Fibrocystic Changes at Anterosuperior Femoral Neck: Prevalence in Hips with Femoroacetabular Impingement

PURPOSE: To retrospectively evaluate if there is an association between juxtaarticular fibrocystic changes at the anterosuperior femoral neck and femoroacetabular impingement (FAI).

MATERIALS AND METHODS: The institutional review board approved this study and did not require informed patient consent. An orthopedic surgeon and a radiologist in consensus retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 117 hips with FAI and compared these images with the AP radiographs of a control group of 132 hips with developmental dysplasia (DD) to determine the prevalence of juxtaarticular fibrocystic changes at the anterosuperior femoral neck. Criteria for juxtaarticular fibrocystic changes at the anterosuperior femoral neck were location close to the physis and a diameter (of the fibrocystic change) of greater than 3 mm. The sensitivity and specificity of AP pelvic radiography in the detection of these fibrocystic changes were calculated by using an additional 61 hips with FAI and on the basis of findings at magnetic resonance (MR) arthrography, which was routinely performed for assessment of FAI. In 24 patients who underwent joint-preserving surgery for FAI, the fibrocystic changes were localized intraoperatively and the spatial relation of the region of these changes to the area of FAI was identified. Joint-preserving surgery consisted of anterior surgical dislocation of the hip with osteochondroplasty of the proximal femur and/or the acetabular rim to improve the impingement-free range of hip motion. For statistical comparisons, nonparametric tests were performed.

RESULTS: Fibrocystic changes were identified on the AP radiographs of 39 (33%) of the 117 FAI-affected hips and on none of the radiographs of the 132 DD-affected hips. According to MR arthrogram findings, the sensitivity, specificity, and positive and negative predictive values of AP pelvic radiography were 64%, 93%, 91%, and 71%, respectively. The mean diameter of the juxtaarticular fibrocystic changes was 5 mm (range, 3–15 mm); smaller lesions were more prevalent. Dynamic MR imaging with the hip flexed and intraoperative observations revealed a close spatial relationship between the region of the fibrocystic changes at the anterosuperior femoral neck and the acetabular rim.

CONCLUSION: The high prevalence of juxtaarticular fibrocystic changes at the anterosuperior femoral neck and their spatial relation to the impingement site suggest an association and possible causal relationship between these alterations and FAI.

© RSNA, 2005


  • 1 Crabbe JP, Martel W, Matthews LS. Rapid growth of femoral herniation pit. AJR Am J Roentgenol 1992; 159: 1038–1040. Crossref, MedlineGoogle Scholar
  • 2 Daenen B, Preidler KW, Padmanabhan S, et al. Symptomatic herniation pits of the femoral neck: anatomic and clinical study. AJR Am J Roentgenol 1997; 168: 149–153. Crossref, MedlineGoogle Scholar
  • 3 Lee L, Manolios N, De Costa R, Howe G, Spencer D. Herniation pit of the femoral neck. J Rheumatol 2000; 27: 2278–2280. MedlineGoogle Scholar
  • 4 Lerais JM, Jacob D, Thibaud JC, et al. Spontaneous disappearance of herniation pit on the femoral neck. J Radiol 1995; 76: 593–595. MedlineGoogle Scholar
  • 5 Pitt MJ, Graham AR, Shipman JH, Birkby W. Herniation pit of the femoral neck. AJR Am J Roentgenol 1982; 138: 1115–1121. Crossref, MedlineGoogle Scholar
  • 6 Polger M, Aliabadi P. Radiologic vignette: the radiographic findings are typical of herniation pit of the femoral neck. Arthritis Rheum 1993; 36: 572–574. Crossref, MedlineGoogle Scholar
  • 7 Thomason CB, Silverman ED, Walter RD, Olshaker R. Focal bone tracer uptake associated with a herniation pit of the femoral neck. Clin Nucl Med 1983; 8: 304–305. Crossref, MedlineGoogle Scholar
  • 8 Angel JL. The reaction area of the femoral neck. Clin Orthop 1964; 32: 130–141. MedlineGoogle Scholar
  • 9 Hewitt J, Guilak F, Glisson R, Vail TP. Regional material properties of the human hip joint capsule ligaments. J Orthop Res 2001; 19: 359–364. Crossref, MedlineGoogle Scholar
  • 10 Hedvabny Z, Zidkova H, Kofranek I. Herniation pits. Acta Chir Orthop Traumatol Cech 1993; 60: 351–353. MedlineGoogle Scholar
  • 11 Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop 2003; 413: 201–207. Crossref, MedlineGoogle Scholar
  • 12 Siebenrock KA, Wahab K, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop 2004; 418: 54–60. Crossref, MedlineGoogle Scholar
  • 13 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock K. Femoro-acetabular impingement: an important cause of early osteoarthritis of the hip. Clin Orthop 2003; 417: 112–120. MedlineGoogle Scholar
  • 14 Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: an MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001; 83: 171–176. Crossref, MedlineGoogle Scholar
  • 15 Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. 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. Crossref, MedlineGoogle Scholar
  • 16 Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: The hip: proceedings of the Third Open Scientific Meeting of the Hip Society. St Louis, Mo: Mosby, 1975; 212–228. Google Scholar
  • 17 Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol 1965; 38: 810–824. Crossref, MedlineGoogle Scholar
  • 18 Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop 1999; 19: 419–424. Crossref, MedlineGoogle Scholar
  • 19 Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 1976; 58: 176–183. MedlineGoogle Scholar
  • 20 Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 1999; 81: 1747–1770. Crossref, MedlineGoogle Scholar
  • 21 Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis: relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 1997; 79: 1489–1497. [Published correction appears in J Bone Joint Surg Am 1999; 81:592.] Crossref, MedlineGoogle Scholar
  • 22 Hoaglund FT, Shiba R, Newberg AH, Leung KY. Diseases of the hip: a comparative study of Japanese Oriental and American white patients. J Bone Joint Surg Am 1985; 67: 1376–1383. Crossref, MedlineGoogle Scholar
  • 23 Ledingham J, Dawson S, Preston B, Milligan G, Doherty M. Radiographic progression of hospital referred osteoarthritis of the hip. Ann Rheum Dis 1993; 52: 263–267. Crossref, MedlineGoogle Scholar
  • 24 Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop 2003; 417: 263–269. MedlineGoogle Scholar
  • 25 MacDonald SJ, Garbuz D, Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplast 1997; 8: 3–9. Google Scholar
  • 26 Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome: a clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 1991; 73: 423–429. MedlineGoogle Scholar
  • 27 Eijer H, Leunig M, Mahomed MN, Ganz R. Anterior femoral head-neck off-set: a method for measurement. Hip Int 2001; 11: 37–41. CrossrefGoogle Scholar
  • 28 Reynolds D, Lucas D, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br 1999; 81: 281–288. Crossref, MedlineGoogle Scholar
  • 29 Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop 2003; 407: 241–248. Crossref, MedlineGoogle Scholar
  • 30 Severin E. Contribution to the knowledge of congenital dislocation of the hip joint: late results of closed reduction and arthrographic studies of recent years. Acta Chir Scand 1941; 63: 53–54. Google Scholar
  • 31 Tonnis D. The prearthrotic deformity as origin of coxarthrosis: radiographic measurements and their value in the prognosis. Z Orthop 1978; 116: 444–446. MedlineGoogle Scholar
  • 32 Tucker FR. Arterial supply of the femoral head and its clinical importance. J Bone Joint Surg Br 1949; 31: 82–93. Google Scholar
  • 33 Letournel E, Judet R. Fractures of the acetabulum. Berlin, Germany: Springer Verlag, 1993. Google Scholar
  • 34 Gibson A. Posterior exposure of the hip. J Bone Joint Surg Br 1950; 32: 183–186. MedlineGoogle Scholar
  • 35 Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001; 83: 1119–1124. Crossref, MedlineGoogle Scholar
  • 36 Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000; 82: 679–683. Crossref, MedlineGoogle Scholar
  • 37 Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement. I. Technique of joint preserving surgery. Clin Orthop 2004; 418: 61-66. Crossref, MedlineGoogle Scholar
  • 38 Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg Am 2003; 85: 278–286. Crossref, MedlineGoogle Scholar
  • 39 Anda S, Svenningsen S, Grontvedt T, Benum P. Pelvic inclination and spatial orientation of the acetabulum: a radiographic, computed tomographic and clinical investigation. Acta Radiol 1990; 31: 389–394. Crossref, MedlineGoogle Scholar
  • 40 Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 2001; 15: 475–481. Crossref, MedlineGoogle Scholar
  • 41 Mast JW, Mayo KA, Chosa E, Berlemann U, Ganz R. The acetabular rim fracture: a variant of the acetabular rim syndrome. Semin Arthroplast 1997; 8: 97–101. Google Scholar
  • 42 Woertler K, Brinkschmidt C. Imaging features of subperiosteal aneurysmal bone cyst. Acta Radiol 2002; 43: 336–339. Crossref, MedlineGoogle Scholar
  • 43 Poleksic L, Zdravkovic D, Jablanovic D, Watt I, Bacic G. Magnetic resonance imaging of bone destruction in rheumatoid arthritis: comparison with radiography. Skeletal Radiol 1993; 22: 577–580. MedlineGoogle Scholar
  • 44 Allen H. A system of human anatomy including its medical and surgical relations, section II: bones and joints. Philadelphia, Pa: Henry C. Lea's Sons, 1882; 189–193. Google Scholar
  • 45 Fick R. Handbuch der Anatomie und Mechanik der Gelenke, unter Berücksichtigung der bewegenden Muskeln. I. Anatomie der Gelenke. Jena, Germany: Fischer, 1904. Google Scholar
  • 46 Poirier P, Charpy A. Traité d'anatomie humaine. Paris, France: Masson, 1911. Google Scholar
  • 47 Meyer AW. The cervical fossa of Allen. Am J Phys Anthrop 1924; 7: 257–269. CrossrefGoogle Scholar
  • 48 Schajowicz F, Clavel Sainz M, Slullitel JA. Juxta-articular bone cysts (intra-osseous ganglia): a clinicopathological study of eighty-eight cases. J Bone Joint Surg Br 1979; 61: 107–116. MedlineGoogle Scholar
  • 49 Locher S, Werlen S, Leunig M, Ganz R. Inadequate detectability of early stages of coxarthrosis with conventional roentgen images. Z Orthop Ihre Grenzgeb 2001; 139: 70–74. [German] Crossref, MedlineGoogle Scholar
  • 50 Rosenthal DI, Marota JJ, Hornicek FJ. Osteoid osteoma: elevation of cardiac and respiratory rates at biopsy needle entry into tumor in 10 patients. Radiology 2003; 226: 125–128. LinkGoogle Scholar
  • 51 Markovits E. Bone and joint radiology. New York, NY: Macmillan, 1949. Google Scholar
  • 52 Freiberger RH, Edeiken J, Jacobson HG, Norman A. In: Freiberger RH, ed. Bone disease (second series) syllabus. Chicago, Ill: American College of Radiology, 1976. Google Scholar
  • 53 Keats TE. An atlas of normal roentgen variants that may simulate disease. Chicago, Ill: Year Book Medical, 1973. Google Scholar

Article History

Published in print: July 2005