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Is the Femoro-Epiphyseal Acetabular Roof (FEAR) index on MRI a relevant predictive factor of instability in a borderline dysplastic hip?
Abstract
Aims: A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. Patients and Methods: The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of ‘borderline dysplastic hips’ with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of ‘borderline dysplastic hips’ with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. Results: The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (sd 9.1°)) compared with the unstable borderline group (mean 7.9° (sd 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. Conclusion: The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578–1584
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“Much previous research has debated the morphological characteristics to diagnose hip instability; however, the optimal evaluation method of dynamic hip instability remains unclear [2, 4, 17, 20, 22, 23].”
From Femoral head translation in borderline and definite dysplastic hips during weight‐bearing: 2D/3D image registration analysis (2023) · cites this paper as [2]
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Sakai, S., Kutsuna, T., Kono, K., Kinoshita, T., Mashima, N., & Takao, M. (2023) · Journal of Experimental Orthopaedics · doi:10.1186/s40634-023-00707-8 · Cited by 16
“In addition, we evaluated the breakdown in Shenton’s line, Cliff sign and femoro-epiphyseal acetabular roof (FEAR) index [2, 17, 20, 22, 23].”
BackgroundMethod
Metadata
- Authors
- Batailler, C., Weidner, J., Wyatt, M., Pfluger, D., & Beck, M.
- Affiliations
- Hôpital de la Croix-Rousse (FR)
- Luzerner Kantonsspital (CH)
- Palmerston North Hospital (NZ)
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
- Venue
- The Bone & Joint Journal
- Published
- 2019-12
- Volume
- 101-B
- Issue
- 12
- Pages
- 1578-1584
- ISSN
- 2049-4394 (ISSN-L)
- 2049-4408
- OpenAlex
- W2993346384
- Cited by
- 37
- References
- 0
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 15 · 2021: 4 · 2020: 2
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Bone & Joint Journal (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Keywords
- hip instability, lateral center-edge angle, acetabular index, femoral anteversion, periacetabular osteotomy, measurement reliability, predictive factors
- MeSH terms
- Acetabulum, Clinical Decision Rules, Adolescent, Adult, Epiphyses, Female, Femur Head, Follow-Up Studies, Hip Dislocation, Humans, Joint Instability, Magnetic Resonance Imaging, Male, Middle Aged, Radiography, Retrospective Studies, Sensitivity and Specificity, Reproducibility of Results, Observer Variation, Young Adult
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