Purpose
To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in
the arthroscopic treatment of femoroacetabular impingement syndrome and compare those
results with traditional unguided resections.
Methods
Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome
between July 2019 and October 2019 were evaluated. Cases with CVI were identified
along with controls, consisting of patients from the same study period who underwent
surgery without the CVI and were balanced for age, sex, laterality, and preoperative
alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs,
as well as intraoperatively for the CVI group. Cam resections were quantified by measuring
pre- and postresection alpha angles and compared between groups. The correlation between
CVI views and office-based radiographs was assessed, and the 3 CVI views that best
correlated with each of the 3 standard clinic radiographs were evaluated for accuracy
and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based
films as the reference.
Results
A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI
group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control
group. There were no significant differences between groups with respect to age, sex,
laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative
clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45
with the anteroposterior (ρ = 0.588, P = .0025), 12:30 with the Dunn lateral (ρ = 0.632, P = .0009), and 1:45 with the false-profile (ρ = 0.575, P = .0033). Greater reliability was observed with 12:30/Dunn (accuracy = 83.33%, P < .0001; sensitivity = 77.14%; specificity = 87.76%) and 1:45/false-profile (accuracy =
82.35%, P = .0051; sensitivity = 81.82%; specificity = 82.61%) than with 11:45/anteroposterior
(accuracy = 69.15%, P = .0077; sensitivity = 56.10%; specificity = 79.25%).
Conclusions
CVI-guided cam resection results in successful resection of proximal femur cam lesions
and represents a femoroplasty templating method that does not require preoperative
computed tomography imaging or additional invasive intraoperative referencing modules.
The accuracy and adequacy of this resection was validated by comparison with routine
clinic radiographs.
Level of Evidence
Therapeutic Level III: retrospective comparative analysis.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop Relat Res. 2003; 417: 112-120
- Natural history of structural hip abnormalities and the potential for hip preservation.J Am Acad Orthop Surg. 2018; 26: 515-525
- Femoroacetabular impingement: Evidence of an established hip abnormality.Radiology. 2010; 257: 8-13
- Femoroacetabular cam-type impingement: Diagnostic sensitivity and specificity of radiographic views compared to radial MRI.Eur J Radiol. 2011; 80: 805-810
- Femoroacetabular impingement caused by a femoral osseous head–neck bump deformity: Clinical, radiological, and experimental results.J Orthop Sci. 2004; 9: 256-263
- Hip pain in young adults: Femoroacetabular impingement.J Arthroplasty. 2007; 22 (7 suppl 3): 37-42
- A new radiological index for assessing asphericity of the femoral head in cam impingement.J Bone Joint Surg Br. 2007; 89-B: 1309-1316
- Femoroacetabular impingement.Arthritis Rheumatol. 2015; 67: 17-27
- Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis.Acta Orthop Scand. 2000; 71: 370-375
- Femoroacetabular impingement: Question-driven review of hip joint pathophysiology from asymptomatic skeletal deformity to end-stage osteoarthritis.J Orthop Traumatol. 2019; 20: 32
- Patterns of joint damage seen on MRI in early hip osteoarthritis due to structural hip deformities.Osteoarthritis Cartilage. 2012; 20: 661-669
- 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
- Correlations between the alpha angle and femoral head asphericity: Implications and recommendations for the diagnosis of cam femoroacetabular impingement.Eur J Radiol. 2014; 83: 788-796
- Surgical management of labral tears during femoroacetabular impingement surgery: A systematic review.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 756-762
- Surgical treatment of femoroacetabular impingement: A systematic review of the literature.Clin Orthop Relat Res. 2010; 468: 555-564
- The importance of comprehensive cam correction: Radiographic parameters are predictive of patient-reported outcome measures at 2 years after hip arthroscopy.Am J Sports Med. 2018; 46: 2072-2078
- Hip arthroscopic surgery: Patient evaluation, current indications, and outcomes.Am J Sports Med. 2013; 41: 1174-1189
- Comparison of six radiographic projections to assess femoral head/neck asphericity.Clin Orthop Relat Res. 2006; 445: 181-185
- Surgical indications for arthroscopic management of femoroacetabular impingement.Arthroscopy. 2012; 28: 1170-1179
- The learning curve in hip arthroscopy: Effect on surgical times in a single surgeon cohort.Arthroscopy. 2020; 36: 1293-1298
- Residual deformity is the most common reason for revision hip arthroscopy: A three-dimensional CT study.Clin Orthop Relat Res. 2015; 473: 1388-1395
- Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.Arthroscopy. 2013; 29: 589-595
- A systematic approach to the plain radiographic evaluation of the young adult hip.J Bone Joint Surg Am. 2008; 90: 47-66
- Anteversion of the neck of the femur; a method of measurement.J Bone Joint Surg Br. 1952; 34-B: 181-186
- Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement.Clin Orthop Relat Res. 2011; 469: 464-469
- Do normal radiographs exclude asphericity of the femoral head–neck junction?.Clin Orthop Relat Res. 2009; 467: 651-659
- A guideline of selecting and reporting intraclass correlation coefficients for reliability research.J Chiropr Med. 2016; 15: 155-163
- Arthroscopic management of labral tears in the hip.J Bone Joint Surg Am. 2008; (90 suppl 4): 2-19
- Improved arthroscopic visualization of peripheral compartment.Arthrosc Tech. 2012; 1: e57-e62
- Routine complete capsular closure during hip arthroscopy.Arthrosc Tech. 2013; 2: e89-e94
- Interobserver and intraobserver reliability of the radiographic analysis of femoroacetabular impingement and dysplasia using computer-assisted measurements.Am J Sports Med. 2014; 42: 2393-2401
- Correlation of alpha angle between various radiographic projections and radial magnetic resonance imaging for cam deformity in femoral head–neck junction.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 77-83
- What are the risk factors for revision surgery after hip arthroscopy for femoroacetabular impingement at 7-year followup?.Clin Orthop Relat Res. 2017; 475: 1169-1177
- Revision hip arthroscopy: Findings and outcomes.J Hip Preserv Surg. 2017; 4: 318-323
- Revision hip arthroscopy.Am J Sports Med. 2007; 35: 1918-1921
- Alpha angle correction in femoroacetabular impingement.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 812-821
- Rates and risk factors for revision hip arthroscopy.Iowa Orthop J. 2019; 39: 95-99
- Academic Network of Conservation Hip Outcome Research (ANCHOR) Members. Persistent structural disease is the most common cause of repeat hip preservation surgery.Clin Orthop Relat Res. 2013; 471: 3788-3794
- Revision hip arthroscopy: A systematic review of diagnoses, operative findings, and outcomes.Arthroscopy. 2015; 31: 1382-1390
- Clinical outcomes and causes of arthroscopic hip revision surgery.Sci Rep. 2019; 9: 1230
- Hip arthroscopy learning curve: A prospective single-surgeon study.Int Orthop. 2018; 42: 777-782
- The effect of surgeon’s learning curve: Complications and outcome after hip arthroscopy.Arch Orthop Trauma Surg. 2018; 138: 1415-1421
- Right versus left hip arthroscopy for surgeons on the learning curve.Arthrosc Tech. 2017; 6: e1837-e1844
- Defining the learning curve for hip arthroscopy: A threshold analysis of the volume-outcomes relationship.Am J Sports Med. 2018; 46: 1284-1293
- Independent risk factors for revision surgery or conversion to total hip arthroplasty after hip arthroscopy: A review of a large statewide database from 2011 to 2012.Arthroscopy. 2018; 34: 464-470
- Computer-assisted correction of cam-type femoroacetabular impingement: A Sawbones study.J Bone Joint Surg Am. 2011; : 70-75
- Imageless versus image-based registration in navigated arthroscopy of the hip: A cadaver-based assessment.J Bone Joint Surg Br. 2012; 94: 624-629
- Computer-assisted femoral head–neck osteochondroplasty using a surgical milling device an in vitro accuracy study.J Arthroplasty. 2012; 27: 310-316
- Accuracy of navigated cam resection in femoroacetabular impingement: A randomised controlled trial.Int J Med Robot. 2017; 13
- Computer-assisted modeling of osseous impingement and resection in femoroacetabular impingement.Arthroscopy. 2012; 28: 204-210
- Dynamic hip examination for assessment of impingement during hip arthroscopy.Arthrosc Tech. 2016; 5: e1367-e1372
- Evaluation of a computed tomography-based navigation system prototype for hip arthroscopy in the treatment of femoroacetabular cam impingement.Arthroscopy. 2009; 25: 382-391
- Noninvasive three-dimensional assessment of femoroacetabular impingement.J Orthop Res. 2007; 25: 122-131
- Restricted surface matching—numerical optimization and technical evaluation.Comput Aided Surg. 2001; 6: 143-152
Article info
Publication history
Published online: May 02, 2021
Accepted:
April 15,
2021
Received:
March 22,
2020
Footnotes
See commentary on page 3383
The authors report the following potential conflicts of interest: S.J.N. receives research support from AlloSource; other from the American Orthopaedic Association and American Orthopaedic Society for Sports Medicine; nonfinancial support from Arthrex; other from the Arthroscopy Association of North America; nonfinancial support from Athletico, DJ Orthopaedics, Linvatec, and Miomed; personal fees from Ossur; nonfinancial support from Smith & Nephew; and personal fees from Springer and Stryker, outside the submitted work. No potential conflict reported by S.J.N. provided any form of funding or material or financial support for this work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
