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The faux profil (oblique view) of the hip in the standing position. Contribution to the evaluation of osteoarthritis of the adult hip
Abstract
OBJECTIVE—The technique and results of a special oblique radiograph of the hip called the "faux profil" (FP) of the hip are described. The FP was evaluated for the detection of joint space narrowing in incipient osteoarthritis of the hip (OAH) as compared with the anteroposterior (AP) radiograph.
METHODS—58 hips with incipient osteoarthritis (joint space narrowing, 0-25% on the AP view) in 48 patients were identified among 200 consecutive patients fulfilling American College of Rheumatology criteria for OAH. Joint space narrowing was measured on the AP and FP radiographs of these 58 hips.
RESULTS—The FP view provides a true lateral projection of the femoral head and neck, and an oblique view of the acetabulum tangential to its superoanteromedial edge. On this view, the width of the anterosuperior and posteroinferior parts of the joint space can be measured and compared. Among the 58 hips with incipient OAH, 36 (62%) showed joint space narrowing on the AP view and 51 (91%) on the FP view. Among the 22 hips without joint space narrowing on the AP radiograph, 16 (72.7%) showed joint space narrowing on the FP view, involving the anterosuperior part of the joint in 11 cases and the posteroinferior part in five cases.
CONCLUSION—The FP view in the standing position should be used in incipient OAH as a complement to the AP view in patients with suspected OAH but no joint space narrowing on the AP radiograph. In this situation, nearly three quarters of hips in the study had joint space narrowing on the FP view, usually in the anterosuperior part and less often in the posteroinferior part of the joint.
Keywords: hip; radiographs; osteoarthritis
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Selected References
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Figures and Tables
Diagram of the patient's position. (A) Position of the patient for an FP radiograph of the right hip. Axis of the foot (2nd metatarsus) should be parallel to the radiographic table. (B) For the left hip. (C) Cross sectional diagram of the pelvis showing: (a) the 25° angle between the anterior edge of the acetabulum and the coronal plane; (b) the position of the pelvis, rotated 25° backward around a vertical axis to align the superoanteromedial edge of the targeted acetabulum with the x ray beam; (c) the position of the lower limb with the axis of the foot parallel to the film so as to obtain a true lateral view of the proximal third of the femur.
Normal findings on the FP view. Radiograph and diagram. (1) Anteromedial edge of the acetabulum; (2) The superior part of the acetabulum appears as a sclerotic curved line ending at point A, which is the anterior extremity of the acetabular roof. The posterior part of the acetabulum (that is, the posterior extension of the above mentioned superior sclerotic line) ends inferiorly at the posteroinferior rim—that is, at the acetabular horn (3). The distance between the two femoral heads (4 and 4 bis) is two to three thirds of the diameter of the ipsilateral femoral head. The femoral neck (5) is visible through the greater trochanter. The posterior (6) and the superior edges (7) of the greater trochanter are well delineated. The lesser trochanter (8) appears as a small prominence posterior to the inferior part of the greater trochanter. The ischiopubic ramus joining the ischial tuberosity (9) to the pubic bone (10) is partly superimposed on the proximal femur. The anterosuperior part of the pubic bone (10) is superimposed on the anterior margin of the greater trochanter.
Anteroposterior (A) and faux profil (B) views in incipient OAH. (A) In this 50 year old man with clinical OAH characterised by pain, minimal osteophytosis, and a supra-acetabular cyst, the anteroposterior view shows no JSN. JSN is visible only on the FP view (B), at the anterosuperior part of the joint (white arrow). The posterior JS is widened (black arrow). The femoral head has begun to migrate anteriorly and superiorly.
Anteroposterior and FP views in incipient OAH. This 54 year old woman with painful left hip subsequently underwent total hip replacement. The pathologist confirmed the diagnosis of typical OA of the hip. (A) On the AP view, neither osteophytosis nor JSN are visible. The only abnormalities were two cysts in the acetabular roof (short arrows). This case was therefore not included in the series reported in this article because it did not meet ACR criteria.12 (B) On the FP view, the equal width of the anterosuperior and posterior portions of the JS (long arrows) already indicates anterosuperior JSN with incipient anterior subluxation of the femoral head, as the cartilage is normally thicker at the superior than at the posterior part of the joint (fig 2B and fig 6). Subchondral cysts are visible in the same location (short arrow).
Anteroposterior and faux profile views during arthrography. Incipient OA of the hip. This 58 year old woman had a one year history of pain in her left hip. (A) The AP view does not show cartilage thinning. (B) On the FP view, the width of the acetabular cartilage is markedly reduced at the anterosuperior part of the joint (arrow). The widened posterior JS is filled with contrast medium.
FP view during arthrography. Normal hip.The anterosuperior part of the JS (especially the acetabular cartilage) is normally thicker (arrow) than its posterior part. Note the mild acetabular deficiency: the anterior part of the acetabular roof is too short.
