Hip MRI and Its Implications for Surgery in Osteoarthritis Patients

Evaluation of focal cartilage lesions of the knee using MRI T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC)

Background

Assessment of degenerative changes of the cartilage is important in knee cartilage repair surgery. Magnetic Resonance Imaging (MRI) T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) are able to detect early degenerative changes. The hypothesis of the study was that cartilage surrounding a focal cartilage lesion in the knee does not possess degenerative changes.

Methods

Twenty-eight consecutive patients included in a randomized controlled trial on cartilage repair were evaluated using MRI T2 mapping and dGEMRIC before cartilage treatment was initiated. Inclusion was based on disabling knee problems (Lysholm score of ≤ 75) due to an arthroscopically verified focal femoral condyle cartilage lesion. Furthermore, no major malalignments or knee ligament injuries were accepted. Mean patient age was 33 ± 9.6 years, and the mean duration of knee symptoms was 49 ± 60 months. The MRI T2 mapping and the dGEMRIC measurements were performed at three standardized regions of interest (ROIs) at the medial and lateral femoral condyle, avoiding the cartilage lesion

Results

The MRI T2 mapping of the cartilage did not demonstrate significant differences between condyles with or without cartilage lesions. The dGEMRIC results did not show significantly lower values of the affected condyle compared with the opposite condyle and the contra-lateral knee in any of the ROIs. The intraclass correlation coefficient (ICC) of the dGEMRIC readings was 0.882.

Conclusion

The MRI T2 mapping and the dGEMRIC confirmed the arthroscopic findings that normal articular cartilage surrounded the cartilage lesion, reflecting normal variation in articular cartilage quality.

Study identifier

NCT00885729, registered April 17 2009.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-0941-y) contains supplementary material, which is available to authorized users.

Hip arthroscopy: state of the art

INTRODUCTION

The unique anatomy of the hip is challenging, and has slowed the progress of hip arthroscopy. The aim of this review is to provide an updated synthesis of existing clinical evidence on hip arthroscopy.

SOURCES OF DATA

A systematic computerized literature search was conducted by two independent reviewers using an iterative manipulation process of the keywords used singularly or in combination. The following databases were accessed on 30th November, 2009: PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez/); Ovid (http://www.ovid.com); and Cochrane Reviews (http://www.cochrane.org/reviews/). Case reports, literature reviews, letters to editors and articles not including outcome measures were excluded. Twenty-three publications met the inclusion criteria and were included.

AREAS OF AGREEMENT

Hip arthroscopy can provide an alternative to traditional arthrotomy with great therapeutic potential. However, the available data do not allow definitive conclusion on its routine use.

AREAS OF CONTROVERSY

It is still unclear whether arthroscopy is superior to open surgery in the management of femoroacetabular impingement and labral lesions.

GROWING POINTS

Rather than providing strong evidence for or against the use of hip arthroscopy, this study generates potential areas for additional prospective investigations to evaluate the role of hip arthroscopy in clinical practice.

AREAS TIMELY FOR DEVELOPING RESEARCH

There is a need to perform appropriately planned and powered studies to clarify the role of arthroscopy in hip pathology.