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Are "normal hips" being labeled as femoroacetabular impingement due to EE angle?

Abstract Gluteal muscle contracture (GMC) is a clinical syndrome characterized by gait abnormality and limb dysfunction, as well as secondary deformities of pelvis and femur. Femoroacetabular impingement (FAI) typically could be diagnosed on the basis of computed tomography (CT) such as the equatorial-edge angle (EE angle), but it did not work well in GMC patients. In this study, we retrospected all image data and found small EE angles in GMCs, which meant retroverted acetabulum; however, none of them showed no symptoms and signs of FAI. Therefore, we had reasons to think that, some normal hips with unbalanced hip myodynamia as same as GMCs, may be incorrectly diagnosed as FAI through measuring EE angle only.In consequence, the paper was designed to assess the use of the EE angle in the assessment of FAI in the diagnosis, as described by Werner.Twenty-three patients (46 hips) were collected and calculated with the "equatorial-edge angle" (EE angle) by CT scans. All of them were excluded from FAI.Review of the hips showed a mean EE angle was 12.93°, with a minimum of -3.42° and a maximum of 24.08°. The mean value for males and females were 13.52° and 12.40°, respectively, without statistical significance, although the mean value of left hips and right sides reached 13.32° and 12.54° individually, not having statistical differences neither. There were not any symptoms or signs of FAI in all patients. Thus, the reduced EE angle could suggest the local excessive coverage of the femoral head by the anterior acetabular edge, but might not be a reasonably good predictor of FAI.GMC patient's acetabular deformity mainly manifests as increased retroversion, which may be the anatomical basis for FAI and lead to high risks of the acetabular impingement. However, all patients in this study showed no symptoms and signs of FAI, suggesting that the measurement of EE angle can only be applied to assessing those people with normal hip myodynamia, and the bone deformity and the muscular disorder should be both considered in the diagnosis of FAI.
PMID
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Authors

Mayor MeshTerms

Diagnostic Errors

Keywords
Journal Title medicine
Publication Year Start




PMID- 28353567
OWN - NLM
STAT- MEDLINE
DA  - 20170329
DCOM- 20170406
LR  - 20170406
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 13
DP  - 2017 Mar
TI  - Are "normal hips" being labeled as femoroacetabular impingement due to EE angle?
PG  - e6410
LID - 10.1097/MD.0000000000006410 [doi]
AB  - Gluteal muscle contracture (GMC) is a clinical syndrome characterized by gait
      abnormality and limb dysfunction, as well as secondary deformities of pelvis and 
      femur. Femoroacetabular impingement (FAI) typically could be diagnosed on the
      basis of computed tomography (CT) such as the equatorial-edge angle (EE angle),
      but it did not work well in GMC patients. In this study, we retrospected all
      image data and found small EE angles in GMCs, which meant retroverted acetabulum;
      however, none of them showed no symptoms and signs of FAI. Therefore, we had
      reasons to think that, some normal hips with unbalanced hip myodynamia as same as
      GMCs, may be incorrectly diagnosed as FAI through measuring EE angle only.In
      consequence, the paper was designed to assess the use of the EE angle in the
      assessment of FAI in the diagnosis, as described by Werner.Twenty-three patients 
      (46 hips) were collected and calculated with the "equatorial-edge angle" (EE
      angle) by CT scans. All of them were excluded from FAI.Review of the hips showed 
      a mean EE angle was 12.93 degrees , with a minimum of -3.42 degrees and a maximum
      of 24.08 degrees . The mean value for males and females were 13.52 degrees and
      12.40 degrees , respectively, without statistical significance, although the mean
      value of left hips and right sides reached 13.32 degrees and 12.54 degrees
      individually, not having statistical differences neither. There were not any
      symptoms or signs of FAI in all patients. Thus, the reduced EE angle could
      suggest the local excessive coverage of the femoral head by the anterior
      acetabular edge, but might not be a reasonably good predictor of FAI.GMC
      patient's acetabular deformity mainly manifests as increased retroversion, which 
      may be the anatomical basis for FAI and lead to high risks of the acetabular
      impingement. However, all patients in this study showed no symptoms and signs of 
      FAI, suggesting that the measurement of EE angle can only be applied to assessing
      those people with normal hip myodynamia, and the bone deformity and the muscular 
      disorder should be both considered in the diagnosis of FAI.
FAU - You, Tian
AU  - You T
AD  - aDepartment of Sports Medicine and Rehabilitation, Peking University Shenzhen
      Hospital bNanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen,
      China.
FAU - Yang, Bei
AU  - Yang B
FAU - Zhang, Xin-Tao
AU  - Zhang XT
FAU - Jiang, Xiao-Cheng
AU  - Jiang XC
FAU - Wang, Shuang
AU  - Wang S
FAU - Zhang, Wen-Tao
AU  - Zhang WT
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - *Diagnostic Errors
MH  - Female
MH  - Femoracetabular Impingement/*diagnostic imaging
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
EDAT- 2017/03/30 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/03/30 06:00
AID - 10.1097/MD.0000000000006410 [doi]
AID - 00005792-201703310-00013 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Mar;96(13):e6410. doi: 10.1097/MD.0000000000006410.

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