High prevalence of hip lesions secondary to arthroscopic over- or undercorrection of femoroacetabular impingement in patients with postoperative pain

Abstract

Objectives To compare the prevalence of pre- and postoperative osseous deformities and intra-articular lesions in patients with persistent pain following arthroscopic femoroacetabular impingement (FAI) correction and to identify imaging findings associated with progressive cartilage damage. Methods Retrospective study evaluating patients with hip pain following arthroscopic FAI correction between 2010 and 2018. Pre- and postoperative imaging studies were analyzed independently by two blinded readers for osseous deformities (cam-deformity, hip dysplasia, acetabular overcoverage, femoral torsion) and intra-articular lesions (chondro-labral damage, capsular lesions). Prevalence of osseous deformities and intra-articular lesions was compared with paired t-tests/McNemar tests for continuous/dichotomous data. Association between imaging findings and progressive cartilage damage was assessed with logistic regression. Results Forty-six patients (mean age 29 ± 10 years; 30 female) were included. Postoperatively, 74% (34/46) of patients had any osseous deformity including 48% (22/46) acetabular and femoral deformities. Ninety-six percent (44/46) had an intra-articular lesion ranging from 20% (9/46) for femoral to 65% (30/46) for acetabular cartilage lesions. Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of cam-deformity decreased (83 to 28%, p < 0.001). Progressive cartilage damage was detected in 37% (17/46) of patients and was associated with extensive preoperative cartilage damage > 2 h, i.e., > 60° (OR 7.72; p = 0.02) and an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Conclusion Prevalence of osseous deformities secondary to over- or undercorrrection was high. Extensive preoperative cartilage damage and higher postoperative alpha angles increase the risk for progressive degeneration. Key Points • The majority of patients presented with osseous deformities of the acetabulum or femur (74%) and with intra-articular lesions (96%) on postoperative imaging. • Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of a cam deformity decreased (83 to 28%, p < 0.001). • Progressive cartilage damage was present in 37% of patients and was associated with extensive preoperative cartilage damage > 2 h (OR 7.72; p = 0.02) and with an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04).

A Deep Learning Method for Quantification of Femoral Head Necrosis Based on Routine Hip MRI for Improved Surgical Decision Making

“…FHN was graded according to the commonly recommended 2019 ARCO grading [ 12 ]: I (negative x-rays): two hips; II (no fracture): four hips; IIIA (head collapse < 2 mm): 13 hips; IIIB (head collapse > 2 mm): 11 hips. Patients underwent preoperative MR arthrography at 3T (Skyra, Siemens Healthineers, Erlangen, Germany) for their hips including the application of traction according to a previously described technique [ 16 , 17 ]. This included the acquisition of multiplanar proton-density (PD) weighted turbo spin-echo (TSE) imaging without fat saturation (coronal, radial and axial orientation) and a high-resolution axial-oblique 3D T1-weighted volume interpolated breath-hold examination (VIBE) sequence [ 18 ].…”

Bildgebung in der gelenkerhaltenden Hüftchirurgie

“…Die entwicklungsbedingte Hüftdysplasie wird zumeist im Adoleszentenalter symptomatisch und tritt bei bis zu 20 % der Patienten (v. a. bei Frauen) auf, welche für eine gelenkerhaltenden Hüftoperation abgeklärt werden [ 6 , 15 ]. Wird die Hüftdysplasie nicht zeitgerecht behandelt, kann sie beim symptomatischen Patienten zur frühzeitigen Coxarthrose führen und ist eine der Hauptgründe für die Implantation einer Hüftprothese bei Patienten unter 60 Jahren [ 16 , 17 ].…”

“…Wird die Hüftdysplasie nicht zeitgerecht behandelt, kann sie beim symptomatischen Patienten zur frühzeitigen Coxarthrose führen und ist eine der Hauptgründe für die Implantation einer Hüftprothese bei Patienten unter 60 Jahren [ 16 , 17 ]. Iatrogen kann eine Dysplasie nach übermäßiger Pfannenrandtrimmung im Rahmen der FAI-Korrektur auftreten und führt zur vorzeitigen Gelenkdegeneration [ 6 , 15 ].…”

Does the dGEMRIC Index Recover 3 Years After Surgical FAI Correction and an Initial dGEMRIC Decrease at 1-Year Follow-up? A Controlled Prospective Study

“…5 Joint-preserving surgery can delay the degenerative cascade by normalizing joint biomechanics, and outcome is dependent on the already existing cartilage damage. 6,17,30 Therefore, accurate preoperative identification and quantification of cartilage damage are of crucial importance to determine which patients will benefit from joint-preserving surgery and which will not. 4,6,17,30 While morphologic magnetic resonance imaging (MRI) is limited to a macroscopic and qualitative evaluation of cartilage damage, compositional imaging techniques such as delayed gadolinium-enhanced MRI of cartilage (dGEM-RIC) allow for quantitative cartilage mapping and therefore enable a more objective assessment of cartilage damage in a noninvasive fashion.…”

“…6,17,30 Therefore, accurate preoperative identification and quantification of cartilage damage are of crucial importance to determine which patients will benefit from joint-preserving surgery and which will not. 4,6,17,30 While morphologic magnetic resonance imaging (MRI) is limited to a macroscopic and qualitative evaluation of cartilage damage, compositional imaging techniques such as delayed gadolinium-enhanced MRI of cartilage (dGEM-RIC) allow for quantitative cartilage mapping and therefore enable a more objective assessment of cartilage damage in a noninvasive fashion. 14 dGEMRIC is a histologically validated imaging biomarker for cartilage quality that has the potential to improve the understanding of degenerative hip disease and the effect of different treatment protocols on cartilage composition based on the indirect assessment of cartilage glycosaminoglycan content.…”