title: A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation--cadaveric validation study.
abstract: BACKGROUND
  Femoroacetabular impingement (FAI) is caused by an anatomic deviation of the acetabular rim or proximal femur, which causes chronic groin pain. Radiological identification of FAI can be challenging. Advances in imaging techniques with the use of computed tomography (CT) scan enable 3D simulation of FAI. We made an experimental cadaveric validation study to validate the 3D simulation imaging software.
  
  
  METHODS
  The range of motion (ROM) of five cadaveric hips was measured using an electromagnetic tracking system (EMTS). Specific marked spots in the femur and pelvis were created as reproducible EMTS registration points. Reproducible motions were measured. Hips were subsequently imaged using high-resolution CT after introduction of artificial cam deformities. A proprietary software tool was used, Articulis (Clinical Graphics) to simulate the ROM during the presence and absence of the induced cam deformities.
  
  
  RESULTS
  According to the EMTS, 13 of the 30 measured ROM end-points were restricted by > 5° due to the induced cam deformities. Using Articulis, with the same 5° threshold, we correctly detected 12 of these 13 end point limitations and detected no false positives. The median error of the measured limitations was 1.9° (interquartile range 1.1° - 4.4°). The maximum absolute error was 5.4°.
  
  
  CONCLUSIONS
  The use of this dynamic simulation software to determine the presence of motion limiting deformities of the femoroacetabular is validated. The simulation software is able to non-invasively detect a reduction in achievable ROM, caused by a cam type deformity.
authors: Department of Orthopedic surgery, Reinier de Graafweg 3-11, 2526 AD, Delft, Netherlands. roling@rdgg.nl.
authors: Maarten A
authors: MA
authors: Röling
authors: Department of Orthopedic surgery, Reinier de Graafweg 3-11, 2526 AD, Delft, Netherlands. moniquingeborg@hotmail.com.
authors: Monique I
authors: MI
authors: Visser
authors: Department of Radiology Erasmus Medical Center, Rotterdam, Netherlands. e.oei@erasmusmc.nl.
authors: Edwin H G
authors: EH
authors: Oei
authors: Department of Orthopedic surgery, Reinier de Graafweg 3-11, 2526 AD, Delft, Netherlands. pilot@rdgg.nl.
authors: Peter
authors: P
authors: Pilot
authors: Department of Neuroscience, Erasmus Medical Center, Rotterdam, Netherlands. g.kleinrensink@erasmusmc.nl.
authors: Gert-Jan
authors: GJ
authors: Kleinrensink
authors: Department of Orthopedic surgery, Reinier de Graafweg 3-11, 2526 AD, Delft, Netherlands. bloem@rdgg.nl.
authors: Rolf M
authors: RM
authors: Bloem
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002102:Cadaver; D003198:Computer Simulation; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005269:Femur / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012984:Software; D014057:Tomography, X-Ray Computed