Evaluation of Statistical Shape Modeling in Quantifying Femoral Morphologic Differences Between Symptomatic and Nonsymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement Syndrome

PURPOSE: To determine whether statistical shape modeling can detect subtle morphologic differences in the shape of the proximal femur that correlate with clinical findings of unilateral femoroacetabular impingement syndrome. METHODS: Patients who had diagnoses of unilateral femoroacetabular impingement syndrome and who had existing computed tomography scans of their pelvises were included. Three-dimensional shape models in the form of triangle meshes were generated from the computed tomography images. Statistical shapes of cam-type and normal hips were compared to identify structural differences. RESULTS: The study included 33 hips in 17 subjects. Of the subjects, 7 (41.1%) were male, and 10 (58.9%) were female. The subjects ranged in age from 17-60 years of age (mean 36.3 ± 11.0 years old). The statistical shape modeling found mean shapes and modes after optimizing the groupwise correspondence. Symptomatic hips demonstrated 1 mm of thickening as compared to the femoral necks of asymptomatic hips, corresponding to cam lesions. CONCLUSIONS: Symptomatic cam deformities were an average of 1 mm more prominent in the femoral neck region as compared to the asymptomatic hips when using statistical shape modeling. The present study provides a proof of the concept that statistical shape modeling can be used to examine and help define cam morphology and that subtle morphologic differences may account for developing femoroacetabular impingement syndrome. CLINICAL RELEVANCE: Using the methods presented in this study, it would be possible to define cam and pincer morphologies by creating statistical shape models, and this work could potentially lead to the development of a new classification system for femoroacetabular impingement syndrome lesions.