Labral calcification in end‐stage osteoarthritis of the hip correlates with pain and clinical function

Hubert, Jan; Hawellek, Thelonius; Moe, Martin A.; Hischke, Sandra; Krause, Matthias; Rolvien, Tim; Schmidt, Tobias; Rüther, W.; Niemeier, Andreas

doi:10.1002/jor.23736

Cited by 19 publications

(29 citation statements)

References 41 publications

(86 reference statements)

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“…Cartilage degeneration was associated with the presence of macrophages (CD68+ cells) in the synovium, consistent with previous reports [46,49]. In addition, cartilage lesions were also associated with increased calcium crystal deposition in the labrum, as previously shown for end-stage HOA [24].…”

Section: Discussionsupporting

confidence: 91%

“…We also found that the presence of labral crystal calcium deposition was associated with lower pre-operative HOOS and, interestingly, with worst post-operative symptoms independent from age and radiographic severity. The same observation was previously reported [24] in end-stage OA, supporting the hypothesis that labral calcification might play a key role in hip pain and symptoms both in FAI and endstage OA. A higher local concentration of calcium crystal deposition in the labrum could lead to increased release of nociceptor stimulating substances [26,27] within the fibrocartilage tissue, which densely innervated [42].The presence of labral calcification is also associated with a worst labral matrix integrity and subsequent degradation of the acetabular cartilage as described by Song et al [43],thus possibly jeopardizing the effect of the surgical repair [41].…”

Section: Discussionsupporting

confidence: 90%

“…An impaired lubrication and an increased joint friction deteriorate articular cartilage and lead to OA [23]. Moreover, the labral fibrocartilage is highly innervated by nociceptors and therefore, it has been suggested as a relevant source of pain in hip and knee OA [24]. As calcium crystal deposition is common in OA menisci [25], also labral calcifications are present in patients with FAI [23].…”

Section: Introductionmentioning

confidence: 99%

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Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

et al. 2020

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Background: Hip osteoarthritis (HOA) is the most common hip disorder and a major cause of disability in the adult population, with an estimated prevalence of end-stage disease and total hip replacement. Thus, the diagnosis, prevention, and treatment of the early stages of the disease in young adults are crucial to reduce the incidence of end-stage HOA. The purpose of this study was to determine whether (1) a relationship among the inflammatory status of labrum and synovium collected from patients with femoroacetabular impingement (FAI) would exist; and (2) to investigate the associations among the histopathological features of joint tissues, the pre-operative symptoms and the postoperative outcomes after arthroscopic surgery. Methods: Joint tissues from 21 patients undergoing hip arthroscopy for FAI were collected and their histological and immunohistochemical features were correlated with clinical parameters. Results: Synovial mononuclear cell infiltration was observed in 25% of FAI patients, inversely correlated with the hip disability and osteoarthritis outcome score (HOOS) pain and function subscales and with the absolute and relative change in total HOOS. All the labral samples showed some pattern of degeneration and 67% of the samples showed calcium deposits. The total labral score was associated with increased CD68 positive cells in the synovium. The presence of labral calcifications, along with the chondral damage worsened the HOOS post-op symptoms (adjusted R-square = 0.76 p = 0.0001). Conclusions: Our study reveals a relationship between the histologic labral features, the synovial inflammation, and the cartilage condition at the time of FAI. The presence of labral calcifications, along with the cartilage damage and the synovitis negatively affects the postoperative outcomes in patients with FAI.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

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“…2 Before arthroscopic treatment, each patient failed an extensive course of conservative management, commonly including rest, activity modification, physical therapy, and diagnostic/therapeutic intra-articular hip corticosteroid injections. 12 The risks and benefits of hip arthroscopy were discussed with each patient by the senior author (G.D.D. ), and informed consent was obtained prior to surgery.…”

Section: Indications For Surgerymentioning

confidence: 99%

Para-acetabular Radiopaque Densities in Patients With Femoroacetabular Impingement: A Retrospective Assessment of Prevalence and Characteristics

Dumont

Menge

Money

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Femoroacetabular impingement (FAI) syndrome is a common source of hip pain associated with chondrolabral injury. There is a subset of patients with FAI syndrome who present with radiopaque densities (RODs) adjacent to the acetabular rim. Purpose: To evaluate the prevalence, characteristics, and patient-specific factors associated with RODs adjacent to the acetabulum in patients treated with hip arthroscopy for symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Between November 2014 and March 2018, a total of 296 patients who underwent hip arthroscopy for FAI with a labral tear were reviewed retrospectively. Patient-specific variables were collected, including age, sex, lateral center-edge angle (LCEA), and alpha angle. Imaging (computed tomography) and surgical reports were reviewed for the location and characteristics of RODs, as well as subsequent labral treatment technique. Patients were excluded if they were treated for extra-articular hip pathology, had a revision procedure, or had a diagnosis other than FAI with a labral tear. No patient was excluded for any history of systemic inflammatory disease. Binary logistic regression was used to compare age, LCEA, and alpha angle for patients with or without radiopaque fragments. An alpha level of 0.05 was used to indicate statistical significance. Results: A total of 204 patients met inclusion criteria; 33 patients (16.2%; 16 males, 17 females) had para-acetabular RODs. There were no statistically significant differences in age ( P = .82), sex ( P = .92), LCEA ( P = .24), or alpha angle ( P = .10) among patients with or without an ROD. Of the 33 patients, 29 (87.9%) had fragments in the anterosuperior quadrant. Overall, 31 patients (93.9%) were treated with labral repair in addition to correction of the underlying bony impingement, while 2 patients (6.1%) underwent focal labral debridement owing to poor labral tissue quality around the RODs. Twenty-five patients (76%) had identifiable RODs, which were excised at the time of surgery. The mean (± SD) ROD size measured on axial and coronal computed tomography imaging was 6.3 ± 5.5 mm and 4 ± 4.5 mm, respectively. Conclusion: Age, sex, LCEA, and alpha angle were not predictive of the presence of para-acetabular RODs. Approximately one-sixth of all patients with FAI had RODs identified on computed tomography, which were typically located at the anterosuperior acetabulum. The majority of hips with para-acetabular RODs were amenable to labral repair. The relative prevalence and lack of predictive patient-specific indicators for these fragments suggest that a high degree of suspicion is necessary when evaluating patients with FAI.

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“…Nach klinischen Standardscores erhoben, korreliert die Menge des Knorpelmineralgehalts an Hüfte und Kniegelenk mit dem subjektiv empfundenen Schmerzniveau [15,16]. Wenn man die Lokalisation der ektopen Mineralisation weiter differenziert und die Kalzifikation des Labrum acetabulare von der Kalzifikation des Gelenkknorpels im Hüftgelenk separat betrachtet und parallel analysiert, wird evident, dass der Faserknorpel des Labrums besonders anfällig für Kalzifikation ist (Faktor 1,55 mehr Mineralgehalt gegenüber dem hyalinen Gelenkknorpel) und dass die Labrummineralisation stärker als die Gelenkknorpelmineralisation mit dem subjektiven Schmerzniveau korreliert [17,18].…”

Section: Schmerz Und Chondrokalzinoseunclassified

Chondrokalzinose

Niemeier¹,

Rüther²

2020

Arthritis und Rheuma

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ZUSAMMENFASSUNGAls Chondrokalzinose bezeichnet man die Ablagerung von Kalziumphosphaten im chondralen Gewebe. Im Gelenk treten die Minerale sowohl im hyalinen Knorpel wie im Faserknorpel auf. Die Kalzifikationen sind teils amorph, teils kristallin. Es werden sowohl apatitische Kristalle wie Pyrophosphatkristalle beobachtet. Die Ätiologie ist unklar, möglicherweise nicht monokausal. Es mehren sich die Hinweise, dass es sich um ein systemisches Geschehen, d. h. alle Gelenke betreffend, handelt, das – in geringerer Ausprägung – schon in jungem Alter einsetzt. Die Chondrokalzinose lässt sich so nicht als Sekundärphänomen einer Arthrose verstehen. Die Chondrokalzinose ist wahrscheinlich viel häufiger als sie diagnostiziert wird. Im Röntgenbild ist die Kalzinose erst dann erkennbar, wenn stärkere Depositionen vorliegen und wenn sich die Knorpelgewebe ohne Knochenüberlagerung projizieren lassen. Apatitische Kristalle sind derart klein, dass sie weder im Punktat noch im histologischen Schnitt lichtmikroskopisch erkennbar sind. Das Serumlabor ist unergiebig.

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Labral calcification in end‐stage osteoarthritis of the hip correlates with pain and clinical function

Cited by 19 publications

References 41 publications

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Para-acetabular Radiopaque Densities in Patients With Femoroacetabular Impingement: A Retrospective Assessment of Prevalence and Characteristics

Chondrokalzinose

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