Student Presentation -- Penny Atkins
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Ph.D. Dissertation Defense, Friday May 25, 2018 -- Characterization of Cam Femoroacetabular Impingement using Subject-Specific Biomechanics and Population-Based Morphological Measurements

Orthopaedic Center Eccles Conference Room (590 Wakara Way, RM 3850), 8:00 am

Speaker: Penny Atkins. Advisor: Dr. Andrew Anderson


Abstract:

Cam-type femoroacetabular impingement syndrome (FAIS) is a recently described pathology of the hip, characterized by reduced sphericity of the femoral head and pain during high range-of-motion activities. While cam FAIS is thought to be a major etiologic factor for the development of hip osteoarthritis (OA), the natural history of cam FAIS is unknown. The over-arching objective of this dissertation was to address this knowledge gap by quantifying the morphological and biomechanical characteristics of cam FAIS.

The aspherical femoral head in cam FAIS patients is thought to alter hip articulation patterns. However, the conclusions from studies evaluating hip kinematics in cam FAIS patients have been inconsistent. Unfortunately, skin marker motion capture is subject to substantial errors, up to 20 degrees in rotation, due to skin motion artifact, and thus is likely not sufficient to study differences in hip motion between cam FAIS patients and control subjects. To this end, dual fluoroscopy has been used to quantify in-vivo hip kinematics during activities of daily living in patients with cam FAIS to within 1mm and 1 degree.

Measurements of morphology from radiographs are used to quantify femoral shape for diagnosis and to evaluate the sufficiency of surgical correction. However, there is little agreement as to which radiographic view provides the best visualization of the asphericity of the femoral head. Using statistical shape modeling, the specific shape variability of cam FAIS has been defined and used to assess the ability of various radiographic views to capture the morphology of cam FAIS. Importantly, insufficient resection is the most common reason for revision arthroscopy, indicating that further research on this topic is necessary. As such, the use of cortical bone thickness was evaluated for use as a guide for depth of surgical resection and to assess possible differences in cortical morphology in cam FAIS that should be considered when investigating the mechanical strength of the femur after resection.

Together, this work provided comprehensive measurements of hip morphometrics and biomechanics in patients with cam FAIS that improved our understanding of the role of morphology and movement patterns in FAIS hip joint degeneration.