Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports.
Purpose:
To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology.
Results:
A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% (P = .03).
Conclusion:
The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
AgricolaRBessemsJHJMGinaiAZ. The development of cam-type deformity in adolescent and young male soccer players. Am J Sports Med. 2012;40(5):1099-1106.
2.
AgricolaRHeijboerMPBierma-ZeinstraSMAVerhaarJANWeinansHWaarsingJH.Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918-923.
3.
AgricolaRHeijboerMPGinaiAZ. A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up. Am J Sports Med. 2014;42(4):798-806.
4.
AgricolaRHeijboerMPRozeRH. Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK). Osteoarthritis Cartilage. 2013;21(10):1514-1521.
5.
AgricolaRReijmanMBierma-ZeinstraSMVerhaarJAWeinansHWaarsingJH.Total hip replacement but not clinical osteoarthritis can be predicted by the shape of the hip: a prospective cohort study (CHECK). Osteoarthritis Cartilage. 2013;21(4):559-564.
6.
AgricolaRWaarsingJHArdenNK. Cam impingement of the hip—a risk factor for hip osteoarthritis. Nat Rev Rheumatol. 2013;9(10):630-634.
7.
AgricolaRWaarsingJHThomasGE. Cam impingement: defining the presence of a cam deformity by the alpha angle: data from the CHECK cohort and Chingford cohort. Osteoarthritis Cartilage. 2014;22(2):218-225.
8.
AhlbergALinderBBinhemdTA.Osteoarthritis of the hip and knee in Saudi Arabia. Int Orthop. 1990;14(1):29-30.
9.
AndersonLAKapronALAokiSKPetersCL.Coxa profunda: is the deep acetabulum overcovered?Clin Orthop Relat Res. 2012;470(12):3375-3382.
10.
Castaño-BetancourtMCVan MeursJBJBierma-ZeinstraS. The contribution of hip geometry to the prediction of hip osteoarthritis. Osteoarthritis Cartilage. 2013;21(10):1530-1536.
11.
ChungCYParkMSLeeKM. Hip osteoarthritis and risk factors in elderly Korean population. Osteoarthritis Cartilage. 2010;18(3):312-316.
12.
DuddaMKimYJZhangY. Morphologic differences between the hips of Chinese women and white women: could they account for the ethnic difference in the prevalence of hip osteoarthritis?Arthritis Rheum. 2011;63(10):2992-2999.
13.
EngesæterIØLaborieLBLehmannTG. Prevalence of radiographic findings associated with hip dysplasia in a population-based cohort of 2081 19-year-old Norwegians. Bone Joint J. 2013;95(2):279-285.
14.
FelsonDTNevittMCZhangY. High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects. Arthritis Rheum. 2002;46(5):1217-1222.
15.
FrankJMHarrisJDEricksonBJ. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199-204.
16.
FranklinJIngvarssonTEnglundMLohmanderLS.Sex differences in the association between body mass index and total hip or knee joint replacement resulting from osteoarthritis. Ann Rheum Dis. 2009;68(4):536-540.
17.
FukushimaKUchiyamaKTakahiraN. Prevalence of radiographic findings of femoroacetabular impingement in the Japanese population. J Orthop Surg. 2014;9(1):25.
18.
GerhardtMBRomeroAASilversHJHarrisDJWatanabeDMandelbaumBR.The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584-588.
19.
GosvigKKJacobsenSPalmHSonne-HolmSMagnussonE.A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg Br. 2007;89(10):1309-1316.
20.
GregoryJSWaarsingJHDayJ. Early identification of radiographic osteoarthritis of the hip using an active shape model to quantify changes in bone morphometric features: can hip shape tell us anything about the progression of osteoarthritis?Arthritis Rheum. 2007;56(11):3634-3643.
21.
HoaglundFT.Primary osteoarthritis of the hip: a genetic disease caused by European genetic variants. J Bone Joint Surg Am. 2013;95(5):463-468.
22.
HoaglundFTOishiCSGialamasGG.Extreme variations in racial rates of total hip arthroplasty for primary coxarthrosis: a population-based study in San Francisco. Ann Rheum Dis. 1995;54(2):107-110.
23.
HogervorstTEilanderWFikkersJTMeulenbeltI.Hip ontogenesis: how evolution, genes, and load history shape hip morphotype and cartilotype. Clin Orthop Relat Res. 2012;470(12):3284-3296.
24.
JohnsonADohertyPJFreemontA.Investigation of growth, development, and factors associated with injury in elite schoolboy footballers: prospective study. BMJ. 2009;338:b490.
25.
JooJHLeeSCAhnHSParkJSLeeWJJungKA.Evaluation of the alpha angle in asymptomatic adult hip joints: analysis of 994 hips. Hip Int. 2013;23(4):395-399.
26.
JordanJMHelmickCGRennerJB. Prevalence of hip symptoms and radiographic and symptomatic hip osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2009;36(4):809-815.
27.
KapronAL.Radiographic prevalence of femoroacetabular impingement in collegiate football players. J Bone Joint Surg Am. 2011;93(19):e111
28.
KapronALPetersCLAokiSK. The prevalence of radiographic findings of structural hip deformities in female collegiate athletes. Am J Sports Med. 2015;43(6):1324-1330.
29.
KimHAKohSHLeeB. Low rate of total hip replacement as reflected by a low prevalence of hip osteoarthritis in South Korea. Osteoarthritis Cartilage. 2008;16(12):1572-1575.
30.
KopecJASayreECSchwartzTA. Occurrence of radiographic osteoarthritis of the knee and hip among African Americans and whites: a population-based prospective cohort study. Arthritis Care Res. 2013;65(6):928-935.
31.
KuttySSchneiderPFarisP. Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Int Orthop. 2011;36(3):505-510.
32.
LaborieLBLehmannTGEngesæterIØEastwoodDMEngesæterLBRosendahlK.Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiology. 2011;260(2):494-502.
33.
LaneNELinPChristiansenL. Association of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elderly white women: the study of osteoporotic fractures. Arthritis Rheum. 2000;43(2):400-404.
34.
LievenseAMBierma-ZeinstraSMAVerhagenAPvan BaarMEVerhaarJAKoesBW.Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatology (Oxford). 2002;41(10):1155-1162.
35.
MakhdomAMAl-SayyadMJ.Results of primary total hip replacement with special attention to technical difficulties encountered in a cohort of Saudi patients. Saudi Med J. 2010;31(8):904-908.
36.
MalaviyaANShehabDBhargavaS. Characteristics of osteoarthritis among Kuwaitis: a hospital-based study. Clin Rheumatol. 1998;17(3):210-213.
37.
MeyerDCBeckMEllisTGanzRLeunigM.Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181-185.
38.
MoriRYasunagaYYamasakiT. Are cam and pincer deformities as common as dysplasia in Japanese patients with hip pain?Bone Joint J. 2014;96(2):172-176.
39.
MoslerABCrossleyKMThorborgKWhiteleyRJWeirASernerAHölmichP.Hip strength and range of motion: normal values from a professional football league. J Sci Med Sport. In press.
40.
MoussaMAlomranA.Acetabular dysplasia in adult hips of a Saudi population. A possible relation to coxarthrosis. Saudi Med J. 2007;28(7):1059-1061.
41.
NelsonAELiuFLynchJA. Association of incident symptomatic hip osteoarthritis with differences in hip shape by active shape modeling: the Johnston County Osteoarthritis Project. Arthritis Care Res. 2014;66(1):74-81.
42.
NeppleJJBrophyRHMatavaMJWrightRWClohisyJC.Radiographic findings of femoroacetabular impingement in national football league combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy. 2012;28(10):1396-1403.
43.
NeppleJJLehmannCLRossJRSchoeneckerPLClohisyJC.Coxa profunda is not a useful radiographic parameter for diagnosing pincer-type femoroacetabular impingement. J Bone Joint Surg Am. 2013;95(5):417-423.
44.
NeppleJJVigdorchikJMClohisyJC.What is the association between sports participation and the development of proximal femoral cam deformity? A systematic review and meta-analysis. Am J Sports Med. 2015;43(11):2833-2840.
45.
NevittMCXuLZhangY. Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study. Arthritis Rheum. 2002;46(7):1773-1779.
46.
NichollsASKiranAPollardTCB. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum. 2011;63(11):3392-3400.
47.
NötzliHPWyssTFStoecklinCHSchmidMRTreiberKHodlerJ.The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556-560.
48.
OishiCSHoaglundFTGordonLRossPD.Total hip replacement rates are higher among Caucasians than Asians in Hawaii. Clin Orthop Relat Res. 1998;353:166-174.
49.
PhilipponMJHoCPBriggsKKStullJLaPradeRF.Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013;41(6):1357-1362.
50.
ReijmanMHazesJMWPolsHAKoesBWBierma-ZeinstraSMA. Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis Rheum. 2005;52(3):787-793.
51.
RoelsPAgricolaROeiEHWeinansHCampoliGZadpoorAA.Mechanical factors explain development of cam-type deformity. Osteoarthritis Cartilage. 2014;22(12):2074-2082.
52.
SandoughiMZakeriZTehrani BanihashemiA. Prevalence of musculoskeletal disorders in southeastern Iran: a WHO-ILAR COPCORD study (stage 1, urban study). Int J Rheum Dis. 2013;16(5):509-517.
53.
SiebenrockKAFernerFNoblePCSantoreRFWerlenSMamischTC.The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res. 2011;469(11):3229-3240.
54.
SiebenrockKAKaschkaIFrauchigerLWerlenSSchwabJM.Prevalence of cam-type deformity and hip pain in elite ice hockey players before and after the end of growth. Am J Sports Med. 2013;41(10):2308-2313.
55.
TakIWeirALanghoutR. The relationship between the frequency of football practice during skeletal growth and the presence of a cam deformity in adult elite football players. Br J Sports Med. 2015;49(9):630-634.
56.
ValdesAMLoughlinJOeneMV. Sex and ethnic differences in the association of ASPN, CALM1, COL2A1, COMP, and FRZB with genetic susceptibility to osteoarthritis of the knee. Arthritis Rheum. 2007;56(1):137-146.
57.
ValdesAMSpectorTDTammA. Genetic variation in the SMAD3 gene is associated with hip and knee osteoarthritis. Arthritis Rheum. 2010;62(8):2347-2352.
58.
Van HouckeJYauWPYanCH. Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects. J Bone Joint Surg Am. 2015;97(4):310-317.
59.
van SaaseJLvan RomundeLKCatsAVandenbrouckeJPValkenburgHA.Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989;48(4):271-280.
60.
Von ElmEAltmanDGEggerM. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453-1457.
61.
WeirAde VosRJMoenMHolmichPTolJL.Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2009;45(1):6-9.
62.
WibergG.Studies on dysplastic acetabula and congenital subluxation of the hip joint. With special reference to the complications of osteoarthritis. Acta Chir Scand. 1939;58(suppl):5e135.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
