Imaging in Hip Arthroscopy for Femoroacetabular Impingement: A Comprehensive Approach

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Key points

  • Plain radiographs, including anteroposterior pelvis, Dunn lateral, and false-profile view, are key in initial assessment of patients suspected of femoroacetabular impingement.

  • Computed tomography scans rely less patient positioning and allow for accurate definition of the exact location and size of pincer-type and cam-type deformities, and can be particularly helpful in revision hip arthroscopy.

  • Studies have shown high incidence of labral tears in asymptomatic patients, thus correlation between

Plain radiography

Plain radiographs play a key role in initial management of patients presenting with hip pain when FAI is suspected. Several options exist regarding views and these should be fully understood to optimize information obtained. From these radiographs, several parameters can be obtained to help evaluate patients before hip preservation surgery. These same radiographs can be helpful when considering revision hip arthroscopy and postoperative correction of deformity.

Anteroposterior (AP) pelvis

Computed tomography

3D imaging allows for advanced characterization of the patient’s bony morphology. Computed tomography (CT) can be profoundly helpful in surgical planning for FAI.3, 19 Advances in preoperative planning software and motion analysis technology based on advanced imaging represent a growing area of hip preservation surgery.19, 20 CT is helpful in further delineation of a bony pathologic state noted on plain radiographs, though routine use is controversial given the degree of radiation exposure.21

Magnetic resonance imaging

MRI is a common diagnostic option to evaluate soft tissue hip injuries in patients undergoing workup for FAI. Imaging techniques include but are not limited to conventional noncontrast MRI, indirect magnetic resonance arthrography (MRA) and direct MRA. The latter techniques differ by route of contrast injection. Indirect MRA is intravenously injected; direct MRA is intra-articularly injected.2 Routine imaging sequences include coronal fat-saturated T2 fast spin echo (FSE), coronal T1 FSE,

Role of imaging in preoperative planning

Following an appropriate and thorough history and physical examination, diagnostic imaging plays an important role in determining the correct diagnosis for the young patient with hip pain.50 Recognition and correlation of physical examination findings with bony and soft tissue abnormalities identified on diagnostic imaging allows the surgeon to appreciate the unique fingerprint of disease in each patient. Preoperatively identifying the individualized pathologic condition helps to devise a

Imaging parameters of successful femoroacetabular impingement correction

Incomplete resection of underlying FAI deformity is a major reason for residual hip pain following surgery and a leading cause of revision hip arthroscopy.24, 25, 61, 62, 63, 64 Over-resection of offending osseous disease may lead to iatrogenic instability and poor outcomes.61, 65, 66 In addition to careful attention to preoperative imaging, recent research has suggested that systematic implementation of intraoperative fluoroscopy can assist in providing adequate acetabular and femoral

Future directions

Cartilage disease may be predictive of poorer outcomes after hip preservation surgery. Despite the limitations of conventional MRI, recent advances in biochemical imaging techniques have shown promise for detecting cartilage disease earlier and on a microscopic level.76, 77, 78, 79 These techniques include quantitative T2 and T2* relaxation mapping to assess cartilage water content and collagen organization,77, 80 as well as T1rho (T1ρ)78 and delayed gadolinium-enhanced MRI of cartilage

Summary

Hip arthroscopy continues to experience incredible growth and advances in imaging have progressed concomitantly. Plain radiographs play a key role in initial management of patients presenting with hip pain when FAI is suspected. 3D imaging with CT and MRI allows for advanced characterization of the patient’s bony morphology and soft tissue injury. Incomplete resection of underlying FAI deformity is a major reason for residual hip pain following surgery and a leading cause of revision hip

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