Preoperative T2 mapping MRI of articular cartilage values predicts postoperative osteoarthritis progression following rotational acetabular osteotomy

Abstract

Aims Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. Methods We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. Results There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum’s anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). Conclusion This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J 2021;103-B(9):1472–1478.

Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip

“… 52 Preoperative T2 mapping demonstrated significantly higher signal intensity to the center of the acetabulum’s anterolateral portion and the femoral head in patients with OA progression versus those without OA progression. 52 Logistic regression analysis identified T2 values of the center to the anterolateral region of the acetabulum as independent predictors of subsequent OA progression (p < 0.001). 52 These data suggest that T2 preoperative mapping in DDH may prove superior to traditional radiological measures in predicting OA prognosis, with further study needed elucidate its role in long-term joint preservation.…”

“… 52 Logistic regression analysis identified T2 values of the center to the anterolateral region of the acetabulum as independent predictors of subsequent OA progression (p < 0.001). 52 These data suggest that T2 preoperative mapping in DDH may prove superior to traditional radiological measures in predicting OA prognosis, with further study needed elucidate its role in long-term joint preservation.…”

“…Shoji et al reviewed 61 hips with early-stage OA that underwent RAO for DDH, with 16 patients having postoperative OA progression, defined as joint space narrowing of more than 1 mm at five years follow-up. 52 In this study, a robust, single-sliced 3T MR image was used that passed through the center of the femoral head and crossed the cartilage at a right angle. 52 Preoperative T2 mapping demonstrated significantly higher signal intensity to the center of the acetabulum’s anterolateral portion and the femoral head in patients with OA progression versus those without OA progression.…”

“… 52 In this study, a robust, single-sliced 3T MR image was used that passed through the center of the femoral head and crossed the cartilage at a right angle. 52 Preoperative T2 mapping demonstrated significantly higher signal intensity to the center of the acetabulum’s anterolateral portion and the femoral head in patients with OA progression versus those without OA progression. 52 Logistic regression analysis identified T2 values of the center to the anterolateral region of the acetabulum as independent predictors of subsequent OA progression (p < 0.001).…”

Total hip arthroplasty after rotational acetabular osteotomy for developmental dysplasia of the hip: a retrospective observational study

“…It is commonly performed in young and adolescent patients with DDH [ 16 , 17 ]. While positive postoperative outcomes of RAO have been reported [ 4 ], there are cases of advanced osteoarthritis leading to THA [ 18 , 19 ]. Whether a previous RAO has an impact on the clinical outcomes of subsequent THA remains controversial.…”