Bone density changes following surgical correction of femoroacetabular impingement deformities

Speirs, Andrew; Rakhra, Kawan; Weiss, M; Beaulé, Paul E.

doi:10.1016/j.joca.2018.08.015

Cited by 5 publications

(5 citation statements)

References 37 publications

(45 reference statements)

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“…The squat is a task with naturally higher ROM, and its joint ranges are not necessarily associated with larger ground reaction forces (that would likely reflect joint reaction loading). Therefore although previous studies on gait 32,38 reported a decrease in HCF had been linked with decreased bone mineral joint density 57 or improved T1rho signal associated with better cartilage health 6,37 , the higher muscle forces and HCF in the present study can be the initial evidence of postoperative joint health restoration and alleviated symptoms. In this line, finite element analysis would be able to translate HCF to shear stresses providing a clearer picture of the pathomechanism.…”

Section: Discussionmentioning

confidence: 48%

Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery

Catelli

Wesseling

et al. 2020

Journal of Bone and Joint Surgery

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Background: Corrective hip surgery for cam-type femoroacetabular impingement (FAI) aims to improve hip function and prevent joint degeneration. The purpose was to compare muscle and hip contact forces (HCF) during squatting in cam-FAI patients before and after hip corrective surgery, and in healthy control participants (CTRL).Methods: Ten symptomatic cam-FAI male patients performed deep squatting pre-and at 2 years postoperatively. Patients were age, and body-mass-index matched to 10 CTRL male participants. Full-body kinematics and kinetics were computed and, muscle forces and HCF were estimated using musculoskeletal model and static optimization. Normalized squat cycle (%SC) trials were compared using statistical non-parametric mapping (SnPM). Results: Postoperative patients squatted down with higher anterior pelvic tilt (11-29%SC, P=.004), higher hip flexion (9-31%SC, P=.003) and greater hip extension moments (21-26%SC, P=.008) compared to preoperative FAI. Preoperative patients also demonstrated lower anterior pelvic tilt (7-9%SC, P=.023; 92-99%SC, P=.016) and lower hip flexion (87-97%SC, P=.008) compared to the CTRL. Postoperative patients showed increased semimembranosus force concerning their preoperative values (68-73%SC, P=.002). Preoperative forces were also lower than the CTRL for the adductor magnus (28-34%SC, P=.011), psoas major (49-58%SC, P=.

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Section: Discussionmentioning

confidence: 48%

Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery

Catelli

Wesseling

et al. 2020

Journal of Bone and Joint Surgery

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“…Thus, the need and amount for surgical correction should always be balanced to improve patient outcomes, 60,61 reverse osteoarthritic subchondral bone stiffening, and prevent cartilage degeneration. 2,62 Our observations of higher post-resection microinstability considered hips with intact labrums, thus even in an optimal setting where the labrum is fully repaired or reconstructed during surgery, extreme caution must be taken to not over-resect a mild cam deformity or disrupt the labral seal intraoperatively. 14 Although a cam deformity, alone, may not be protective against instability and as a mild cam morphology is surgically resected, it can form a sharp "cliff sign" that can lead to microseparation between the labrum and the femoral head contour upon combined flexion and internal rotation,.…”

Section: Discussionmentioning

confidence: 94%

Cam Osteochondroplasty for Femoroacetabular Impingement Increases Microinstability in Deep Flexion: A Cadaveric Study

Daou

Bankes

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Acetabular segmentation began by defining the region of interest. An automatic bone segmentation procedure was applied to generate a pelvic surface model [47]. The acetabulum was defined through an iterative process.…”

Section: Acetabular Characteristicsmentioning

confidence: 99%

Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

Verhaegen

DeVries

Rakhra

et al. 2023

Clin Orthop Relat Res

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Background Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studied have used patients with unknown physical status to define morphological thresholds to guide management. Questions/purposes (1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management. Methods Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [28]), if they had a PROMIS less than 50 (1% [18]), or their Tönnis score was higher than 1 (0.4% [6]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 ± 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 ± 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls. Results Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 ± 2 mm, with an articular cartilage surface of 2619 ± 415 mm2, covering 70% ± 6% of the articular surface, a mean acetabular inclination of 48° ± 6°, and a minimal difference between anatomical (24° ± 7°) and functional (22° ± 6°) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 ± 4 mm versus 22 ± 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% ± 5% versus 70% ± 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48° ± 6° versus 47° ± 7°, mean difference 0.5° [95% CI -2° to 3°]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24° ± 7° versus 19° ± 8°, mean difference 6° [95% CI 3° to 9°]; p < 0.001) and functional anteversion (22° ± 6° versus 13°± 9°, mean difference 9° [95% CI 6° to 12°]; p < 0.001). Subtended angles were higher in asymptomatic at 105° (124° ± 7° versus 114° ± 12°, mean difference 11° [95% CI 3° to 17°]; p < 0.001), 135° (122° ± 9° versus 111° ± 12°, mean difference 10° [95% CI 2° to 15°]; p < 0.001), and 165° (112° ± 9° versus 102° ± 11°, mean difference 10° [95% CI 2° to 14°]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8° ± 8° versus 11° ± 5°, mean difference 3° [95% CI 1° to 5°]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19° (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105° (AUC 0.76 [95% CI 0.65 to 0.88]), 135° (AUC 0.78 [95% CI 0.70 to 0.86]), and 165° (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface. Conclusion An anatomical and functional acetabular anteversion of 24° and 22°, with a pelvic tilt of 10°, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105°, 135°, and 165° of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes. Level of Evidence Level III, prognostic study.

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Bone density changes following surgical correction of femoroacetabular impingement deformities

Cited by 5 publications

References 37 publications

Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery

Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery

Cam Osteochondroplasty for Femoroacetabular Impingement Increases Microinstability in Deep Flexion: A Cadaveric Study

Which Acetabular Measurements Most Accurately Differentiate Between Patients and Controls? A Comparative Study

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