Femoroacetabular impingement in ancient Nubia 1400-656 BC.

introductionThere is significant recent interest in femoroacetabular impingement (FAI) in orthopaedics. The etiology of the cam deformity is unknown but has been hypothesized to be due to stresses from sporting activities in our modern society. Few archeological studies exist of femora and FAI. This study reviewed proximal femoral anatomy in a skeletal collection from the ancient Nile valley archeological site at Tombos 1400-656 BC.

methodsDigital photographs of the femora were used to obtain angular measurements of the apparent neck shaft, true neck shaft, version, inclination, and α and β angles of Nötzli. All photographs were reviewed by two orthopaedic surgeons for cam and pincer lesions. Sex and age of the specimens was determined when possible. A cam lesion was defined as any femur demonstrating an α angle > 50° or when a cam deformity was seen on visual inspection by both orthopaedic surgeons. Pincer lesions were identified upon visual inspection by both orthopaedic surgeons, when the femoral neck demonstrated impaction lesions, as pelvis radiographs could not be obtained.

resultsThere were 126 unique femora; 69 female and 57 male. Age estimates were possible in 100 and was 15-24 years in 14, 25-34 years in 33, 35-49 years in 28, 50-69 years in 17, and ≥ 70 years in 8. There were nine femora (seven individuals) with cam lesions (7%) and five femora (four individuals) with pincer lesions (4%). One demonstrated a combined lesion.

conclusionFAI existed in ancient Nile valley inhabitants and is thus not only a product of modern day life style athletics. This contrasts with Native Americans living in Ohio 700-1000 AD where no FAI was identified. This difference is likely due to combinations of different types of activity, diet, and genetics. Further research of ancient populations is needed to further answer this question. LEVEL OF EVIDENCE: IV-cohort study.