Cam impingement: defining the presence of a cam deformity by the alpha angle R. Agricola, J.H. Waarsing, G.E. Thomas, A.J. Carr, M. Reijman, S.M.A. Bierma-Zeinstra,

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Cam impingement: defining the presence of a cam deformity by the alpha angle R. Agricola, J.H. Waarsing, G.E. Thomas, A.J. Carr, M. Reijman, S.M.A. Bierma-Zeinstra, S. Glyn-Jones, H. Weinans, N.K. Arden Osteoarthritis and Cartilage Volume 22, Issue 2, Pages 218-225 (February 2014) DOI: 10.1016/j.joca.2013.11.007 Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 The alpha angle quantifies the asphericity of the femoral head. A. A normal alpha angle of 41° is shown representing a spherical femoral head. B. An abnormal alpha angle of 98° is shown representing a cam deformity. Osteoarthritis and Cartilage 2014 22, 218-225DOI: (10.1016/j.joca.2013.11.007) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Bland Altman plot. The difference vs average alpha angle showing the agreement in alpha angle measurement of 30 hips between the SSM point set and Hipmorf technique. Osteoarthritis and Cartilage 2014 22, 218-225DOI: (10.1016/j.joca.2013.11.007) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Presence of cam deformity: 60°. Histograms of the alpha angle as measured on anteroposterior radiographs with kernel density plot show a clear bimodal distribution in the CHECK cohort (A), the Chingford cohort (B), and the combined data of both cohorts (C). A corresponding normal distribution of the alpha angle until a value of 60° is shown in both men (D) and women (E) in the CHECK cohort. These histograms also illustrate the higher prevalence of cam deformity in men than in women. Osteoarthritis and Cartilage 2014 22, 218-225DOI: (10.1016/j.joca.2013.11.007) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 ROC curve. A. The ROC curve of the alpha angle as a continuous measure for end-stage OA is shown, with the pathological threshold of 78° indicated. B. The area under the ROC curve for each alpha angle threshold is shown. Osteoarthritis and Cartilage 2014 22, 218-225DOI: (10.1016/j.joca.2013.11.007) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Pathological alpha angle threshold: 78°. Scatterplot showing the alpha angle on the X-axis and a random variable on the Y-axis. The dots represent the combined hips of the CHECK cohort (green) and Chingford cohort (blue) at baseline with a cam deformity that developed end-stage OA (K&L 3, 4, or THA). The pathological threshold of 78° is indicated. Osteoarthritis and Cartilage 2014 22, 218-225DOI: (10.1016/j.joca.2013.11.007) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions