Can We Discriminate Symptomatic Hip Patients From Asymptomatic Volunteers Based on Anatomic Predictors? A 3-Dimensional Magnetic Resonance Study on Cam, Pincer, and Spinopelvic Parameters
Can We Discriminate Symptomatic Hip Patients From Asymptomatic Volunteers Based on Anatomic Predictors? A 3-Dimensional Magnetic Resonance Study on Cam, Pincer, and Spinopelvic Parameters
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DOI：
10.1177/0363546518800825
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发表时间：
2018-11-01
影响因子：
4.8
通讯作者：
Guimaraes Consciencia, J.
中科院分区：
文献类型：
--
作者：
Mascarenhas, Vasco V.;Rego, Paulo;Guimaraes Consciencia, J.
Background: Given the high prevalence of patients with hip deformities and no ongoing hip dysfunction, understanding the anatomic factors predicting the symptomatic state is critical. One such variable is how the spinopelvic parameters (SPPs) may interplay with hip anatomic factors. Hypothesis/Purpose: SPPs and femoral- and acetabular-specific parameters may predict which patients will become symptomatic. The purpose was to determine which anatomic characteristics with specific cutoffs were associated with hip symptom development and how these parameters relate to each other. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: 548 participants were designated either symptomatic patients (n = 176, scheduled for surgery with hip pain and/or functional limitation) or asymptomatic volunteers (n = 372, no pain) and underwent 3-dimensional magnetic resonance imaging. Multiple femoral (alpha angle, omega angle, neck angle, torsion), acetabular (version, coverage), and spinopelvic (pelvic tilt, sacral slope [SS], pelvic incidence) parameters were measured semiautomatically. Normative values, optimal differentiating thresholds, and a logistic regression analysis were computed. Results: Symptomatic patients had larger cam deformities (defined by increased omega angle and alpha angle), smaller acetabular coverage, and larger pelvic incidence and SS angles compared with the asymptomatic volunteers. Discriminant receiver operating characteristic analysis confirmed that radial 2-o'clock alpha angle (threshold 58 degrees-60 degrees, sensitivity 75%-60%, specificity 80%-84%; area under the curve [AUC] = 0.831), omega angle (threshold 43 degrees, sensitivity 72%, specificity 70%; AUC = 0.830), acetabular inclination (threshold 6 degrees, sensitivity 65%, specificity 70%; AUC = 0.709), and SS (threshold 44 degrees, sensitivity 72%, specificity 75%; AUC = 0.801) (P < .005) were the best parameters to classify participants. When parameters were entered into a logistic regression, significant positive predictors for the symptomatic patients were achieved for SS, acetabular inclination, omega angle, and alpha angle at 2-o'clock, correctly classifying 85% of cases (model sensitivity 72%, specificity 91%; AUC = 0.919). Conclusion: Complex dynamic interplay exists between the hip and SPPs. A cam deformity, acetabular undercoverage, and increased SPP angles are predictive of a hip symptomatic state. SPPs were significant to discriminate between participants and were important in combination with other hip deformities. Symptomatic patients can be effectively differentiated from asymptomatic volunteers based on predictive anatomic factors.
