Using a numerical method to precisely evaluate the alpha angle in a hip image.

The alpha angle is a parameter extensively used to assess for cam-type femoroacetabular impingement (FAI) in a 2D image of the hip. As this angle requires estimation of the axis of the femoral neck, the drawing of this axis often results in measurement errors due to subjective judgment, influencing inter-rater and intra-rater agreements. In the present study, sampling points were captured from the edges of a femoral neck and head in the 2D image, and the best curves of the two were fitted respectively by using the curve fitting method. The morphology of the femoral neck was outlined by two polynomials, and the femoral head was represented by an equation of a circle. By means of the proposed method, the results reveal that the inter-rater ICCs in X-ray and MRI were respectively 0.905 and 0.969, and the intra-rater ICCs in X-ray and MRI were respectively 0.892 and 0.840. The Bland-Altman plot shows that the values obtained by the proposed method and the conventional method were not consistent; nevertheless, the linear regression analysis indicated the two measurement results had a significant association (p < 0.001). This study provides a repeatable and agreed α angle measuring method, which contributes to identifying normal and abnormal femoral head-neck morphologies. The proposed numerical method would contribute to diagnose early FAI.