Posterior Hip Impingement at Maximal Hip Extension in Female Patients With Increased Femoral Version or Increased McKibbin Index and Its Effect on Sports Performance

BACKGROUND: The location of posterior hip impingement at maximal extension in patients with posterior femoroacetabular impingement (FAI) is unclear. PURPOSE: To investigate the frequency and area of impingement at maximal hip extension and at 10° and 20° of extension in female patients with increased femoral version (FV) and posterior hip pain. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Osseous patient-specific 3-dimensional (3D) models were generated of 50 hips (37 female patients, 3D computed tomography) with a positive posterior impingement test and increased FV (defined as >35°). The McKibbin index (combined version) was calculated as the sum of FV and acetabular version (AV). Subgroups of patients with an increased McKibbin index >70° (24 hips) and FV >50° (20 hips) were analyzed. A control group of female participants (10 hips) had normal FV, normal AV, and no valgus deformity (neck-shaft angle, <139°). Validated 3D collision detection software was used for simulation of osseous impingement-free hip extension (no rotation). RESULTS: The mean impingement-free maximal hip extension was significantly lower in patients with FV >35° compared with the control group (15° ± 15° vs 55° ± 19°; P < .001). At maximal hip extension, 78% of patients with FV >35° had osseous posterior extra-articular ischiofemoral hip impingement. At 20° of extension, the frequency of posterior extra-articular ischiofemoral impingement was significantly higher for patients with a McKibbin index >70° (83%) and for patients with FV >35° (76%) than for controls (0%) (P < .001 for both). There was a significant correlation between maximal extension (no rotation) and FV (r = 0.46; P < .001) as well as between impingement area at 20° of extension (external rotation [ER], 0°) and McKibbin index (0.61; P < .001). Impingement area at 20° of extension (ER, 0°) was significantly larger for patients with McKibbin index >70° versus <70° (251 vs 44 mm(2); P = .001). CONCLUSION: The limited hip extension found in our study could theoretically affect the performance of sports activities such as running, ballet dancing, or lunges. Therefore, although not examined directly in this study, these activities are not advisable for these patients. Preoperative evaluation of FV and the McKibbin index is important in female patients with posterior hip pain before hip preservation surgery (eg, hip arthroscopy).