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. 2022 Apr 21;9(2):67-77.
doi: 10.1093/jhps/hnac016. eCollection 2022 Jul.

Combined abnormalities of femoral version and acetabular version and McKibbin Index in FAI patients evaluated for hip preservation surgery

Till D Lerch  1 , Tiziano Antioco  1 , Malin K Meier  2 , Adam Boschung  2 , Markus S Hanke  2 , Moritz Tannast  2 , Klaus A Siebenrock  2 , Florian Schmaranzer  1 , Simon D Steppacher  2
Affiliations

Combined abnormalities of femoral version and acetabular version and McKibbin Index in FAI patients evaluated for hip preservation surgery

Till D Lerch et al. J Hip Preserv Surg. .

Abstract

Frequencies of combined abnormalities of femoral version (FV) and acetabular version (AV) and of abnormalities of the McKibbin index are unknown. To investigate the prevalence of combined abnormalities of FV and AV and of abnormalities of the McKibbin index in symptomatic patients with femoroacetabular impingement (FAI), a retrospective, Institutional Review Board (IRB)-approved study of 333 symptomatic patients (384 hips) that were presented with hip pain and FAI was performed. The computed tomography/magnetic resonance imaging based measurement of central AV, cranial AV and FV was compared among five subgroups with distinguished FAI subgroups and patients that underwent a hip preservation surgery. The allocation to each subgroup was based on AP radiographs. Normal AV and FV were 10-25°. The McKibbin index is the sum of central AV and FV. Of patients that underwent a hip preservation surgery, 73% had a normal McKibbin index (20-50°) but 27% had an abnormal McKibbin index. Of all patients, 72% had a normal McKibbin index, but 28% had abnormal McKibbin index. The prevalence of combined abnormalities of FV and AV varied among subgroups: a higher prevalence of decreased central AV combined with decreased FV of patients with acetabular-retroversion group (12%) and overcoverage (11%) was found compared with mixed-type FAI (5%). Normal AV combined with normal FV was present in 41% of patients with cam-type FAI and in 34% of patients with overcoverage. Patients that underwent a hip preservation surgery had normal mean FV (17 ± 11°), central AV (19 ± 7°), cranial AV (16 ± 10°) and McKibbin index (36 ± 14°). Frequency of combined abnormalities of AV and FV differs between subgroups of FAI patients. Aggravated and compensated McKibbin index was prevalent in FAI patients. This has implications for open hip preservation surgery (surgical hip dislocation or femoral derotation osteotomy) or hip arthroscopy or non-operative treatment.

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Figures

Fig. 1.
Fig. 1.
Exclusion criteria and subgroups for the patients are shown.
Fig. 2.
Fig. 2.
The nine possible combinations of FV and AV are shown. Two combinations (top left, A and right below, I) had an aggravated McKibbin index (red). Normal values for both AV and FV were between 10° and 25° according to Tönnis et al. [4]. The two combinations on below left (C) and on top right (G) had a compensated McKibbin index.
Fig. 3.
Fig. 3.
(A and  B) Prevalences of possible combinations of FV and AV are shown for all patients (A) and for patients treated surgically (B).
Fig. 4.
Fig. 4.
Prevalences of possible combinations of FV and AV are shown for patients with cam-type FAI. Two combinations (top left, and right below) had an aggravated McKibbin index (red). Normal values for both AV and FV were between 10° and 25° according to Tönnis et al. [4]. The two combinations on below left and on top right had a compensated McKibbin index.
Fig. 5.
Fig. 5.
Prevalences of possible combinations of FV and AV are shown for patients with mixed-type FAI. Two combinations (top left, and right below) had an aggravated McKibbin index (red). Normal values for both AV and FV were between 10° and 25° according to Tönnis et al. [4]. The two combinations on below left and on top right had a compensated McKibbin index.
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