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Lamo-Espinosa JM, Gómez-Álvarez J, Pascual Roquet-Jalmar E, Iribarren A, Recke A, Roa MC, Valentí-Azcárate A, Granero-Moltó F, San-Julián M. Femoroacetabular Impingement and the Effect of Osteochondroplasty on Hip Osteoarthritis Prevention: The Pandora's Box Opening Process. Cartilage 2024; 15:120-129. [PMID: 37723972 DOI: 10.1177/19476035231191202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE This study was conducted to assess the effect of osteochondroplasty on osteoarthritis (OA) prevention, comparing radiological evolution between identical hips from the same patient who had undergone unilateral surgery. DESIGN We retrospectively reviewed radiological evolution between hips with similar shape from the same patient who had undergone unilateral surgery. In all, 56 FAI patients (112 hips) with a mean age of 42.18 ± 9.16 years and had undergone unilateral arthroscopy treatment have been included. Four independent researchers measured Wiberg, Acetabular and Alpha angles, Extrusion index, and Tönnis classification preoperatively to verify that operated and non-operated hips had the same shape. OA evolution was assessed by joint space width (JSW) in 3 different articular points and Tönnis classification. RESULTS No preoperative anatomical differences were present between groups (P > 0.05). At the end of follow-up (31.9 months), a decrease of JSW in the 3 points measured was found in OP hips (OP vs. N-OP; P < 0.01). These results were correlated with changes in the proportion of patients who progressed to grade III in Tönnis classification (from 1.3% preoperative to 23.2% at the end of follow-up). CONCLUSIONS Osteochondroplasty and labrum procedures were not associated with OA prevention. The OP hips showed a faster OA degeneration, which was not seen in the N-OP. These results will encourage hip surgeons to perform further investigations to avoid the "Pandora's Box Opening Process."
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Affiliation(s)
- José M Lamo-Espinosa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
- Regenerative Medicine Program, Instituto de Investigación Sanitaria de Navarra (Idisna), Cima Universidad de Navarra, Pamplona, Spain
| | - Jorge Gómez-Álvarez
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Asier Iribarren
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Anne Recke
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Cruz Roa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Andrés Valentí-Azcárate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Froilán Granero-Moltó
- Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
- Regenerative Medicine Program, Instituto de Investigación Sanitaria de Navarra (Idisna), Cima Universidad de Navarra, Pamplona, Spain
| | - Mikel San-Julián
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
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2
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Lewis CL, Shefelbine SJ. Lost in research translation: Female athletes are not male athletes, especially at the hip. J Orthop Res 2024. [PMID: 38644357 DOI: 10.1002/jor.25860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male-dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control-factors which affect hip structure development and loading. Without female-focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life-long hip health for females.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
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3
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van Buuren MMA, Riedstra NS, van den Berg MA, Boel FDEM, Ahedi H, Arbabi V, Arden NK, Bierma-Zeinstra SMA, Boer CG, Cicuttini F, Cootes TF, Crossley K, Felson D, Gielis WP, Heerey J, Jones G, Kluzek S, Lane NE, Lindner C, Lynch JA, Van Meurs J, Mosler AB, Nelson AE, Nevitt M, Oei E, Runhaar J, Tang J, Weinans H, Agricola R. Cohort profile: Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) - an international consortium of prospective cohort studies with individual participant data on hip osteoarthritis. BMJ Open 2024; 14:e077907. [PMID: 38637130 PMCID: PMC11029301 DOI: 10.1136/bmjopen-2023-077907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Hip osteoarthritis (OA) is a major cause of pain and disability worldwide. Lack of effective therapies may reflect poor knowledge on its aetiology and risk factors, and result in the management of end-stage hip OA with costly joint replacement. The Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) consortium was established to pool and harmonise individual participant data from prospective cohort studies. The consortium aims to better understand determinants and risk factors for the development and progression of hip OA, to optimise and automate methods for (imaging) analysis, and to develop a personalised prediction model for hip OA. PARTICIPANTS World COACH aimed to include participants of prospective cohort studies with ≥200 participants, that have hip imaging data available from at least 2 time points at least 4 years apart. All individual participant data, including clinical data, imaging (data), biochemical markers, questionnaires and genetic data, were collected and pooled into a single, individual-level database. FINDINGS TO DATE World COACH currently consists of 9 cohorts, with 38 021 participants aged 18-80 years at baseline. Overall, 71% of the participants were women and mean baseline age was 65.3±8.6 years. Over 34 000 participants had baseline pelvic radiographs available, and over 22 000 had an additional pelvic radiograph after 8-12 years of follow-up. Even longer radiographic follow-up (15-25 years) is available for over 6000 of these participants. FUTURE PLANS The World COACH consortium offers unique opportunities for studies on the relationship between determinants/risk factors and the development or progression of hip OA, by using harmonised data on clinical findings, imaging, biomarkers, genetics and lifestyle. This provides a unique opportunity to develop a personalised hip OA risk prediction model and to optimise methods for imaging analysis of the hip.
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Affiliation(s)
- Michiel M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Noortje S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Myrthe A van den Berg
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Fleur D E M Boel
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Harbeer Ahedi
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - Vahid Arbabi
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Orthopaedic-Biomechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Nigel K Arden
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | | | - Cindy G Boer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Flavia Cicuttini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Timothy F Cootes
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - David Felson
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Willem Paul Gielis
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Joshua Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - Graeme Jones
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - Stefan Kluzek
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - Nancy E Lane
- Department of Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Claudia Lindner
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - J Van Meurs
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - Amanda E Nelson
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Edwin Oei
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jinchi Tang
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, Zuid-Holland, Netherlands
| | - Rintje Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
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van den Bosch MHJ, Blom AB, van der Kraan PM. Inflammation in osteoarthritis: Our view on its presence and involvement in disease development over the years. Osteoarthritis Cartilage 2024; 32:355-364. [PMID: 38142733 DOI: 10.1016/j.joca.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
Inflammation, both locally in the joint and systemic, is nowadays considered among the mechanisms involved in osteoarthritis (OA). However, this concept has not always been generally accepted. In fact, for long OA has been described as a relatively simple degeneration of articular cartilage as the result of wear and tear only. In this narrative review, we present what our understanding of OA was at the time of the inaugural release of Osteoarthritis and Cartilage about 30 years ago and discuss a set of pivotal papers that changed our view on the role of inflammation in OA development. Furthermore, we briefly discuss the current view on the involvement of inflammation in OA. Next, we use the example of transforming growth factor-β signaling to show how inflammation might influence processes in the joint in a manner that is beyond the simple interaction of ligand and receptor leading to the release of inflammatory and catabolic mediators. Finally, we discuss our view on what should be done in the future to bring the field forward.
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Affiliation(s)
| | - Arjen B Blom
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter M van der Kraan
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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5
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Tomomatsu K, Taniguchi T, Hashizume H, Harada T, Iidaka T, Asai Y, Oka H, Muraki S, Akune T, Kawaguchi H, Nakamura K, Yoshida M, Tanaka S, Yoshimura N, Yamada H. Factors associated with cam deformity in Japanese local residents. Sci Rep 2024; 14:1585. [PMID: 38238438 PMCID: PMC10796762 DOI: 10.1038/s41598-024-51876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
Femoroacetabular impingement has increasingly been recognized as a cause of primary hip osteoarthritis; however, its epidemiological indications remain unclear. We aimed to clarify the epidemiological indications and factors associated with cam deformity in a large-scale population-based cohort in Japan. Overall, 1480 participants (2960 hips) (491 men, 989 women; mean age, 65.3 years) analyzed in the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability study were included. The α angle and spinopelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence) were radiographically measured. Cam deformity was defined as α angle ≥ 60°. Overall, the cam deformity prevalence was 147/2960 (5.0%). Cam deformity prevalence tended to increase with age; in the univariate analysis, a higher percentage of men was observed in the group with cam deformity than in the group without it. No relationship was observed between cam deformity and hip pain. Factors associated with α angle were examined via multiple regression analysis for each gender; α angle was significantly associated with age and BMI in each gender. The α angle and PT were correlated in women. Thus, α angle and cam deformity prevalence increase with age in Japanese individuals. Accordingly, cam deformity can be considered a developmental disease.
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Affiliation(s)
- Koichi Tomomatsu
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan
| | - Takaya Taniguchi
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan.
| | - Hiroshi Hashizume
- School of Health and Nursing Science, Wakayama Medical University, 590 Mikazura, Wakayama City, Wakayama, Japan
| | - Teiji Harada
- Naga Municipal Hospital, 1282 Uchida, Kinokawa City, Wakayama, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811‑1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical &Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons With Disabilities, 4‑1 Namiki, Tokorozawa City, Saitama, Japan
| | | | - Kozo Nakamura
- Department of Orthopaedic Surgery, Towa Hospital, 4‑7‑10 Towa, Adachi‑ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Sumiya Orthopedic Hospital, 337 Yoshida, Wakayama City, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, Faculty of Medicine, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811‑1 Kimiidera, Wakayama City, Wakayama, Japan
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Heppenstall SV, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH, Frysz M, Faber BG. Hip geometric parameters are associated with radiographic and clinical hip osteoarthritis: Findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2023; 31:1627-1635. [PMID: 37704099 PMCID: PMC7615936 DOI: 10.1016/j.joca.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine the extent to which geometric parameters derived from dual-energy x-ray absorptiometry (DXA) scans in the UK Biobank study are related to hip osteoarthritis (HOA) independently of sex, age and body size. DESIGN Femoral neck width (FNW), diameter of the femoral head (DFH) and hip axis length (HAL) were derived automatically from left hip DXA scans in UK Biobank using outline points placed around the hip by a machine-learning program. Correlations were calculated between geometric parameters, age, height, and weight. Logistic regression was used to examine the relationship of geometric parameters with radiographic HOA, hospital diagnosed HOA (HESOA), and Cox proportional hazards model to evaluate the relationship with total hip replacement (THR). Analyses were adjusted for sex, age, height, weight, and geometric parameters. RESULTS The study consisted of 40,312 participants. In age and sex-adjusted analyses, FNW, HAL and DFH were related to increased risk of radiographic HOA. In a model adjusted for age, sex, height, weight and other geometric parameters, both FNW and HAL retained independent relationships with radiographic HOA [FNW: odds ratios 2.38 (2.18-2.59), HAL: 1.25 (1.15-1.36)], while DFH was now protective [0.55 (0.50-0.61)]. Only FNW was independently related to HESOA [2.20 (1.80-2.68)] and THR [hazard ratios 2.51 (1.89-3.32)]. CONCLUSION Greater FNW and HAL were independently related to an increased risk of radiographic HOA, whereas greater DFH appeared to be protective. Greater FNW was independently associated with HESOA and THR. These results suggest that DXA-derived geometric parameters, particularly FNW, could help determine HOA and THR risk.
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Affiliation(s)
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
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7
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Tang J, van Buuren MMA, Riedstra NS, Boel F, Runhaar J, Bierma-Zeinstra S, Agricola R. Cam morphology is strongly and consistently associated with development of radiographic hip osteoarthritis throughout 4 follow-up visits within 10 years. Osteoarthritis Cartilage 2023; 31:1650-1656. [PMID: 37598743 DOI: 10.1016/j.joca.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To determine the association between cam morphology and the development of radiographic hip osteoarthritis (RHOA) at four time points within 10-year follow-up. DESIGN The nationwide prospective Cohort Hip and Cohort Knee study includes 1002 participants aged 45-65 years with 2-, 5-, 8-, and 10-year follow-ups. The associations of cam morphology (alpha angle >60°) and large cam morphology (alpha angle >78°) in hips free of osteoarthritis at baseline (Kellgren & Lawrence (KL) grade <2) with the development of both incident RHOA (KL grade≥2) and end-stage RHOA (KL grade≥3) were estimated using logistic regression with generalized estimating equation at each follow-up and using Cox regression over 10 years, adjusted for age, sex, and body mass index. RESULTS Both cam morphology and large cam morphology were associated with the development of incident RHOA at all follow-ups with adjusted Odd Ratios (aORs) ranging from 2.7 (95% Confidence interval 1.8-4.1) to 2.9 (95% CI 2.0-4.4) for cam morphology and ranging from 2.5 (95% CI 1.5-4.3) to 4.2 (95% CI 2.2-8.3) for large cam morphology. For end-stage RHOA, cam morphology resulted in aORs ranging from 4.9 (95% CI 1.8-13.2) to 8.5 (95% CI 1.1-64.4), and aORs for large cam morphology ranged from 6.7 (95% CI 3.1-14.7) to 12.7 (95% CI 1.9-84.4). CONCLUSIONS Cam morphology poses the hip at 2-13 times increased odds for developing RHOA within a 10-year follow-up. The association was particularly strong for large cam morphology and end-stage RHOA, while the strength of association was consistent over time.
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Affiliation(s)
- Jinchi Tang
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Michiel M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Noortje S Riedstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Fleur Boel
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Sita Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Rintje Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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8
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Westermann RW, Nepple JJ, Pascual-Garrido C, Larson CM, Zaltz I, Beaulé PE, Kim YJ, Millis M, Sucato DJ, Sink EL, Sierra RJ, Podeszwa DA, Sankar WN, Bedi A, Matheney TH, Novais EN, Belzile EL, Clohisy JC. The Impact of Age on Clinical Outcomes of Acetabular Microfracture During FAI Surgery. Am J Sports Med 2023; 51:2559-2566. [PMID: 37470491 DOI: 10.1177/03635465231184398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Full-thickness acetabular cartilage lesions are common findings during primary surgical treatment of femoroacetabular impingement (FAI). PURPOSE To evaluate clinical outcomes after acetabular microfracture performed during FAI surgery in a prospective, multicenter cohort. STUDY DESIGN Cohort Study; Level of evidence, 3. METHODS Patients with FAI who had failed nonoperative management were prospectively enrolled in a multicenter cohort. Preoperative and postoperative (mean follow-up, 4.3 years) patient-reported outcome measures were obtained with a follow-up rate of 81.6% (621/761 hips), including 54 patients who underwent acetabular microfracture. Patient characteristics, radiographic parameters, intraoperative disease severity, and operative procedures were analyzed. Propensity matching using linear regression was used to match 54 hips with microfracture to 162 control hips (1:3) to control for confounding variables. Subanalyses of hips ≤35 and >35 years of age with propensity matching were also performed. RESULTS Patients who underwent acetabular microfracture were more likely to be male (81.8% vs 40.9%; P < .001), be older in age (35.0 vs 29.9 years; P = .001), have a higher body mass index (27.2 vs 25.0; P = .001), and have a greater alpha angle (69.6° vs 62.3°; P < .001) compared with the nonmicrofracture cohort (n = 533). After propensity matching to control for covariates, patients treated with microfracture displayed no differences in the modified Harris Hip Score or Hip Disability and Osteoarthritis Outcome Score (P = .22-.95) but were more likely to undergo total hip arthroplasty (THA) (13% [7/54] compared with 4% [6/162] in the control group; P = .002), and age >35 years was associated with conversion to THA after microfracture. Microfracture performed at or before 35 years of age portended good outcomes with no significant risk of conversion to THA at the most recent follow-up. CONCLUSION Microfracture of acetabular cartilage defects appears to be safe and associated with reliably improved short- to mid-term results in younger patients; modified expectations should be realized when full-thickness chondral lesions are identified in patients >35 years of age.
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Affiliation(s)
- Robert W Westermann
- University of Iowa Sports Medicine, University of Iowa Hospitals & Clinics, Iowa City Iowa, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey J Nepple
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher M Larson
- Twin Cities Orthopedics, Edina, Minnesota, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ira Zaltz
- Michigan Orthopaedic Surgeons, Royal Oak, Michigan, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Young-Jo Kim
- Boston Children's Hospital, Boston, Massachusetts, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael Millis
- Boston Children's Hospital, Boston, Massachusetts, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel J Sucato
- Texas Scottish Rite Hospital, Dallas, Texas, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ernest L Sink
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rafael J Sierra
- Mayo Clinic Rochester, Minnesota, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Podeszwa
- Texas Scottish Rite Hospital, Dallas, Texas, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wudbhav N Sankar
- University of Pennsylvania, Philadelphia, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Asheesh Bedi
- NorthShore Orthopaedic, Chicago, Illinois, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Travis H Matheney
- Boston Children's Hospital, Boston, Massachusetts, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eduardo N Novais
- Boston Children's Hospital, Boston, Massachusetts, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - Etienne L Belzile
- Capitale-Nationale, Quebec, Canada
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Investigation performed at Washington University School of Medicine, St. Louis, Missouri, USA
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9
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Kun E, Javan EM, Smith O, Gulamali F, de la Fuente J, Flynn BI, Vajrala K, Trutner Z, Jayakumar P, Tucker-Drob EM, Sohail M, Singh T, Narasimhan VM. The genetic architecture and evolution of the human skeletal form. Science 2023; 381:eadf8009. [PMID: 37471560 PMCID: PMC11075689 DOI: 10.1126/science.adf8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
The human skeletal form underlies bipedalism, but the genetic basis of skeletal proportions (SPs) is not well characterized. We applied deep-learning models to 31,221 x-rays from the UK Biobank to extract a comprehensive set of SPs, which were associated with 145 independent loci genome-wide. Structural equation modeling suggested that limb proportions exhibited strong genetic sharing but were independent of width and torso proportions. Polygenic score analysis identified specific associations between osteoarthritis and hip and knee SPs. In contrast to other traits, SP loci were enriched in human accelerated regions and in regulatory elements of genes that are differentially expressed between humans and great apes. Combined, our work identifies specific genetic variants that affect the skeletal form and ties a major evolutionary facet of human anatomical change to pathogenesis.
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Affiliation(s)
- Eucharist Kun
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Emily M. Javan
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Olivia Smith
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Faris Gulamali
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier de la Fuente
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Brianna I. Flynn
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Kushal Vajrala
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Zoe Trutner
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, TX, USA
| | | | - Mashaal Sohail
- Centro de Ciencias Genómicas (CCG), Universidad Nacional Autónoma de México (UNAM), 62209 Cuernavaca, Mexico
| | - Tarjinder Singh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- The New York Genome Center, New York, NY, USA
- Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia University, New York, NY, USA
| | - Vagheesh M. Narasimhan
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
- Department of Statistics and Data Science, The University of Texas at Austin, Austin, TX, USA
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10
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Battistelli M, Tassinari E, Trisolino G, Govoni M, Ruspaggiari G, De Franceschi L, Dallari D, Burini D, Ramonda R, Favero M, Traina F, Grigolo B, Olivotto E. Hip Labral Morphological Changes in Patients with Femoroacetabular Impingement Speed Up the Onset of Early Osteoarthritis. Calcif Tissue Int 2023; 112:666-674. [PMID: 36949181 DOI: 10.1007/s00223-023-01076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
Over the last decade, evidence has mounted for a prominent etiologic role of femoroacetabular impingement (FAI) in the development of early hip osteoarthritis (OA). The aim of this study was to compare the ultrastructure and tissue composition of the hip labrum in healthy and pathological conditions, as FAI and OA, to provide understanding of structural changes which might be helpful in the future to design targeted therapies and improve treatment indications. We analyzed labral tissue samples from five healthy multi-organ donors (MCDs) (median age, 38 years), five FAI patients (median age, 37 years) and five late-stage OA patients undergoing total hip replacement (median age, 56 years). We evaluated morpho-functional by histology and transmission electron microscopy. Extracellular matrix (ECM) structure changes were similar in specimens from FAI compared to those from patients with OA (more severe in the latter) showing disorganization of collagen fibers and increased proteoglycan content. In FAI and in OA nuclei the chromatin was condensed, organelle degenerated and cytoplasm vacuolized. Areas of calcification were mainly observed in FAI and OA labrum, as well as apoptotic-like features. We showed that labral tissue of patients with FAI had similar pathological alterations of tissue obtained from OA patients, suggesting that FAI patients might have high susceptibility to develop OA.
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Affiliation(s)
- Michela Battistelli
- Department of Biomolecular Science, Urbino University "Carlo Bo", Via Ca' Le Suore 2, 61029, Urbino, PU, Italy.
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Pediatric Orthopedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Govoni
- Reconstructive Orthopedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Ruspaggiari
- Reconstructive Orthopedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia De Franceschi
- Reconstructive Orthopedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Dante Dallari
- Reconstructive Orthopedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Debora Burini
- Department of Biomolecular Science, Urbino University "Carlo Bo", Via Ca' Le Suore 2, 61029, Urbino, PU, Italy
| | - Roberta Ramonda
- Department of Medicine (DIMED), Rheumatology Unit, University Hospital of Padova, Padua, Italy
| | - Marta Favero
- Department of Medicine (DIMED), Rheumatology Unit, University Hospital of Padova, Padua, Italy
- Medicine Unit 1, Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Brunella Grigolo
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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11
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Cho BW, Kwon HM, Park JY, Park KK, Kim T, Lee WS. Sex differences in the anatomy of the anterior-superior acetabular rim in relation to pincer-type femoroacetabular impingement in Koreans: a three-dimensional quantitative analysis. J Orthop Surg Res 2023; 18:161. [PMID: 36864441 PMCID: PMC9983210 DOI: 10.1186/s13018-023-03526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE The aim of this study was to compare the anatomical structures of the acetabular rim around the anterior inferior iliac spine (AIIS) ridge that indicate anterior focal coverage of acetabulum between the sexes using a three-dimensional (3D) model. METHODS 3D models of 71 adults (38 men and 33 women) with normal hip joints were used. Based on the location of the inflection point (IP) of the acetabular rim around the AIIS ridge, the patients were classified into anterior and posterior types, and the ratios thereof for each sex were compared. Coordinates for the IP, the most anterior point (MAP), and the most lateral point (MLP) were obtained and compared between the sexes and between anterior and posterior types. RESULTS Coordinates for IPs in men were located anterior and inferior to those in women. MAP coordinates for men were located inferior to those for women, and MLP coordinates for men were located lateral and inferior to those for women. Comparing AIIS ridge types, we noted that coordinates for IPs of the anterior type were located medial, anterior, and inferior to those of the posterior type. Meanwhile, MAP coordinates of the anterior type were located inferior to those of the posterior type, and MLP coordinates of the anterior type were located lateral and inferior to those of the posterior type. CONCLUSION Anterior focal coverage of the acetabulum appears to differ between the sexes, and this difference may affect the development of pincer-type femoroacetabular impingement (FAI). Additionally, we found that anterior focal coverage differs according to anterior or posterior positioning of the bony prominence around the AIIS ridge, which may affect development of FAI.
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Affiliation(s)
- Byung Woo Cho
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Hyuck Min Kwon
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Jun Young Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do Republic of Korea
| | - Kwan Kyu Park
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Taehyun Kim
- grid.15444.300000 0004 0470 5454Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Woo-Suk Lee
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, Republic of Korea.
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12
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Kun E, Javan EM, Smith O, Gulamali F, de la Fuente J, Flynn BI, Vajrala K, Trutner Z, Jayakumar P, Tucker-Drob EM, Sohail M, Singh T, Narasimhan VM. The genetic architecture of the human skeletal form. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.03.521284. [PMID: 36712136 PMCID: PMC9881884 DOI: 10.1101/2023.01.03.521284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The human skeletal form underlies our ability to walk on two legs, but unlike standing height, the genetic basis of limb lengths and skeletal proportions is less well understood. Here we applied a deep learning model to 31,221 whole body dual-energy X-ray absorptiometry (DXA) images from the UK Biobank (UKB) to extract 23 different image-derived phenotypes (IDPs) that include all long bone lengths as well as hip and shoulder width, which we analyzed while controlling for height. All skeletal proportions are highly heritable (∼40-50%), and genome-wide association studies (GWAS) of these traits identified 179 independent loci, of which 102 loci were not associated with height. These loci are enriched in genes regulating skeletal development as well as associated with rare human skeletal diseases and abnormal mouse skeletal phenotypes. Genetic correlation and genomic structural equation modeling indicated that limb proportions exhibited strong genetic sharing but were genetically independent of width and torso proportions. Phenotypic and polygenic risk score analyses identified specific associations between osteoarthritis (OA) of the hip and knee, the leading causes of adult disability in the United States, and skeletal proportions of the corresponding regions. We also found genomic evidence of evolutionary change in arm-to-leg and hip-width proportions in humans consistent with striking anatomical changes in these skeletal proportions in the hominin fossil record. In contrast to cardiovascular, auto-immune, metabolic, and other categories of traits, loci associated with these skeletal proportions are significantly enriched in human accelerated regions (HARs), and regulatory elements of genes differentially expressed through development between humans and the great apes. Taken together, our work validates the use of deep learning models on DXA images to identify novel and specific genetic variants affecting the human skeletal form and ties a major evolutionary facet of human anatomical change to pathogenesis.
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Affiliation(s)
- Eucharist Kun
- Department of Integrative Biology, The University of Texas at Austin
| | - Emily M Javan
- Department of Integrative Biology, The University of Texas at Austin
| | - Olivia Smith
- Department of Integrative Biology, The University of Texas at Austin
| | | | | | - Brianna I Flynn
- Department of Integrative Biology, The University of Texas at Austin
| | - Kushal Vajrala
- Department of Integrative Biology, The University of Texas at Austin
| | - Zoe Trutner
- Department of Surgery and Perioperative Care, The University of Texas at Austin
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, The University of Texas at Austin
| | | | - Mashaal Sohail
- Centro de Ciencias Genómicas (CCG), Universidad Nacional Autónoma de México (UNAM)
| | - Tarjinder Singh
- The Department of Psychiatry at Columbia University Irving Medical Center
- The New York Genome Center
- Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia University
| | - Vagheesh M Narasimhan
- Department of Integrative Biology, The University of Texas at Austin
- Department of Statistics and Data Science, The University of Texas at Austin
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13
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Nelson AE, Smith JA, Alvarez C, Arbeeva L, Renner JB, Murphy LB, Jordan JM, Golightly YM, Duryea J. Associations Between Baseline and Longitudinal Semiautomated Quantitative Joint Space Width at the Hip and Incident Hip Osteoarthritis: Data From a Community-Based Cohort. Arthritis Care Res (Hoboken) 2022; 74:1978-1988. [PMID: 34219398 PMCID: PMC8727661 DOI: 10.1002/acr.24742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate quantitative joint space width (JSW) at 10-, 30-, and 50-degree locations in relation to incident radiographic and symptomatic hip osteoarthritis (HOA) in a community-based cohort. METHODS Data were from Johnston County OA Project participants with supine hip radiographs at each of 4 time points; all had Kellgren/Lawrence (K/L) grades and quantitative JSW. We assessed covariates (age, race, height, weight, body mass index [BMI]) associated with quantitative JSW and hip-level associations between quantitative JSW and HOA over time using sex-stratified and multivariable-adjusted linear mixed models. A cluster analysis with logistic regression estimated associations between quantitative JSW trajectory groups and incident radiographic HOA and symptomatic HOA. RESULTS At baseline, 397 participants (784 hips, 41% men, 24% Black, mean age 57 years) had a mean BMI of 29 kg/m2 . Over a mean of 18 years, 20% and 12% developed incident K/L grade-defined radiographic HOA or symptomatic HOA, respectively. Quantitative JSW was more sensitive to changes over time at 50 degrees. Values were stable among men but declined over time in women. Heavier women lost more quantitative JSW; changes in quantitative JSW were not significantly associated with race, education, or injury in women or men. In women only, loss of quantitative JSW over time was associated with 2-3 times higher odds of radiographic HOA and symptomatic HOA; among women and men, narrower baseline quantitative JSW was associated with these outcomes. CONCLUSION Hip quantitative JSW demonstrates marked differences in respect to sex, with significant loss over time only in women. Loss of quantitative JSW over time in women and narrower baseline quantitative JSW in men and women were associated with incident radiographic HOA and symptomatic HOA.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jacquelyn A. Smith
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Rheumatology Associates, Louisville, KY
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise B. Murphy
- Centers for Disease Control and Prevention, Atlanta, GA; Optum Life Sciences, Inc., Eden Prairie, MN
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology-Gillings School of Global Public Health, Injury Prevention Research Center, and Division of Physical Therapy-Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
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14
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Nepple JJ, Parilla FW, Ince DC, Freiman S, Clohisy JC. Does Femoral Osteoplasty Improve Long-term Clinical Outcomes and Survivorship of Hip Arthroscopy? A 15-Year Minimum Follow-up Study. Am J Sports Med 2022; 50:3586-3592. [PMID: 36178189 DOI: 10.1177/03635465221123048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although femoral osteoplasty is common practice in treating cam-type femoroacetabular impingement (FAI), long-term data are lacking that support the ability of this procedure to optimize outcomes and alter natural history. PURPOSE To compare long-term clinical outcomes and survivorship of treatment for symptomatic FAI via arthroscopic correction of labral or chondral pathology with and without femoral osteoplasty. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective cohort study was performed across 2 consecutive cohorts of patients with isolated cam-type FAI who underwent hip arthroscopic treatment of labral or chondral pathology without femoral osteoplasty (HS group) or with femoral osteoplasty (HS-OST group). These unique cohorts were established at a distinct transition time in our practice before and after adoption of femoral osteoplasty for treatment of FAI. Clinical outcomes were measured using the modified Harris Hip Score (mHHS). Kaplan-Meier analysis was used to assess for total hip arthroplasty (THA)-free and reoperation-free survivorship. RESULTS The final HS group included 17 hips followed for 19.7 ± 1.2 years, and the final HS-OST group included 23 hips followed for 16.0 ± 0.6 years. No significant patient or morphological differences were found between groups. Compared with the HS group, the HS-OST group had significantly higher final mHHS (82.7 vs 64.7 for HS-OST vs HS, respectively; P = .002) and mHHS improvement (18.4 vs 6.1; P = .02). The HS-OST group also had significantly greater 15-year THA-free survivorship versus the HS group (78% vs 41%, respectively; P = .02) and reoperation-free survivorship (78% vs 29%; P = .003). CONCLUSION This study demonstrated superior long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared with hip arthroscopy alone. These long-term data strongly support the practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI at long-term follow-up.
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Affiliation(s)
- Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Deniz C Ince
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Serena Freiman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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15
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Hilfiker R, Hunkeler M, Limacher A, Leunig M, Bonel H, Egger M, Jüni P, Reichenbach S. Is Internal Rotation Measurement of the Hip Useful for Ruling in Cam or Pincer Morphology in Asymptomatic Males? A Diagnostic Accuracy Study. Clin Orthop Relat Res 2022; 480:1989-1998. [PMID: 35700433 PMCID: PMC9473784 DOI: 10.1097/corr.0000000000002244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cam and pincer morphologies are associated with limited internal rotation. However, the routine clinical examination for hip rotation has limited reliability. A more standardized method of measuring hip rotation might increase test-retest and interobserver reliability and might be useful as a screening test to detect different hip morphologies without the need for imaging. We developed an examination chair to standardize the measurement of internal hip rotation, which improved interobserver reliability. However, the diagnostic test accuracy for this test is unknown. QUESTION/PURPOSE Is a standardized method of determining internal hip rotation using an examination chair useful in detecting cam and pincer morphology with MRI as a reference standard? METHODS A diagnostic test accuracy study was conducted in a sample of asymptomatic males. Using an examination chair with a standardized seated position, internal rotation was measured in 1080 men aged 18 to 21 years who had been conscripted for the Swiss army. The chair prevents compensatory movement by stabilizing the pelvis and the thighs with belts. The force to produce the internal rotation was standardized with a pulley system. Previous results showed that the measurements with the examination chair are similar to clinical assessment but with higher interobserver agreement. A random sample of 430 asymptomatic males was invited to undergo hip MRI. Of those, 244 White European males responded to the invitation and had a mean age of 20 ± 0.7 years and a mean internal rotation of the hip of 33° ± 8.5°. Using MRI as the reference standard, 69% (169 of 244) had a normal hip, 24% (59 of 244) a definite cam morphology (Grades 2 and 3), 3% (8 of 244) an increased acetabular depth, and 3% (8 of 244) a combination of both. One experienced radiologist graded cam morphology as follows: 0 = normal, 1 = mild, 2 = moderate, and 3 = severe. Pincer morphology was defined by increased acetabular depth (≤ 3 mm distance between the center of the femoral neck and the line connecting the anterior and posterior acetabular rims). The intraobserver agreement was substantial (weighted κ of 0.65). A receiver operating characteristic (ROC) curve was fitted, and sensitivity, specificity, and likelihood ratios were estimated for different internal rotation cutoffs. RESULTS For cam morphology, the area under the ROC curve was 0.75 (95% CI 0.67 to 0.82). Internal hip rotation of less than 20° yielded a positive likelihood ratio of 9.57 (sensitivity 0.13, specificity 0.99), and a value of 40° or more resulted in a negative likelihood ratio of 0.36 (sensitivity 0.93, specificity 0.20). The area under the curve for detecting the combination of cam and pincer morphologies was 0.87 (95% CI 0.74 to 1.0). A cutoff of 20° yielded a positive likelihood ratio of 9.03 (sensitivity 0.33, specificity 0.96). CONCLUSION This examination chair showed moderate-to-good diagnostic value to rule in hip cam morphology in White European males. However, at the extremes of the 95% confidence intervals, diagnostic performance would be poor. Nonetheless, we believe this test can contribute to identifying cam morphologies, and we hope that future, larger studies-ideally in more diverse patient populations-will seek to validate this to arrive at more precise estimates of the diagnostic performance of this test. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Roger Hilfiker
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marc Hunkeler
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | - Harald Bonel
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Switzerland
- Campus Stiftung Lindenhof, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Rogers MJ, Sato EH, LaBelle MW, Ou Z, Presson AP, Maak TG. Association of Cam Deformity on Anteroposterior Pelvic Radiographs and More Severe Chondral Damage in Femoroacetabular Impingement Syndrome. Am J Sports Med 2022; 50:2980-2988. [PMID: 35975987 DOI: 10.1177/03635465221111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal proximal femoral morphology in femoroacetabular impingement syndrome (FAIS) identifiable on the anteroposterior (AP) pelvic radiograph has been described as the "pistol grip" deformity. The effect of a superior cam deformity identified on this radiographic view remains unknown. PURPOSES To assess the relationship between AP cam deformity (AP alpha angle [AP AA] >55°) and cartilage injury; to assess the relationship between AP cam deformity and labral injury; and to determine if patient factors are correlated with cartilage and labral injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing osteochondroplasty and labral repair for FAIS with a single surgeon were identified retrospectively. Intraoperative size, location, and severity of cartilage and labral damage were prospectively collected. Chondrolabral and femoral/acetabular cartilage damage were graded with the Beck labral and cartilage injury criteria. Radiographic data included the AP AA, lateral center-edge angle (LCEA), and maximum femoral alpha angle (MF AA). Patients with hip dysplasia (LCEA <18°; LCEA 18°-25° with acetabular index >10°) were excluded. Outcomes were compared across cartilage and labral severity grades. We report odds ratios (ORs) with 95% confidence intervals and P values from multivariable logistic regressions. RESULTS Of the 158 included hips (154 patients), 69% were female and the mean (± standard deviation [SD]) age was 30.3 ± 9.7 years. Increase in age, increase in body mass index (BMI), and male sex were associated with increasing severity of cartilage and labral injury. More severe cartilage damage was associated with increasing AP AA (P < .001) and MF AA (P < .001). The odds of developing a higher category of cartilage injury severity (grade ≥3) were 119% higher (OR, 2.19 [95% CI, 1.36-3.64]; P = .002) for every SD increase (16.7°) in AP AA, adjusting for age, sex, and BMI. The odds of developing a severe labral injury (grade ≥3) were 118% higher (OR, 2.18 [95% CI 1.17-4.32]; P = .018) for every SD increase (10.5°) in MF AA, adjusting for age, sex, BMI, and AP AA. CONCLUSION Increasing age and BMI, and male sex are associated with increasing severity of cartilage and labral injury in FAIS. The odds of developing a cartilage injury are significantly higher with independent increases in AP AA and MF AA.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Eleanor H Sato
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Mark W LaBelle
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA
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17
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Zucker BE, Ebsim R, Lindner C, Hardcastle S, Cootes T, Tobias JH, Whitehouse MR, Gregson CL, Faber BG, Hartley AE. High bone mass and cam morphology are independently related to hip osteoarthritis: findings from the High Bone Mass cohort. BMC Musculoskelet Disord 2022; 23:757. [PMID: 35933372 PMCID: PMC9356486 DOI: 10.1186/s12891-022-05603-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High bone mass (HBM, BMD Z-score ≥ + 3.2) and cam morphology (bulging of lateral femoral head) are associated with greater odds of prevalent radiographic hip osteoarthritis (rHOA). As cam morphology is itself a manifestation of increased bone deposition around the femoral head, it is conceivable that cam morphology may mediate the relationship between HBM and rHOA. We therefore aimed to determine if individuals with HBM have increased odds of prevalent cam morphology. In addition, we investigated whether the relationship between cam and prevalent and incident osteoarthritis was preserved in a HBM population. METHODS In the HBM study, a UK based cohort of adults with unexplained HBM and their relatives and spouses (controls), we determined the presence of cam morphology using semi-automatic methods of alpha angle derivation from pelvic radiographs. Associations between HBM status and presence of cam morphology, and between cam morphology and presence of rHOA (or its subphenotypes: osteophytes, joint space narrowing, cysts, and subchondral sclerosis) were determined using multivariable logistic regression, adjusting for age, sex, height, weight, and adolescent physical activity levels. The association between cam at baseline and incidence of rHOA after an average of 8 years was determined. Generalised estimating equations accounted for individual-level clustering. RESULTS The study included 352 individuals, of whom 235 (66.7%) were female and 234 (66.5%) had HBM. Included individuals contributed 694 hips, of which 143 had a cam deformity (20.6%). There was no evidence of an association between HBM and cam morphology (OR = 0.97 [95% CI: 0.63-1.51], p = 0.90) but a strong relationship was observed between cam morphology and rHOA (OR = 3.96 [2.63-5.98], p = 5.46 × 10-11) and rHOA subphenotypes joint space narrowing (OR = 3.70 [2.48-5.54], p = 1.76 × 10-10), subchondral sclerosis (OR = 3.28 [1.60-6.60], p = 9.57 × 10-4) and osteophytes (OR = 3.01 [1.87-4.87], p = 6.37 × 10-6). Cam morphology was not associated with incident osteoarthritis (OR = 0.76 [0.16-3.49], p = 0.72). CONCLUSIONS The relationship between cam morphology and rHOA seen in other studies is preserved in a HBM population. This study suggests that the risk of OA conferred by high BMD and by cam morphology are mediated via distinct pathways.
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Affiliation(s)
- B. E. Zucker
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - R. Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - C. Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - S. Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - T. Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - J. H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - M. R. Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - C. L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - B. G. Faber
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - A. E. Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
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18
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Becker LD, Floerkemeier T, Derksen A, Schwarze M, Budde S, Windhagen H, Wirries N. Analysis of factors affecting the time for implantation of a total hip arthroplasty in patients with symptomatic primary and secondary hip osteoarthritis. Hip Int 2022:11207000221114618. [PMID: 35876182 DOI: 10.1177/11207000221114618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many studies have identified factors associated with an unfavourable clinical outcome or an early conversion to total hip arthroplasty (THA) after joint-preserving treatment. We analysed the effect and reliability of different factors on the age at which THA becomes necessary. METHODS Hip joint radiographs of 2485 cases were evaluated using the lateral centre-edge angle (LCEA) and acetabulum angle (ACA) as well as the alpha angle to describe the femoral head shapes. Regressions were performed using patient's age at the time of THA and body mass index (BMI) as well as LCEA and ACA. Multiple linear regressions were used to create a formula comprising factors that significantly correlated with patient age at the time of joint replacement surgery. RESULTS The BMI, LCEA, and ACA showed significant correlations with the age of THA implantation (p < 0.001). Multiple linear regressions produced the following formula: age (THA) = 72.40-0.40 × BMI + 0.20 × LCEA-0.18 × ACA. BMI showed a stronger impact on the age of end-stage osteoarthritis than the ACA. The formula explained 12.1% of the distributing data (r2). Surprisingly, the alpha angle did not show an impact on the age of THA surgery. CONCLUSIONS BMI had the greatest impact on patient's age at the time of THA, followed by the characteristic radiological angles for hip dysplasia. The resulting formula could emphasise and visualise the significant impact of these factors. However, despite the calculation being based on 2485 cases, the calculated validity of 12.1% was limited.
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Affiliation(s)
- Leon D Becker
- Department of Orthopaedic Surgery at Diakovere Annastift (Hannover Medical School), Hannover, Germany
| | | | - Alexander Derksen
- Department of Orthopaedic Surgery at Diakovere Annastift (Hannover Medical School), Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Stefan Budde
- Department of Orthopaedic Surgery at Diakovere Annastift (Hannover Medical School), Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery at Diakovere Annastift (Hannover Medical School), Hannover, Germany
| | - Nils Wirries
- Department of Orthopaedic Surgery at Diakovere Annastift (Hannover Medical School), Hannover, Germany
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19
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A computational approach to determine key anatomic landmarks on pelvis and its application to acetabular orientation assessment and hip computational biomechanics. Med Eng Phys 2022; 105:103824. [DOI: 10.1016/j.medengphy.2022.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/07/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
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20
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Lamo-Espinosa JM, Alfonso A, Pascual E, García-Ausín J, Sánchez-Gordoa M, Blanco A, Gómez-Álvarez J, San-Julián M. Hip Preservation Surgery in Osteoarthritis Prevention: Potential Benefits of the Radiographic Angular Correction. Diagnostics (Basel) 2022; 12:diagnostics12051128. [PMID: 35626284 PMCID: PMC9139807 DOI: 10.3390/diagnostics12051128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the study is to describe the morphology associated with the development of osteoarthritis (OA) in three different age groups. These data will contribute to defining the morphology associated with early and late hip OA. Methods: We studied 400 hips in 377 patients who had undergone primary THA due to idiopathic OA. Three groups were compared: group 1 (n = 147), younger patients, aged up to 60 years; group 2 (n = 155), patients aged between 61 and 74 years; and group 3 (n = 98), aged 75 or over. Five independent researchers measured the hip angles and the mean values were used to build a database. Results: No differences between groups in sex distribution and BMI were detected. Less coverage of the head (extrusion index), higher Tönnis angle, lower Wiberg and alpha angles characterized early OA hips. These differences increased with age, being greater between group 2 and group 3 (p < 0.01). However, significant differences were still present in the comparison between group 1 and group 2 (p < 0.01)). No differences were detected between group 2 and group 3. Conclusion: Elevated acetabular angle, head extrusion and decreased Wiberg angle characterize hip osteoarthritis at younger ages and should be the focus of hip preservation surgery in terms of osteoarthritis prevention. Pincer-type FAI (higher Wiberg and lower Tönnis angle) and higher alpha angle (CAM) are correlated with the development of later OA. These results shed doubt on applying the hip preservation surgery concept in terms of osteoarthritis prevention in FAI, especially in Pincer-type FAI patients.
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Affiliation(s)
- José M. Lamo-Espinosa
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
- Correspondence: ; Tel.: +34-948-25-54-00
| | - Adrián Alfonso
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
| | - Elena Pascual
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Jorge García-Ausín
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
| | - Miguel Sánchez-Gordoa
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
| | - Asier Blanco
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
| | - Jorge Gómez-Álvarez
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
| | - Mikel San-Julián
- Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain; (A.A.); (J.G.-A.); (M.S.-G.); (A.B.); (J.G.-Á.); (M.S.-J.)
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21
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Shapira J, Owens JS, Jimenez AE, Maldonado DR, Rosinsky PJ, Ankem HK, Peskin B, Lall AC, Domb BG. Dunn View Alpha Angle More Useful Than Femoral Head-Neck Offset to Predict Acetabular Cartilage Damage in Patients With Femoroacetabular Impingement Syndrome Undergoing Hip Arthroscopy. Arthroscopy 2022; 38:1193-1200. [PMID: 34537312 DOI: 10.1016/j.arthro.2021.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/06/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify radiographic measurements and demographics that are predictive of acetabular cartilage damage in patients with femoroacetabular impingement syndrome (FAIS) undergoing hip arthroscopy. More specifically, to compare the predictive value of alpha angle and femoral head-neck offset, as measured on Dunn view radiographs, in determining the preoperative likelihood and severity of acetabular cartilage damage. METHODS Patients were included if they underwent primary hip arthroscopy for FAIS between February 2008 and June 2020. Exclusion criteria were prior ipsilateral hip conditions, Tönnis grade of osteoarthritis >1, unwilling to participate, missing intraoperative, demographic or radiographic variables of interest, and lateral center-edge angle (LCEA) >40° or ≤25°. Fourteen variables were assessed in a bivariate comparison and analyzed in a multivariate logistic model. The Acetabular Labrum Articular Disruption (ALAD) and Outerbridge (OB) classifications were used to define acetabular cartilage defects. Those without damage or those with mild acetabular cartilage damage belonged to the ALAD/OB ≤2 group and those with severe damage belonged to the ALAD/OB ≥ 3 group. RESULTS A total of 1485 patients were analyzed, including 1038 patients with ALAD/OB ≤2 and 447 patients with ALAD/OB ≥3. There was a greater proportion of males in the ALAD/OB ≥3 group (64.21% vs 25.82%; P <.001). The multivariate logistic regression selected age, sex, anterior center-edge angle (ACEA), and alpha angle. Every additional degree in the alpha angle was associated with a 6% increase in the odds of severe acetabular cartilage damage (odds ratio [OR], 1.06 [95% confidence interval [CI], 0.12-8.11]). The multivariate analysis did not identify femoral head-neck offset as a predictor. The odds of severe acetabular cartilage damage were 3.73 times higher in males than females (OR, 3.73 [95% CI, 0.01-1705.96]). Higher age was found to increase the likelihood of ALAD/OB ≥3 (OR, 1.04 [95% CI, 0.13-7.75]). CONCLUSIONS In a multivariate analysis, factors identified as preoperative predictors of acetabular cartilage damage in patients with FAIS were age, sex, ACEA, and alpha angle. Femoral head-neck offset was not predictive, suggesting that Dunn view alpha angle may take precedence as a predictor of acetabular cartilage damage. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, IL; Department of Orthopedic Surgery, Rambam Medical Center, Haifa, Israel
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, IL
| | | | | | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, IL
| | - Bezalel Peskin
- Department of Orthopedic Surgery, Rambam Medical Center, Haifa, Israel
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, IL; American Hip Institute, Chicago, IL; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL; American Hip Institute, Chicago, IL; AMITA Health St. Alexius Medical Center, Hoffman Estates, IL.
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22
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Freiman SM, Schwabe MT, Fowler L, Clohisy JC, Nepple JJ. Prevalence of Borderline Acetabular Dysplasia in Symptomatic and Asymptomatic Populations: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671211040455. [PMID: 35155698 PMCID: PMC8832597 DOI: 10.1177/23259671211040455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Patients with borderline acetabular dysplasia are a controversial patient population in hip preservation, as some have primarily impingement-based symptoms and others have instability-based symptoms. Borderline dysplasia is most commonly defined as a lateral center-edge angle (LCEA) of 20° to 25°. However, its prevalence has not been well established in the literature. Purpose: To (1) define the prevalence of borderline hip dysplasia in the general population as well as in populations presenting with hip pain using a systematic review and meta-analysis of the literature and (2) describe differences between male and female patients as well as differences in prevalence from that of classic acetabular dysplasia. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was performed using search terms to capture borderline dysplasia, or studies reporting prevalence by LCEA. The search yielded 1932 results, of which 11 articles met inclusion criteria and were included in the final systematic review. Studies were grouped by patient cohort as (1) asymptomatic general population, (2) asymptomatic targeted population (eg, athletes in a specific sport), and (3) symptomatic hip pain population. The reporting of prevalence rates by subject or by hip was recorded. In a study, the rates of borderline dysplasia were compared with those of classic acetabular dysplasia (LCEA, <20°). Results: The 11 studies included 19,648 hips (11,754 patients). In the asymptomatic general population, the pooled estimate of the prevalence of borderline dysplasia was 19.8% by subject and 23.3% by hip (range, 16.7%-46.0%). The targeted subpopulation group included 236 athletes with subgroups in ballet, football, hockey, volleyball, soccer, and track and field with prevalence ranging from 17.8% to 51.1%. The prevalence of borderline dysplasia in groups presenting with hip pain was 12.8% (range, 12.6%-16.0%). Borderline acetabular dysplasia was 3.5 times more common than classic acetabular dysplasia in the asymptomatic general population. Conclusion: This study demonstrated a prevalence of borderline dysplasia of 19.8% to 23.3% in the asymptomatic general population. Additionally, an estimated prevalence of 12.8% of hips in symptomatic patients highlights the common decision-making challenges in this population.
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Affiliation(s)
- Serena M. Freiman
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Maria T. Schwabe
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Lucas Fowler
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
| | - Jeffrey J. Nepple
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri, USA
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23
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Steens W, Zinser W. Bedeutung der Knorpeltherapie in der Behandlung des FAIS. DER ORTHOPADE 2022; 51:205-210. [DOI: 10.1007/s00132-022-04216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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24
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Natürlicher Verlauf, konservative Behandlungsmethoden und optimaler Operationszeitpunkt der symptomatischen Hüftgelenkdysplasie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Parker EA, Meyer AM, Nasir M, Willey MC, Brown TS, Westermann RW. Abnormal Femoral Anteversion Is Associated With the Development of Hip Osteoarthritis: A Systematic Review and Meta-Analysis. Arthrosc Sports Med Rehabil 2021; 3:e2047-e2058. [PMID: 34977664 PMCID: PMC8689222 DOI: 10.1016/j.asmr.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis of literature and to evaluate the relationship between abnormal femoral version and the development of hip osteoarthritis (OA). METHODS A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluating Level I and II studies. Included studies had to provide granular femoral version (FV) information. The severity of OA was ranked on the Kellgren-Lawrence (KL) scale. Excel version 1808 (Microsoft, Redmond, WA) was used to perform a student t test statistical analyses. RESULTS Our review identified 19 qualifying studies-5 Level I and 14 Level II with 1,756 patients. Patients with FV above normal range (>14°) had greater KL scores than patients with normal range FV (mean ± standard deviation; 3.37 ± 1.44 vs 2.05 ± 1.72, P < .05). Analysis of KL scores in patients with FV >24° (>1 standard deviation) versus patients with FV >14° but <24° also demonstrated a positive correlation between increasing FV and KL (4.00 ± 1.96 vs 2.34 ± 0). This was significant independent of the presence or absence of developmental dysplasia of the hip. Retroverted hips (FV<10°) in the present study showed variable OA results upon analysis. CONCLUSIONS The present review suggests that elevated FV may be a risk factor for more severe hip OA with or without the presence of concurrent dysplasia of the hip. The relative amount of increased anteversion appears positively correlated with severity of OA. Although femoral retroversion may impact hip mechanics, in this review it does not appear to strongly correlate with the development of OA. LEVEL OF EVIDENCE II: systematic review of Level I and II studies.
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Affiliation(s)
- Emily A Parker
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Alex M Meyer
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Momin Nasir
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Timothy S Brown
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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26
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Mohtajeb M, Cibere J, Mony M, Zhang H, Sullivan E, Hunt MA, Wilson DR. Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures. Bone Jt Open 2021; 2:988-996. [PMID: 34825828 PMCID: PMC8636292 DOI: 10.1302/2633-1462.211.bjo-2021-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Sullivan
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Mohtajeb M, Cibere J, Graffos A, Mony M, Zhang H, Hunt MA, Wilson DR. Open MRI validation of a hip model driven with subject-specific motion capture data in predicting anterior femoroacetabular clearance. BMC Musculoskelet Disord 2021; 22:972. [PMID: 34814875 PMCID: PMC8609822 DOI: 10.1186/s12891-021-04820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cam and/or pincer morphologies (CPM) are potential precursors to hip osteoarthritis (OA) and important contributors to non-arthritic hip pain. However, only some CPM hips develop OA and/or pain, and it is not clear why. Anterior impingement between the femoral head/neck contour and acetabular rim during motion is a proposed pathomechanism. Understanding how activity and deformity combine to produce impingement may shed light on the causes of hip degeneration/pain. The objective of this study was to determine the accuracy of a subject-specific hip model driven by subject-specific motion data in predicting anterior impingement. METHODS We recruited 22 participants with CPM (both with and without pain) and 11 controls. We collected subject-specific 3D kinematics during squatting and sitting flexion, adduction, and internal rotation (FADIR) (an active and a passive maneuver, respectively, proposed to provoke impingement). We then developed 3D subject-specific hip models from supine 3T hip MRI scans that predicted the beta angle (a measure of anterior femoroacetabular clearance) for each frame of acquired kinematics. To assess the accuracy of these predictions, we measured the beta angle directly in the final position of squatting and sitting FADIR using open MRI scans. We selected the frame of motion data matching the static imaged posture using the least-squares error in hip angles. Model accuracy for each subject was calculated as the absolute error between the open MRI measure of beta and the model prediction of beta at the matched time frame. To make the final model accuracy independent of goodness of match between open MRI position and motion data, a threshold was set for least-squares error in hip angles, and only participants that were below this threshold were considered in the final model accuracy calculation, yielding results from 10 participants for squatting and 7 participants for sitting FADIR. RESULTS For squatting and sitting FADIR, we found an accuracy of 1.1°(0.8°) and 1.3°(mean (SD), and root mean squared error, respectively) and 0.5°(0.3°) and 0.6°, respectively. CONCLUSION This subject-specific hip model predicts anterior femoroacetabular clearance with an accuracy of about 1°, making it useful to predict anterior impingement during activities measured with motion analysis.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
- Department of Orthopaedics, University of British Columbia, 7/F, 2635 Laurel Street, Vancouver, BC, V5Z1M9, Canada.
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28
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Kemp JL, Østerås N, Mathiessen A, Nordsletten L, Agricola R, Waarsing JH, Heerey JJ, Risberg MA. Relationship between cam morphology, hip symptoms, and hip osteoarthritis: the Musculoskeletal pain in Ullersaker STudy (MUST) cohort. Hip Int 2021; 31:789-796. [PMID: 32701366 DOI: 10.1177/1120700020943853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The primary aim of this study was to determine the prevalence of cam morphology in a cohort of people aged 40-55 years. Secondary aims were to: (1) determine differences in participant characteristics, physical impairments, radiographic and ultrasound appearances of people with and without cam morphology; and (2) explore associations between cam morphology and radiographic measures of hip osteoarthritis (OA). METHODS 107 people (68% women; 49 ± 4 years) from the Musculoskeletal pain in Ullensaker (MUST) Study underwent the clinical and imaging examinations. Examinations included questionnaires, hip range, functional task performance, pelvic radiographs and ultrasound. Alpha angle and radiographic hip OA (Kellgren Lawrence (KL) and minimal joint space (MJS)) were determined. RESULTS The prevalence of cam morphology was 42% and was bilateral in 47%. People with cam morphology were 6 times more likely to have a KL score ⩾2 (adjusted odds ratio [95% confidence intervals, p-value]) 6.386 [1.582-37.646, p = 0.012]) and 4 times more likely to have MJS <2.0 mm (adjusted odds ratio 4.032 [1.031-12.639, p = 0.045]). The prevalence of radiographic OA features ranged from 4-13% in people with cam morphology, and 0-3% in those without. Those with cam morphology also demonstrated reduced hip flexion and rotation range (p = 0.018-0.036) compared with those without. There was no association between ultrasonic features and patient reported outcomes, and cam morphology. CONCLUSIONS In a cohort aged 40-55 years, the prevalence of cam morphology was high (42%), with a significant relationship between cam morphology and radiographic measures of hip OA. Further longitudinal studies should explore the relationship between cam morphology and hip OA in younger people.
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29
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Migliorini F, Maffulli N. Arthroscopic Management of Femoroacetabular Impingement in Adolescents: A Systematic Review. Am J Sports Med 2021; 49:3708-3715. [PMID: 33740385 DOI: 10.1177/0363546521997138] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is highly prevalent in adolescent athletes. There has been an increasing trend for arthroscopic surgery for FAI, and the results of several clinical studies on outcome after arthroscopic surgery for FAI are available. PURPOSE To conduct a systematic review to investigate the role of arthroscopic management for FAI in adolescents. STUDY DESIGN Systematic review. METHODS This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In August 2020, PubMed, Scopus, Google Scholar, and EMBASE were accessed. All clinical trials concerning the arthroscopic treatment for adolescents with FAI were identified. Only studies on patients aged less than 18 years at the time of surgery reporting data over a minimum follow-up of 12 months were considered. RESULTS Data from 406 adolescents (470 procedures; mean age at surgery, 15.9 years; mean follow-up, 30.4 months) with FAI were retrieved. At a mean of 28.0 months of follow-up, 94% of the adolescents had already returned to sport. All the scores of interest were improved at the final follow-up: visual analog scale (P = .01), modified Harris Hip Score (P < .0001), Non-Arthritic Hip Score (P = .03), Hip Outcome Score-Activities of Daily Living (P = .01), Hip Outcome Score-Sport-Specific Subscale (P < .0001), and Tegner score (P < .0001). Complications occurred in 1.1% (5/470) of procedures, and revision arthroscopy was performed in 4.7% (22/470) of procedures. CONCLUSION Arthroscopic surgery in adolescents with FAI achieves excellent outcomes and a high rate of return to sport, with rates of complication and revision surgery of 1% and 5%, respectively.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
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30
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Casartelli NC, Maffiuletti NA, Valenzuela PL, Grassi A, Ferrari E, van Buuren MMA, Nevitt MC, Leunig M, Agricola R. Is hip morphology a risk factor for developing hip osteoarthritis? A systematic review with meta-analysis. Osteoarthritis Cartilage 2021; 29:1252-1264. [PMID: 34171473 DOI: 10.1016/j.joca.2021.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/27/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To appraise the highest evidence on hip morphology as a risk factor for developing hip osteoarthritis (OA). DESIGN We searched for studies evaluating the association between radiological hip morphology parameters and the prevalence, incidence or progression of hip OA (based on different radiographic and clinical criteria) in the MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library and PEDro databases from inception until June 2020. Prospective and cross-sectional studies were separately evaluated. Data are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS We included 9 prospective and 21 cross-sectional studies in the meta-analysis, and evaluated 42,831 hips from 25,898 individuals (mean age: 59 years). Prospective studies showed that, compared with control hips, hips with cam morphology (alpha angle >60°; OR = 2.52, 95% CI: 1.83 to 3.46, P < 0.001) or hip dysplasia (lateral center-edge angle (LCEA) <25°; OR = 2.38, 95% CI: 1.84 to 3.07, P < 0.001), but not hips with pincer morphology (LCEA >39°; OR = 1.08, 95% CI: 0.57 to 2.07, P = 0.810), were more likely to develop hip OA than hips without these morphologies. Cross-sectional studies showed a greater prevalence of pincer morphology (LCEA >39°, OR = 3.71, 95% CI: 2.98 to 4.61, P < 0.001) and acetabular retroversion (crossover sign; OR = 2.65, 95% CI: 1.17 to 6.03, P = 0.020) in hips with OA than in control hips. CONCLUSION Cam morphology and hip dysplasia were consistently associated with the development of hip OA. Pincer morphology was associated with hip OA in cross-sectional but not in prospective studies. The heterogeneous quantification of pincer morphology on radiographs limits a clear conclusion on its association with hip OA.
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Affiliation(s)
- N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - A Grassi
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - E Ferrari
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - M Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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31
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Wilkinson JM, Zeggini E. The Genetic Epidemiology of Joint Shape and the Development of Osteoarthritis. Calcif Tissue Int 2021; 109:257-276. [PMID: 32393986 PMCID: PMC8403114 DOI: 10.1007/s00223-020-00702-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed.
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Affiliation(s)
- J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
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32
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Predictors of total hip replacement in community based older adults: a cohort study. Osteoarthritis Cartilage 2021; 29:1130-1137. [PMID: 33965528 DOI: 10.1016/j.joca.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to describe predictors of total hip replacement (THR) in community dwelling older adults. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. DESIGN At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores and hip bone mineral density (BMD; from dual energy X-ray absorptiometry (DXA)). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. RESULTS Incidence of THR for OA over 14 years was 4.6% (37/801). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.83/SD; 95% CI 1.1-3.04), shape mode 4 score (non-spherical femoral head) (RR 0.59/SD; 95% CI 0.36-0.96), cam morphology (α > 60°) (RR 2.2/SD; 95% CI 1.33-3.36), neck of femur BMD (RR 2.09/SD, 95% CI 1.48-2.94) and bone marrow lesions (BMLs) increased risk of THR (RR 7.10/unit; 95% CI 1.09-46.29). CONCLUSION In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.
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33
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Annin S, Lall AC, Yelton MJ, Shapira J, Rosinsky PJ, Meghpara MB, Maldonado DR, Ankem H, Domb BG. Patient-Reported Outcomes in Athletes Following Hip Arthroscopy for Femoroacetabular Impingement With Subanalysis on Return to Sport and Performance Level: A Systematic Review. Arthroscopy 2021; 37:2657-2676. [PMID: 33887407 DOI: 10.1016/j.arthro.2021.03.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify present trends in demographics, surgical indications, preoperative findings, and surgical treatment of athletes undergoing hip arthroscopy for femoroacetabular impingement and (2) to investigate the outcomes in this patient population, including patient-reported outcome scores (PROS), return-to-sport, complications, and reoperation data at minimum 2-year follow-up in the athletic population. METHODS Cochrane, Embase, and PubMed databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to distinguish articles that reported PROS after hip arthroscopy in athletes. Athletes were defined as anyone who played a sport for minimum 2 years at any level. The standardized mean difference was calculated to compare the effect size of hip arthroscopy on various PROS. RESULTS Eighteen studies, with 904 athlete hips and a collective study period of January 1993 to April 2017, were included in this systematic review. Across all studies, the mean age and body mass index ranged from 15.7-36.7 years and 20.3-26.3, respectively. The follow-up range was 24-240 months. Mean preoperative alpha angle ranged from 57.7° to 80.0°. Athletes most commonly underwent femoroplasty and labral management. At latest follow-up, the modified Harris Hip Score were excellent in 6 studies (range, 92.1-98), good in 10 studies (range, 84.2-88.5), and fair in 1 study (77.1). Each studies' individual athletic cohort showed significant improvement on the modified Harris Hip Score, Nonarthritic Hip Score, the Hip Outcome Score-Activities of Daily Living, the Hip Outcome Score-Sport-Specific Subscale, visual analog scale for pain, and International Hip Outcome Tool at latest follow-up (P < .05). The return-to-sport rate ranged from 72.7% to 100%, with 74.2-100% of these athletes returning to preinjury or greater level. CONCLUSIONS Athletes undergoing arthroscopic hip surgery in the setting of femoroacetabular impingement, not only exhibit significant functional improvement, but also have a high rate of return to sport at the same or greater competition level compared with preinjury level. LEVEL OF EVIDENCE IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Shawn Annin
- American Hip Institute Research Foundation, Chicago
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates; American Hip Institute, Chicago, Illinois, U.S.A
| | | | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates
| | | | - Hari Ankem
- American Hip Institute Research Foundation, Chicago
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates; American Hip Institute, Chicago, Illinois, U.S.A..
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34
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Dijkstra HP, Ardern CL, Serner A, Mosler AB, Weir A, Roberts NW, Mc Auliffe S, Oke JL, Khan KM, Clarke M, Glyn-Jones S. Primary cam morphology; bump, burden or bog-standard? A concept analysis. Br J Sports Med 2021; 55:1212-1221. [PMID: 34281962 PMCID: PMC8551977 DOI: 10.1136/bjsports-2020-103308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. DESIGN We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex 'concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. RESULTS We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. CONCLUSION We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape-a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
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Affiliation(s)
- H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, UK .,Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Clare L Ardern
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia.,Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | - Andreas Serner
- Research & Scientific Support, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Nia Wyn Roberts
- Bodleain Health Care Libraries, University of Oxford Bodleian Libraries, Oxford, UK
| | - Sean Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, Qatar University, Doha, Qatar
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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35
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Winge S, Winge S, Kraemer O, Dippmann C, Hölmich P. Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) in adolescents—5-year follow-up. J Hip Preserv Surg 2021; 8:249-254. [PMID: 35414955 PMCID: PMC8994113 DOI: 10.1093/jhps/hnab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
To report the minimum 5-year outcome after hip arthroscopy with labral repair in adolescents. From 2011 to 2014, 29 consecutive patients with a mean age 16.3 years (range 12.7–19.8 years) underwent hip arthroscopy treatment for femoroacetabular impingement syndrome. Patient-related outcome measures (PROMs) including modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for pain and Copenhagen Hip and Groin Outcome Score (HAGOS) were used preoperatively and at follow-up (FU). Percentage of patients achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for mHHS and HAGOS were determined. Mean FU was 6.7 years (range 5–9.6 years), and a 100% FU was accomplished. Significant improvements were seen for all PROMs at FU in patients not having a periacetabular osteotomy (PAO) with VAS pain score improving from mean 62 to 9, mHHS from 58 to 94 and HAGOS improved in all subgroups. For mHHS, SCB changes were achieved by 76% and MCID by 76% of the patients. Percentage of patients achieving MCID for HAGOS subgroups were 81% for pain, 67% for symptoms, 76% for physical function in daily living, 76% for physical function in sport and recreation, 81% for participation in physical activities and 81% for hip-related quality of life. Two patients had revision hip arthroscopy. PAO was later performed in three patients. The risk of further surgery with center edge (CE) bony edge (CEB) <30° was 42% and 0% with CEB ≥30°. Adolescents having hip arthroscopy with labral repair and resection of cam and pincer morphology achieve significant improvements at mean 6.7 years of FU. CEB < 30° increases the risk of further surgery.
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Affiliation(s)
- Søren Winge
- CPH Private Hospital, Rådhustorvet 4, Farum 3520, Denmark
| | - Sophie Winge
- Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, Copenhagen Ø 2100, Denmark
| | - Otto Kraemer
- Section of Sport Traumatology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg Bakke, Copenhagen 2400, Denmark
| | - Christian Dippmann
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegaard alle 30, Hvidovre 2650, Denmark
| | - Per Hölmich
- Section of Sport Traumatology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg Bakke, Copenhagen 2400, Denmark
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36
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Klontzas ME, Volitakis E, Aydingöz Ü, Chlapoutakis K, Karantanas AH. Machine learning identifies factors related to early joint space narrowing in dysplastic and non-dysplastic hips. Eur Radiol 2021; 32:542-550. [PMID: 34136948 DOI: 10.1007/s00330-021-08070-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To utilise machine learning, unsupervised clustering and multivariate modelling in order to predict severe early joint space narrowing (JSN) from anatomical hip parameters while identifying factors related to joint space width (JSW) in dysplastic and non-dysplastic hips. METHODS A total of 507 hip CT examinations of patients 20-55 years old were retrospectively examined, and JSW, center-edge (CE) angle, alpha angle, anterior acetabular sector angle (AASA), and neck-shaft angle (NSA) were recorded. Dysplasia and severe JSN were defined with CE angle < 25o and JSW< 2 mm, respectively. A random forest classifier was developed to predict severe JSN based on anatomical and demographical data. Multivariate linear regression and two-step unsupervised clustering were performed to identify factors linked to JSW. RESULTS In dysplastic hips, lateral or anterior undercoverage alone was not correlated to JSN. AASA (p < 0.005) and CE angle (p < 0.032) were the only factors significantly correlated with JSN in dysplastic hips. In non-dysplastic hips, JSW was inversely correlated to CE angle, AASA, and age and positively correlated to NSA (p < 0.001). A random forest classifier predicted severe JSN (AUC 69.9%, 95%CI 47.9-91.8%). TwoStep cluster modelling identified two distinct patient clusters one with low and one with normal JSW and different anatomical characteristics. CONCLUSION Machine learning predicted severe JSN and identified population characteristics related to normal and abnormal joint space width. Dysplasia in one plane was found to be insufficient to cause JSN, highlighting the need for hip anatomy assessment on multiple planes. KEY POINTS • Neither anterior nor lateral acetabular dysplasia was sufficient to independently reduce joint space width in a multivariate linear regression model of dysplastic hips. • A random forest classifier was developed based on measurements and demographic parameters from 507 hip joints, achieving an area under the curve of 69.9% in the external validation set, in predicting severe joint space narrowing based on anatomical hip parameters and age. • Unsupervised TwoStep cluster analysis revealed two distinct population groups, one with low and one with normal joint space width, characterised by differences in hip morphology.
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Affiliation(s)
- Michail E Klontzas
- International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE), Heraklion, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Volitakis
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Üstün Aydingöz
- International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE), Heraklion, Greece
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Konstantinos Chlapoutakis
- International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE), Heraklion, Greece
- Department of Radiology, Vioapeikonisi Imaging Lab, Arkoleon 9, 71202, Heraklion, Greece
| | - Apostolos H Karantanas
- International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE), Heraklion, Greece.
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece.
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece.
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece.
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37
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van Buuren MMA, Arden NK, Bierma-Zeinstra SMA, Bramer WM, Casartelli NC, Felson DT, Jones G, Lane NE, Lindner C, Maffiuletti NA, van Meurs JBJ, Nelson AE, Nevitt MC, Valenzuela PL, Verhaar JAN, Weinans H, Agricola R. Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2021; 29:607-618. [PMID: 33338641 DOI: 10.1016/j.joca.2020.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
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Affiliation(s)
- M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland; Laboratory of Exercise and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - D T Felson
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A E Nelson
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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38
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Westermann RW, Schaver A. Editorial Commentary: With Properly Indicated and Performed Surgery, We Can (Hopefully) Prevent Osteoarthritis in Patients With Hip Femoroacetabular Impingement. Arthroscopy 2021; 37:1026-1027. [PMID: 33673957 DOI: 10.1016/j.arthro.2020.12.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 02/02/2023]
Abstract
Surgical treatment of femoroacetabular impingement (FAI) syndrome has been proven to be tremendously successful, outperforming the best conservative care and physical therapy in several prospective multicenter randomized controlled trials. The durability of this operation over time is less commonly reported on. We do know that FAI is associated with the development of hip osteoarthritis, and this is well established. We also know that surgical FAI treatment results in good short-term return to function/sport and improvements in patient-reported outcomes. We do not yet know if we are able to alter the natural history of FAI and prevent or delay conversion to total hip arthroplasty in this population.
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Abstract
Femoral version is extremely variable between patients presenting with femoroacetabular impingement (FAI). Careful and routine measurement of femoral anteversion is essential in comprehensive preoperative planning. In general, low degrees of femoral version can lead to anterior impingement (especially on the subspine and distal medial femoral neck). High degrees of anteversion can be seen in the setting of acetabular dysplasia and can lead to anterior hip instability and or posterior impingement. In this article, the authors will discuss the role of routine femoral version management for optimal outcomes after hip arthroscopy for FAI.
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Affiliation(s)
- Robert W Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
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40
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Hartley A, Hardcastle SA, Frysz M, Parkinson J, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Williams M, Tobias JH, Gregson CL. Increased development of radiographic hip osteoarthritis in individuals with high bone mass: a prospective cohort study. Arthritis Res Ther 2021; 23:4. [PMID: 33407835 PMCID: PMC7788917 DOI: 10.1186/s13075-020-02371-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Individuals with high bone mass (HBM) have a greater odds of prevalent radiographic hip osteoarthritis (OA), reflecting an association with bone-forming OA sub-phenotypes (e.g. osteophytosis, subchondral sclerosis). As the role of bone mineral density (BMD) in hip OA progression is unclear, we aimed to determine if individuals with HBM have increased incidence and/or progression of bone-forming OA sub-phenotypes. METHODS We analysed an adult cohort with and without HBM (L1 and/or total hip BMD Z-score > + 3.2) with pelvic radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Superior/inferior acetabular/femoral osteophyte and medial/superior joint space narrowing (JSN) grades were summed and Δosteophyte and ΔJSN derived. Pain and functional limitations were quantified using the WOMAC questionnaire. Associations between HBM status and change in OA sub-phenotypes were determined using multivariable linear/logistic regression, adjusting for age, sex, height, total body fat mass, follow-up time and baseline sub-phenotype grade. Generalised estimating equations accounted for individual-level clustering. RESULTS Of 136 individuals, 62% had HBM at baseline, 72% were female and mean (SD) age was 59 (10) years. HBM was positively associated with both Δosteophytes and ΔJSN (adjusted mean grade differences between individuals with and without HBM βosteophyte = 0.30 [0.01, 0.58], p = 0.019 and βJSN = 0.10 [0.01, 0.18], p = 0.019). Incident subchondral sclerosis was rare. HBM individuals had higher WOMAC hip functional limitation scores (β = 8.3 [0.7, 15.98], p = 0.032). CONCLUSIONS HBM is associated with the worsening of hip osteophytes and JSN over an average of 8 years, as well as increased hip pain and functional limitation.
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Affiliation(s)
- April Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Sarah A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Parkinson
- Division of Informatics, Imaging & Data Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eugene McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK.,Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK.,Centre for Integrated Research into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - Kenneth E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mo Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Katie Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - Martin Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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41
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Faber BG, Ebsim R, Saunders FR, Frysz M, Davey Smith G, Cootes T, Tobias JH, Lindner C. Deriving alpha angle from anterior-posterior dual-energy x-ray absorptiometry scans: an automated and validated approach. Wellcome Open Res 2021; 6:60. [PMID: 36072553 PMCID: PMC9426635 DOI: 10.12688/wellcomeopenres.16656.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: Alpha angle (AA) is a widely used measure of hip shape that is commonly used to define cam morphology, a bulging of the lateral aspect of the femoral head. Cam morphology has shown strong associations with hip osteoarthritis (OA) making the AA a clinically relevant measure. In both clinical practice and research studies, AA tends to be measured manually which can be inconsistent and time-consuming. Objective: We aimed to (i) develop an automated method of deriving AA from anterior-posterior dual-energy x-ray absorptiometry (DXA) scans; and (ii) validate this method against manual measures of AA. Methods: 6,807 individuals with left hip DXAs were selected from UK Biobank. Outline points were manually placed around the femoral head on 1,930 images before training a Random Forest-based algorithm to place the points on a further 4,877 images. An automatic method for calculating AA was written in Python 3 utilising these outline points. An iterative approach was taken to developing and validating the method, testing the automated measures against independent batches of manually measured images in sequential experiments. Results: Over the course of six experimental stages the concordance correlation coefficient, when comparing the automatic AA to manual measures of AA, improved from 0.28 [95% confidence interval 0.13-0.43] for the initial version to 0.88 [0.84-0.92] for the final version. The inter-rater kappa statistic comparing automatic versus manual measures of cam morphology, defined as AA ³≥60°, improved from 0.43 [80% agreement] for the initial version to 0.86 [94% agreement] for the final version. Conclusions: We have developed and validated an automated measure of AA from DXA scans, showing high agreement with manually measuring AA. The proposed method is available to the wider research community from Zenodo.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
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42
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McCrum CL. Editorial Commentary: Lumbosacral Anatomy and Mechanics Influence Femoroacetabular Impingement Syndrome and Surgical Outcomes: The Hip Bone Is Connected to the Back Bone. Arthroscopy 2021; 37:156-158. [PMID: 33384080 DOI: 10.1016/j.arthro.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
The hip joint in general and femoroacetabular impingement (FAI) in particular do not exist in a vacuum. Impingement kinematics are very closely tied to the relationship between spinopelvic motion and posture, and that of the hip joint itself. While the relationship of lumbar degenerative disease, fusion, and sagittal balance to hip arthroplasty has been well studied, there is a paucity of data on the analogous relationship of the stiff spine with hip arthroscopy and FAI. While further studies are critical in advancing our understanding of this relationship in this unique population, surgeons still must consider the relationship of lumbosacral motion and posture, including the anatomic variant of lumbosacral transitional vertebrae, when evaluating and treating patients with FAI.
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43
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Faber BG, Ebsim R, Saunders FR, Frysz M, Davey Smith G, Cootes T, Tobias JH, Lindner C. Deriving alpha angle from anterior-posterior dual-energy x-ray absorptiometry scans: an automated and validated approach. Wellcome Open Res 2021; 6:60. [PMID: 36072553 PMCID: PMC9426635 DOI: 10.12688/wellcomeopenres.16656.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction: Alpha angle (AA) is a widely used imaging measure of hip shape that is commonly used to define cam morphology, a bulging of the lateral aspect of the femoral head. Cam morphology has shown strong associations with hip osteoarthritis (OA) making the AA a clinically relevant measure. In both clinical practice and research studies, AA tends to be measured manually which can be inconsistent and time-consuming. Objective: We aimed to (i) develop an automated method of deriving AA from anterior-posterior dual-energy x-ray absorptiometry (DXA) scans; and (ii) validate this method against manual measures of AA. Methods: 6,807 individuals with left hip DXAs were selected from UK Biobank. Outline points were manually placed around the femoral head on 1,930 images before training a Random Forest-based algorithm to place the points on a further 4,877 images. An automatic method for calculating AA was written in Python 3 utilising these outline points. An iterative approach was taken to developing and validating the method, testing the automated measures against independent batches of manually measured images in sequential experiments. Results: Over the course of six experimental stages the concordance correlation coefficient, when comparing the automatic AA to manual measures of AA, improved from 0.28 [95% confidence interval 0.13-0.43] for the initial version to 0.88 [0.84-0.92] for the final version. The inter-rater kappa statistic comparing automatic versus manual measures of cam morphology, defined as AA ³≥60°, improved from 0.43 [80% agreement] for the initial version to 0.86 [94% agreement] for the final version. Conclusions: We have developed and validated an automated measure of AA from DXA scans, showing high agreement with manually measuring AA. The proposed method is available to the wider research community from Zenodo.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
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44
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Clinical and radiological hip parameters do not precede, but develop simultaneously with cam morphology: a 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1401-1410. [PMID: 33001216 PMCID: PMC8038954 DOI: 10.1007/s00167-020-06282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated with cam morphology or (2) precede cam morphology development. METHODS Young male football players participated at baseline (n = 89, 12-19 years of age), 2.5-year (n = 63) and 5-year follow-up (n = 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck-shaft angle (NSA), epiphyseal extension (EE), lateral center-edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively. RESULTS A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development. CONCLUSION Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology. LEVEL OF EVIDENCE Level II.
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45
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Collis RW, McCullough AB, Ng C, Prather H, Colditz GA, Clohisy JC, Cheng AL. Rate of Surgery and Baseline Characteristics Associated With Surgery Progression in Young Athletes With Prearthritic Hip Disorders. Orthop J Sports Med 2020; 8:2325967120969863. [PMID: 33294476 PMCID: PMC7705795 DOI: 10.1177/2325967120969863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Prearthritic hip disorders (PAHD), such as femoroacetabular impingement
(FAI), acetabular dysplasia, and acetabular labral tears, are a common cause
of pain and dysfunction in adolescent and young adult athletes, and optimal
patient-specific treatment has not been defined. Operative management is
often recommended, but conservative management may be a reasonable approach
for some athletes. Purpose: To identify (1) the relative rate of progression to surgery in self-reported
competitive athletes versus nonathletes with PAHD and (2) baseline
demographic, pain, and functional differences between athletes who proceeded
versus those who did not proceed to surgery within 1 year of evaluation. Study Design: Cohort study; Level of evidence, 3. Methods: An electronic medical record review was performed of middle school, high
school, and college patients who were evaluated for PAHD at a single
tertiary-care academic medical center between June 22, 2015, and May 1,
2018. Extracted variables included patients’ self-reported athlete status,
decision to choose surgery within 1 year of evaluation, and baseline
self-reported pain and functional scores on Patient-Reported Outcomes
Measurement Information System (PROMIS) domains, the Hip disability and
Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score. Results: Of 260 eligible patients (289 hips), 203 patients (78%; 227 hips) were
athletes. Athletes were no more likely to choose surgery than nonathletes
(130/227 hips [57%] vs 36/62 hips [58%]; relative risk [RR], 0.99 [95% CI,
0.78-1.25]). Among athletes, those who proceeded to surgery over
conservative care were more likely to be female (81% vs 69%; RR, 1.34 [95%
CI, 0.98-1.83]) and had more known imaging abnormalities (FAI: 82% vs 69%,
RR, 1.47 [95% CI, 1.09-1.99]; dysplasia: 48% vs 27%, RR, 1.44 [95% CI,
1.16-1.79]; mixed deformity: 30% vs 10%, RR, 2.91 [95% CI, 1.53-5.54]; known
labral tear: 84% vs 40%, RR, 2.79 [95% CI, 2.06-3.76]). Athletes who chose
surgery also reported worse baseline hip-specific symptoms on all HOOS
subscales (mean difference, 10.8-17.7; P < .01 for
all). Conclusion: Similar to nonathletes, just over half of athletes with PAHD chose surgical
management within 1 year of evaluation. Many competitive athletes with PAHD
continued with conservative management and deferred surgery, but more
structural hip pathology and worse hip-related baseline physical impairment
were associated with the choice to pursue surgery.
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Affiliation(s)
- Reid W Collis
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrea B McCullough
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Ng
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heidi Prather
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Division of Adult Reconstruction and Hip Preservation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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46
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Abdulrahim H, Jiao Q, Swain S, Sehat K, Sarmanova A, Muir K, Zhang W, Doherty M. Constitutional morphological features and risk of hip osteoarthritis: a case-control study using standard radiographs. Ann Rheum Dis 2020; 80:494-501. [PMID: 33229363 DOI: 10.1136/annrheumdis-2020-218739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the risk of association with hip osteoarthritis (OA) of 14 morphological features measured on standard antero-posterior pelvis radiographs. METHODS A case-control study of 566 symptomatic unilateral hip OA cases and 1108 controls without hip OA, using the Genetics of OA and Lifestyle database. Unaffected hips of cases were assumed to reflect pre-OA morphology of the contralateral affected hip. ORs with 95% CI adjusted for confounding factors were calculated using logistic regression. Hierarchical clustering on principal component method was used to identify clusters of morphological features. Proportional risk contribution (PRC) of these morphological features in the context of other risk factors of hip OA was estimated using receiver operating characteristic analysis. RESULTS All morphological features showed right-left symmetry in controls. Each feature was associated with hip OA after adjusting for age, gender and body mass index. Increased sourcil angle had the strongest association (OR: 6.93, 95% CI 5.16 to 9.32). Three clusters were identified. The PRC varied between individual features, as well as between clusters. It was 35% (95% CI 31% to 40%) for all 14 morphological features, compared to 21% (95% CI 19% to 24%) for all other well-established risk factors. CONCLUSIONS Constitutional morphological variation strongly associates with hip OA development and may explain much of its heritability. Relevant morphological measures can be assessed readily on standard radiographs to help predict risk of hip OA. Prospective studies are required to provide further support for causality.
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Affiliation(s)
| | - Qiang Jiao
- Orthopaedic Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | | | - Khosrow Sehat
- Orthopaedic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, University of Bristol, Bristol Medical School, Bristol, UK
| | - Kenneth Muir
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
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47
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Wininger AE, Barter LE, Boutris N, Pulido LF, Ellis TJ, Nho SJ, Harris JD. Hip arthroscopy for lateral cam morphology: how important are the vessels? J Hip Preserv Surg 2020; 7:183-194. [PMID: 33163203 PMCID: PMC7605776 DOI: 10.1093/jhps/hnaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/17/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this narrative review is to identify the anatomy and relevant blood supply to the femoral head as it pertains to hip arthroscopy and lateral cam morphology. The primary blood supply to the femoral head is the lateral ascending superior retinacular vessels, which are terminal branches of the medial femoral circumflex artery. These vessels penetrate the femoral head at the posterolateral head–neck junction. Surgeons performing posterolateral femoral osteoplasty must respect this vasculature to avoid iatrogenic avascular necrosis (AVN). Avoidance of excessive traction, avoidance of distal posterolateral capsulotomy and avoidance of disruption of the superior retinacular vessels should keep the risk for AVN low. Hip extension, internal rotation and distraction are useful in hip arthroscopy to better visualize lateral/posterolateral cam morphology to facilitate an accurate comprehensive cam correction and avoid vascular disruption.
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Affiliation(s)
- Austin E Wininger
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Lindsay E Barter
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Nickolas Boutris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Luis F Pulido
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Thomas J Ellis
- Orthopedic One, 4605 Sawmill Road, Upper Arlington, OH 43220, USA
| | - Shane J Nho
- Midwest Orthopedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
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48
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Seth A, Yen YM, Tourn D, Smit K, Carsen S. A Unique and Characteristic Cam FAI Morphology in Young Patients with Comorbid Inflammatory Conditions. J Bone Joint Surg Am 2020; 102:15-21. [PMID: 32453107 DOI: 10.2106/jbjs.20.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between femoroacetabular impingement (FAI) and inflammatory medical comorbidities has not been established in the pediatric population. The purpose of this study was to investigate the prevalence of inflammatory conditions in pediatric patients with FAI and the morphology of the associated deformity. METHODS We performed a retrospective cohort study of 90 patients who were diagnosed with FAI in our institution's adolescent hip clinic from January 2016 to March 2018. Patients with an inflammatory comorbidity were identified. Standard quantitative radiographic FAI measurements as well as qualitative femoral head-neck junction morphology were analyzed. RESULTS Eight patients (8.9%) with 11 symptomatic hips were found to have an inflammatory condition. These 8 patients all had cam deformities. Nine of the symptomatic hips in this subset of patients had a negative femoral offset, where the cam deformity extended beyond the anterior margin of the femoral head. Qualitative assessment revealed a unique head-neck morphology with a prominent and "sharp-edged" bump at the head-neck junction, which resembled an inflammatory beak. In comparing patients with and without inflammatory comorbidities, a marked difference was found for alpha angles (difference, 26.6°; 95% confidence interval [CI], 18.2° to 35.0°) but not for age at diagnosis (difference, 0.5 years; 95% CI, -0.8 to 1.6 years) or the lateral center-edge angle (difference, 1.9°; 95% CI, -3.9° to 7.7°). CONCLUSIONS At our institution, 8.9% of pediatric patients with FAI were found to have an inflammatory comorbidity. These patients presented with a characteristic prominent "sharp-edged" head-neck morphology that standard radiographic measurements captured as a negative femoral offset and a larger alpha angle than was seen in patients without systemic inflammatory disease. Awareness of the characteristic cam deformity that was found in these patients may help to identify patients with undiagnosed inflammatory conditions. This unique deformity also raises questions regarding the possible role of physeal inflammation in the development of cam deformities and indicates a need for additional studies to investigate the relationship between systemic inflammatory diseases and FAI. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Akshay Seth
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diego Tourn
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Abrahamson J, Jónasson P, Sansone M, Aminoff AS, Todd C, Karlsson J, Baranto A. Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up. J Orthop Surg Res 2020; 15:444. [PMID: 32993723 PMCID: PMC7523319 DOI: 10.1186/s13018-020-01952-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers. METHOD All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire. RESULTS A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries. CONCLUSION Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.
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Affiliation(s)
- Josefin Abrahamson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
- Orthopaedic Research Unit, Sahlgrenska University Hospital, R-house, Level 7, 431 80, Mölndal, Sweden.
| | - Pall Jónasson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Swärd Aminoff
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Todd
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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50
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van Klij P, Reiman MP, Waarsing JH, Reijman M, Bramer WM, Verhaar JAN, Agricola R. Classifying Cam Morphology by the Alpha Angle: A Systematic Review on Threshold Values. Orthop J Sports Med 2020; 8:2325967120938312. [PMID: 32844100 PMCID: PMC7418265 DOI: 10.1177/2325967120938312] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The alpha angle is the most often used measure to classify cam morphology. There is currently no agreement on which alpha angle threshold value to use. Purpose To systematically investigate the different alpha angle threshold values used for defining cam morphology in studies aiming to identify this threshold and to determine whether data are consistent enough to suggest an alpha angle threshold to classify cam morphology. Study Design Systematic review; Level of evidence, 3. Methods The Embase, Medline (Ovid), Web of Science, Cochrane Central, and Google Scholar databases were searched from database inception to February 28, 2019. Studies aiming at identifying an alpha angle threshold to classify cam morphology were eligible for inclusion. Results We included 4 case-control studies, 10 cohort studies, and 1 finite-element study from 2437 identified publications. Studies (n = 3) using receiver operating characteristic (ROC) curve analysis to distinguish asymptomatic people from patients with femoroacetabular impingement syndrome consistently observed alpha angle thresholds between 57° and 60°. A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported. Conclusion Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
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Affiliation(s)
- Pim van Klij
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jan H Waarsing
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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