock).

Ethnic Differences in Bony Hip Morphology in a Cohort of 445 Professional Male Soccer Players

Background: Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports. Purpose: To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology. Results: A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% (P = .03). Conclusion: The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.

Femoral Morphology in Patients Undergoing Periacetabular Osteotomy for Classic or Borderline Acetabular Dysplasia: Are Cam Deformities Common?

BackgroundThe primary purpose of our study was to determine the prevalence of Cam deformity in patients with symptomatic acetabular dysplasia (SAD) who underwent periacetabular osteotomy (PAO). MethodsWe retrospectively reviewed 164 SAD PAO patients from 2 institutions. Preoperative anteroposterior and frog-lateral radiographs were analyzed for lateral center edge angle (LCEA), retroversion, alpha angles, and anterior femoral head-neck offset. Hips were classified as dysplastic (LCEA <20°, group A, n = 142) and borderline dysplastic (LCEA 20°-25°, group B, n = 22). There were 128 females and 36 males with an average age of 29 years (range 13-56). ResultsThe overall prevalence of Cam deformity was 10% (17 of 164) in SAD patients. There was no difference in the prevalence of Cam deformity between the groups (P > .99). ConclusionPrevalence of Cam deformities in our series of SAD patients having undergone PAO is less than prior reports. Careful radiographic measurement should be performed to avoid overtreating these hips with unnecessary osteochondroplasty procedures.

Prevalence, topographic and morphometric features of femoral cam-type deformity: changes in relation to age and gender.

Femoroacetabular impingement (FAI) syndrome is a frequent cause of pain and in recent years considered to be a precursor of premature hip osteoarthritis. The structural abnormalities which characterize FAI syndrome, such as the cam-type deformity, are associated with morphological alterations that may lead to hip osteoarthritis. The aim of this study was to determine the prevalence and topographic and morphometric features of the cam deformity in a series of 326 femur specimens obtained from a Mexican population, as well as changes in prevalence in relation to age and gender. The specimens were subdivided into groups according to gender and age. A standardized photograph of the proximal femur of each specimen was taken, and the photograph was used to determine the alpha angle using a computer program; the location of the lesion was determined by quadrant and the morphometric characteristics were determined by direct observation. The overall prevalence of cam deformities in the femur specimens was 29.8% (97/326), with a prevalence by gender of 35.2% (64/182) in men and 22.9% (33/144) in women. The mean alpha angle was 54.6°±8.5° in all of the osteological specimens and 65.6°±7.5° in those specimens exhibiting a cam deformity. Cam deformities were found topographically in the anterior-superior quadrant of the femoral head-neck junction in 86.6% (84/97) of the femurs. Deformities were found in 28.2% of the right femurs and 31.3% of the left femurs. The prevalence of cam deformity was higher in the femur specimens of young men and in those of middle-aged and older women. There were no significant differences in this deformity in relation to the alpha angle according to age and gender.

The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the copenhagen osteoarthritis study

Cam deformity is a preosteoarthritic malformation causing premature hip-joint degeneration. While the pathogenetic pathway from deformity to osteoarthrosis (OA) has been well established, almost nothing is known of the malformation's epidemiology. To determine the distribution of cam deformity in a large, unselected cohort from standardized anteroposterior (AP) pelvic radiographs. The distribution of cam deformity was assessed in 3202 (1184 male, 2018 female) standardized AP pelvic radiographs using the triangular index (TI) and the alpha angle. The relationships between cam malformation and self-reported hip pain were evaluated, and the relative importance of known risk factors for cam malformation estimated. We found a pronounced sex-related difference in cam-deformity distribution. The overall prevalence of cam deformity was approximately 17% in men and 4% in women. The distribution of cam deformity was unaltered in subjects with normal joint-space width or other features of hip-joint degeneration. We found no significant association with self-reported hip pain, nor did we find any relative importance of possible risk factors for hip deformity, such as body-mass index (BMI), occupational exposure to heavy workloads, or concomitant acetabular dysplasia. The results lend support to the thesis that cam deformity represents a silent slipped capital epiphysis, predominantly in men, and that it is a far from uncommon deformity in subjects with no apparent evidence of hip-joint osteoarthritis.