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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation - cadaveric validation study

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Maarten A Röling, Monique I Visser, Edwin HG Oei, Peter Pilot, Gert-Jan Kleinrensink, Rolf M Bloem
Wichtige Hinweise
Edwin HG Oei, Peter Pilotm, Gert-Jan Kleinrensink and Rolf M Bloem contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MAR, MD. First author, main contributor of study design, experiments, data analysis and manuscript preparation. MIV MD Had major participation in study design, experiments and manuscript preparation. EHGO, MD PhD. Head of radiology department, important role in experiments and revision of manuscript. PP PhD. Senior research member, approvel of study design, important part of manuscript preparation and revision. GJK PhD. Head of department of Anatomy, essential for experiments on cadaver samples. RMB MD PhD. Head of department of Orthopaedic surgery, significant contribution to study design and manuscript revision. All authors read and approved the final manuscript.



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.


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.


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°.


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.
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