The genetic contribution to hip joint morphometry and relationship to hip cartilage thickness

The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips

AIM

To examine the pathogenesis and clinical presentation of sports-related femoroacetabular impingement (SRFAI) in a large consecutive series of symptomatic athletes.

METHODS

Between January 2009 and February 2017 prospectively collected data from competitive athletes within the Gaelic Athletic Association (GAA), and who subsequently underwent arthroscopic treatment for symptomatic FAI, were analysed. Data was collected using internationally validated health questionnaires (Harris Hip Score, UCLA, SF-36, WOMAC) and recognised clinical (ROM, symptom presentation, provocation tests) and radiological (AP pelvis, Dunn, False profile) indicators/measures of FAI.

RESULTS

A total of 1021 consecutive cases (mean 26.6 ± 6.2 years) were included. In every case, conservative treatment failed to resolve symptoms with athletes attending an average of 2.4 ± 1.1 health care professionals prior to referral. Symptoms developed gradually (78%) and consisted primarily of groin pain (76.1%) and hip stiffness (76.5%) following activity. An acetabular rim deformity (pincer) was present in all cases; a cam deformity in 72.1%. The prevalence and degree of cam deformity increased with progressing age groups (p < 0.001); mean lateral centre-edge angle remained static (p = 0.456). Increasing CEA, alpha angle and presence of rim fracture was associated with a reduction in all ranges of hip movement (p < 0.001).

CONCLUSION

Symptomatic SRFAI presented in this large series of GAA athletes failed to resolve with non-operative treatment. Increasing hip deformity resulted in poorer ROM. Abnormal acetabular morphology remains static with increasing athletic age while cam deformity is progressive and most likely a secondary pathology.

Shape variability of the adult human acetabulum and acetabular fossa related to sex and age by geometric morphometrics. Implications for adult age estimation

This study aims to explore shape variability of the acetabulum during the human adult life span, in relation to sex and age. The human acetabular shape was analysed in 682 os coxae from three different documented skeletal collections from the Iberian Peninsula. Two landmarks and thirty-two sliding semi-landmarks were used for the geometric morphometric procedures and a clock-wise standard was used for orientation. The 180° meridian (6:00) line was positioned over the midpoint of the acetabular notch and 36 reference points in 10° increments along the rim were marked. Data showed that size, sex and age significantly influence acetabular shape variation. Sex differences were significant in individuals younger than 65 years old and were characterised by males exhibiting relatively extended acetabular rim profiles from 10:00 to 1:00, narrower acetabular notches, and reduced acetabular fossae. In addition, three main age-related changes occurred to the acetabular shape in both sexes: outer acetabular profile modification, with extension from 10:00 to 1:00 and reduction from 7:00 to 9:00, acetabular notch narrowing, and acetabular fossa reduction. The age-related changes that were observed are shared by both sexes and seem to be related to bone production associated with age. Specifically, age appears to affect the entire border of the lunate surface: the acetabular rim, both acetabular horns, and the outer edge of the acetabular fossa. Furthermore, shape data confirmed the clover-leaf shape of the acetabular fossa in both males and females. These results improve our understanding of acetabular shape, and assist in refining age-estimation methods and enhancing hip surgery and rehabilitation.

The diagnosis and management of femoro-acetabular impingement

INTRODUCTION

Femoro-acetabular impingement (FAI) was first described in 1999 as abnormal abutment between the acetabulum and the femoral head and neck. Since then, it has been shown to be responsible for many acetabular labral tears and is implicated in the aetiology of osteoarthritis of the hip. This review introduces the concept of FAI and reports the key aspects of its diagnosis and management.

MATERIALS AND METHODS

A comprehensive search of the literature was conducted using the Pubmed database. Articles relating to the aetiology, pathophysiology, clinical features, diagnosis and treatment of FAI were reviewed. Search terms included femoro-acetabular impingement, arthroscopic treatment, open treatment, aetiology, pathophysiology. The search was limited to articles published in English. All articles were read in full by the authors and selected for inclusion based on relevance to the article.

RESULTS

An increasing number of studies relating to FAI have been produced in the 10 years since its recognition. A range of clinical and radiological features have been described. Surgical management can be performed using a number of techniques, with promising results from various studies. Early treatment with open surgery has paved the way for less invasive and arthroscopic approaches, with short-to-medium term data demonstrating favourable functional results for arthroscopic treatment of FAI.

CONCLUSIONS

A greater awareness of the diagnostic features of FAI, and the various management options available, will allow timely diagnosis and treatment of a relatively newly recognised syndrome. Early treatment may then help to prevent progression to end-stage osteoarthritis of the hip.

The effects of exercise on human articular cartilage

The effects of exercise on articular hyaline articular cartilage have traditionally been examined in animal models, but until recently little information has been available on human cartilage. Magnetic resonance imaging now permits cartilage morphology and composition to be analysed quantitatively in vivo. This review briefly describes the methodological background of quantitative cartilage imaging and summarizes work on short-term (deformational behaviour) and long-term (functional adaptation) effects of exercise on human articular cartilage. Current findings suggest that human cartilage deforms very little in vivo during physiological activities and recovers from deformation within 90 min after loading. Whereas cartilage deformation appears to become less with increasing age, sex and physical training status do not seem to affect in vivo deformational behaviour. There is now good evidence that cartilage undergoes some type of atrophy (thinning) under reduced loading conditions, such as with postoperative immobilization and paraplegia. However, increased loading (as encountered by elite athletes) does not appear to be associated with increased average cartilage thickness. Findings in twins, however, suggest a strong genetic contribution to cartilage morphology. Potential reasons for the inability of cartilage to adapt to mechanical stimuli include a lack of evolutionary pressure and a decoupling of mechanical competence and tissue mass.

Hip pain in adolescents: results of a cross-sectional study in German pupils and a review of the literature

AIM

To determine the prevalence of hip pain (HP) in adolescents in East Germany and to evaluate the potential factors associated with HP.

DESIGN

Cross-sectional epidemiological study of a total of 2368 pupils (1137 males, 1231 females; age 14.5+/-0.65, range 13-18 y). Demographic data and information on sports activity and consumption of soft legal drugs were obtained using a questionnaire. Physical examination was carried out by school doctors. Odds ratio (OR [95% confidence interval]) was calculated for common factors associated with HP.

RESULTS

The prevalence of adolescents suffering from HP was 6.5% (n=151). Pain episodes were reported as occasional in 3.0%. A total of 69 subjects (2.9%) suffered from permanent pain during physical activity. Permanent pain when at rest was reported in 0.5% (n=12). Female subjects, students attending high school, smoking adolescents and adolescents with a consumption of alcoholic beverages had a significantly higher prevalence of HP. HP was associated with a significantly higher prevalence of low back pain and knee pain. The prevalence of pathological findings of the hip was 2.5% (n=60). Factors significantly associated with HP were: female gender (1.9-fold), attending high school (2.1-fold) and consumption of tobacco (1.6-fold).

CONCLUSIONS

HP in adolescents seems to be mostly caused by functional disorders. There is a possible association between HP and psychological stress or consumption of legal drugs. Prophylactic measures are necessary in this age group in future.

Genetic epidemiology: disease susceptibility and severity

Genetic factors are increasingly recognized to have an important contribution to the occurrence of both inflammatory and noninflammatory rheumatic disease. Although identifying the specific genetic mechanisms involved in the rheumatic diseases continues to present considerable challenges, the prospect of identifying individual gene action has been brought closer by a number of recent developments. These include newer approaches to phenotype definition, refinements in statistical tools for analysis, and the advent of newer technologies, including the use of microarrays. In this article, we review some of these developments together with the recent literature on the contribution of both broad and specific genetic factors to the spectrum of rheumatic disease. We also consider contemporary opinions on the potential impact of genetic discoveries to human health.