Validation of a method to measure three-dimensional hip joint kinematics in subjects with femoroacetabular impingement

Introduction: A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI). Methods: 3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D-2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images. Results: Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D-2D registration demonstrated maximums of 1.64 degrees and 3.96 degrees, respectively. However, if the single outlier was removed, bias and precision were 0.55 degrees and 1.38 degrees. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively. Conclusions: This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10 degrees of rotation represent a clinically significant difference in hip kinematics, the method's accuracy of approximately 1 mm displacement and 1 degrees rotation should enable detection of significant clinical differences.