Conventional radiology and CT techniques in hip impingement, guided by an applied biomechanical study

Abstract

Purpose

The primary purpose of this work is the creation of a standardized protocol for the study of FAI (femoro-acetabular impingement), such asCAM, PINCER and MISTO hip impingement. This protocol must include a radiological projection of high sensitivity and diagnostic reliability for this kind of impingement. The second aim of this work is to create a new standardized protocol for multislice CT scans, used to obtain a detailed image ofthe structure of joints to be used as a medical/diagnostic tool. The ethical and social objective of this project is to have an early diagnosis of the pathological situation in order to delay, where possible, hip replacement therapy, and laying a foundation for a preventative approach, including physical therapy treatment on patients suffering from these disabling conditions.

Materials and Methods

We recruited a sample of 47 patients, diagnosed with of impingement. X-ray images, using four non-standardised projections, already in use and found in the literature: AP standing, Obl. False Profile of Lequesne (standing), Obl. of Lauenstein, Obl. of Ducroquet.

These projections were tested to find out the levels of sensibility and diagnostic reliability, creating a protocol. The projections with the highest levels of sensibility and diagnostic reliability were readapted in CT multislice, creating an appropriate protocol.

Results

The projections used in our research allowed the standardization of an operative protocol for the diagnosis and differentiation of the different kinds of FAI. Each protocol found can identify the appropriate projection fit for the purpose. We confirm the role of  CT multislice is as a second-line diagnostic tool for hip impingement. By using load-bearing images, we can confirm the diagnosis and spatially describe the impingement.