Skip to main content
SpringerLink
Log in

Plain Radiographic Evaluation of the Hip

  • Reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

Abstract

Plain radiographic imaging remains the standard imaging modality for the hip despite modern three-dimensional computer tomography or magnetic resonance imaging. To know the technical principles of radiographic imaging is essential for correct interpretation of plain radiographs. The anatomy of the hip on plain radiographs depends on the conical projection, film-tube and patient-film distance, centering and direction of the x-ray beam, and the pelvic orientation during radiograph acquisition. Standard radiographic evaluation of the hip comprises the anteroposterior pelvic radiograph and an axial view (e.g., cross-table). Hip-centered or deep-centered views are not recommended in hip-preserving surgery since the centering of the x-ray alters the projected anatomy on the radiograph. Additional views are performed to answer specific questions, e.g., a false profile view to judge the anterior acetabular coverage. This article summarizes and illustrates the most common radiographic parameters to describe the acetabular depth, acetabular coverage, acetabular orientation, head-neck sphericity, and joint congruency.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 599.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Burckhardt K. Theoretical study to the sub-project ‘Interactive software for 2D and 3D standardization of pelvic radiographs and CT-scans for accurate evaluation of hip joint morphology’ under CO-ME Project 4. Swiss Federal Institute of Technology. 2003; Report No.: 267.

    Google Scholar 

  2. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F. Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res. 2005;436:144–50.

    Article  PubMed  Google Scholar 

  3. Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–90.

    Article  CAS  PubMed  Google Scholar 

  4. Seradge H, Nagle KR, Miller RJ. Analysis of version in the acetabular cup. Clin Orthop Relat Res. 1982;166:152–7.

    PubMed  Google Scholar 

  5. Dunn DM. Anteversion of the neck of the femur; a method of measurement. J Bone Joint Surg Br. 1952;34(2):181–6.

    PubMed  Google Scholar 

  6. Rippstein J. Zur Bestimmung der Antetorsion des Schenkelhalses mittels zweier Röntgenaufnahmen. Z Orthop Ihre Grenzgeb. 1955;86:345–60.

    CAS  PubMed  Google Scholar 

  7. Wissing H, Buddenbrock B. Determining rotational errors of the femur by axial computerized tomography in comparison with clinical and conventional radiologic determination. Unfallchirurgie. 1993;19(3):145–57.

    Article  CAS  PubMed  Google Scholar 

  8. Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res. 2008;466(2):273–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–5.

    PubMed  Google Scholar 

  10. Lauenstein C. Nachweis der “Kocherschen Verbiegung” des Schenkelhalses bei der Coxa vara durch Röntgenstrahlen. Fortschr Röntgenstr. 4:61–4.

    Google Scholar 

  11. Williams PL. The skeleton of the lower limb. In: Williams PL, Warkick R, Dyson M, Bannister LH, editors. Gray’s anatomy. Edinburgh: Churchill Livingstone; 1989.

    Google Scholar 

  12. Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC. Radiographic findings of femoroacetabular impingement in National Football League combine athletes undergoing radiographs for previous hip or groin pain. Arthrosc J Arthrosc Relat Surg. 2012;28(10):1396–403.

    Article  Google Scholar 

  13. Alexander C. The aetiology of primary protrusio acetabuli. Br J Radiol. 1965;38:567–80.

    Article  CAS  PubMed  Google Scholar 

  14. Gilmour J. Adolescent deformities of the acetabulum an investigation into the nature of protrusio acetabuli. Br J Surg. 1939;26(104):670–99.

    Article  Google Scholar 

  15. Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77(7):985–9.

    CAS  PubMed  Google Scholar 

  16. Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81(12):1747–70.

    CAS  PubMed  Google Scholar 

  17. Tannast M, Albers CE, Steppacher SD, Siebenrock K. Hip pain in the young adult. In: Bentley G, editor. European instructional lectures, vol. 11. New York: Springer; 2011.

    Google Scholar 

  18. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81(2):281–8.

    Article  CAS  PubMed  Google Scholar 

  19. Siebenrock KA, Kistler L, Schwab JM, Buchler L, Tannast M. The acetabular wall index for assessing anteroposterior femoral head coverage in symptomatic patients. Clin Orthop Relat Res. 2012;470:3355–60.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466(3):677–83.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–8.

    Article  PubMed  Google Scholar 

  22. Tannast M, Pfannebecker P, Schwab JM, Albers CE, Siebenrock KA, Buchler L. Pelvic morphology differs in rotation and obliquity between developmental dysplasia of the hip and retroversion. Clin Orthop Relat Res. 2012;470(12):3297–305.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol. 2007;188(6):1540–52.

    Article  PubMed  Google Scholar 

  24. 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(4):556–60.

    Article  CAS  PubMed  Google Scholar 

  25. Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res. 2009;467(4):876–85.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E. A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg Br. 2007;89(10):1309–16.

    Article  CAS  PubMed  Google Scholar 

  27. Shenton EWH. Disease in bone and its detection by the X-rays. London: Macmillan; 1911.

    Google Scholar 

  28. Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthop Relat Res. 1980;152:10–6.

    PubMed  Google Scholar 

  29. Notzli HP, Muller SM, Ganz R. The relationship between fovea capitis femoris and weight bearing area in the normal and dysplastic hip in adults: a radiologic study. Z Orthop Ihre Grenzgeb. 2001;139(6):502–6.

    Article  CAS  PubMed  Google Scholar 

  30. Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm-reliable and validated. J Orthop Res. 2008;26(9):1199–205.

    Article  PubMed  Google Scholar 

  31. Tannast M, Mistry S, Steppacher SD, Reichenbach S, Siebenroc KA, Zheng GA. A comprehensive validation of a new method for correction of radiographic hip parameters for pelvic malpositioning. J Bone Joint Surg Br. 2009;91-B(SUPP III):451.

    Google Scholar 

  32. Tannast M, Siebenrock K. Imaging: plain radiographs. In: Sekiya JK, Safran MR, Ranawat AS, Leunig M, editors. Techniques in hip arthroscopy and joint preservation. Philadelphia: Elsevier Saunders; 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Simon D. Steppacher, Christoph E. Albers, Moritz Tannast & Klaus A. Siebenrock

Authors
  1. Simon D. Steppacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph E. Albers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moritz Tannast
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Klaus A. Siebenrock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Klaus A. Siebenrock .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane J. Nho

  2. Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, Switzerland

    Michael Leunig

  3. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher M. Larson

  4. Department of Orthopaedics, University of Michigan, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Sports Medicine and Shoulder Service and Center for Hip Preservation Surgery, Hospital for Special Surgery, New York, New York, USA

    Bryan T. Kelly

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this entry

Cite this entry

Steppacher, S.D., Albers, C.E., Tannast, M., Siebenrock, K.A. (2015). Plain Radiographic Evaluation of the Hip. In: Nho, S., Leunig, M., Larson, C., Bedi, A., Kelly, B. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6965-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6965-0_3

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6964-3

  • Online ISBN: 978-1-4614-6965-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation