ArticleLiterature Review

Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

November 2011
PM&R 3(11):1055-1067.e1

DOI:10.1016/j.pmrj.2011.08.533

Source
PubMed

Authors:

Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement have been recently implicated as risk factors for hip OA. The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search with PubMed, Embase, and CENTRAL was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case-control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and femoroacetabular impingement and hip OA, and preliminary evidence suggests that AD is a risk factor for OA; however, these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA.

Do psychological factors or radiographic severity play a role in the age of onset in symptomatic developmental dysplasia of hip and femoroacetabular impingement syndrome?

Article

Full-text available

Sep 2019
BMC MUSCULOSKEL DIS

Background: Age of onset in symptomatic developmental dysplasia of the hip (DDH) and femoroacetabular impingement syndrome (FAIS) varies. The purpose of this study was to investigate whether psychological factors, radiographic, and clinical variables were related to age of onset of hip pain in DDH and FAIS. Methods: We collected demographic, clinical, and radiographic data on 56 DDH and 84 FAIS patients. Each was diagnosed based on radiographic findings and clinical history. Age of onset was operationalized by subtracting patient reported duration of symptoms from patient age at presentation. Pain catastrophizing (PCS) and depression were assessed with the pain catastrophizing scale and hospital anxiety and depression scale (HADS), respectively. Multiple linear regression modeling, with Lasso variable selection, was implemented. Results: Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH onset (p-values > 0.27) or age of FAIS onset (p-values > 0.29). LASSO-penalized linear regression revealed alpha Dunn angle, Tonnis grade, prior hip surgery, WOMAC pain score, and iHOT total score were associated with age of onset in FAIS (Adjusted R2 = 0.3099). Lateral center edge angle (LCEA), alpha frog angle, Tonnis grade, SF12 physical functioning, and body mass index (BMI) were associated with age of DDH onset (Adjusted R2 = 0.3578). Conclusions: Psychological factors, as measured by PCS and HADS, were not associated with age of onset in DDH or FAIS. Functional impairment as measured by WOMAC pain and impaired active lifestyle as measured by iHOT were found to affect age of FAIS onset. For DDH, impaired physical functioning and increasing BMI were found to be associated with age of onset. Severity of the disease, as measured radiographically by LCEA and alpha Dunn angle, was also found to be associated with earlier age of onset in DDH and FAIS, respectively. A patient's radiographic severity may have more of a relationship to the onset of pain than physiologic factors.

Is acetabular morphology related to trochlear dysplasia?

Article

Jun 2019

Purpose: To evaluate the correlation between trochlear dysplasia and acetabular coverage. Materials and methods: 109 retrospective CT studies referred from the young adult knee clinic were independently reviewed by two observers. Anterior acetabular (AASA) and posterior acetabular (PASA) sector angles were calculated bilaterally on axial CT. Trochlear dysplasia was graded using the Dejour classification (A-D). ANOVA test was used. Results: Dejour types A, B and D trochlear dysplasia were associated with a significantly increased AASA (P value = 0.0011). Conclusion: Our results demonstrate a significant relationship between trochlear dysplasia and anterior acetabular coverage, as measured by AASA.

Reliability and Agreement of Manual and Automated Morphological Radiographic Hip Measurements

Article

Full-text available

Aug 2024

Abstract Objective To determine the reliability and agreement of manual and automated morphological measurements, and agreement in morphological diagnoses. Methods Thirty pelvic radiographs were randomly selected from the World COACH consortium. Manual and automated measurements of acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg center edge angle (WCEA), lateral center edge angle (LCEA), extrusion index (EI), neck-shaft angle (NSA), and triangular index ratio (TIR) were performed. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to test reliability. Agreement in diagnosing acetabular dysplasia, pincer and cam morphology by manual and automated measurements was assessed using percentage agreement. Visualizations of all measurements were scored by a radiologist. Results The Bland-Altman plots showed no to small mean differences between automated and manual measurements for all measurements except for ADR. Intraobserver ICCs of manual measurements ranged from 0.26 (95%-CI 0–0.57) for TIR to 0.95 (95%-CI 0.87–0.98) for LCEA. Interobserver ICCs of manual measurements ranged from 0.43 (95%-CI 0.10–0.68) for AA to 0.95 (95%-CI 0.86–0.98) for LCEA. Intermethod ICCs ranged from 0.46 (95%-CI 0.12–0.70) for AA to 0.89 (95%-CI 0.78–0.94) for LCEA. Radiographic diagnostic agreement ranged from 47% to 100% for the manual observers and 63%–96% for the automated method as assessed by the radiologist. Conclusion The automated algorithm performed equally well compared to manual measurement by trained observers, attesting to its reliability and efficiency in rapidly computing morphological measurements. This validated method can aid clinical practice and accelerate hip osteoarthritis research.

Specificities in the Structure of the Cartilage of Patients with Advanced Stages of Developmental Dysplasia of the Hip

Article

Full-text available

Apr 2024

Developmental dysplasia of the hip (DDH) presents varying degrees of femoral head dislocation, with severe cases leading to the formation of a new articular surface on the external side of the iliac bone—the neoacetabulum. Despite conventional understanding suggesting otherwise, a tissue resembling hyaline cartilage is found in the neoacetabulum and acetabulum of Crowe III and IV patients, indicating a potential for hyaline cartilage development without mechanical pressure. To test this theory, acetabular and femoral head cartilage obtained from patients with DDH was stained with hematoxylin–eosin and toluidine blue. The immunohistochemical analysis for collagen types II and VI and aggrecan was performed, as well as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) analysis on a 7.0 T micro-MRI machine. The results obtained from DDH patients were compared to those of the control groups. Hyaline cartilage was found in the neoacetabulum and the acetabulum of patients with DDH. The nature of the tissue was confirmed with both the histological and the MRI analyses. The results of this study proved the presence of hyaline cartilage in patients with DDH at anatomical regions genetically predisposed to be bone tissue and at regions that are not subjected to mechanical stress. This is the first time that the neoacetabular cartilage of patients with advanced stages of DDH has been characterized in detail.

Comparison Between Movement Pattern Training and Strengthening on Kinematics and Kinetics in Patients With Chronic Hip-Related Groin Pain

Article

Nov 2023

The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles ( P = .006) and smaller hip external adduction moments ( P = .008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain.

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

Article

Full-text available

Aug 2023
BMC MUSCULOSKEL DIS

Background Patient-reported outcomes are commonly used to assess patient symptoms. The effect of specific hip pathology on relationships between perceived and objectively measured symptoms remains unclear. The purpose of this study was to evaluate differences of function and pain in patients with FAIS and DDH, to assess the correlation between perceived and objective function, and to determine the influence of pain on measures of function. Methods This prospective cross-sectional study included 35 pre-operative patients (60% female) with femoroacetabular impingement syndrome (FAIS) and 37 pre-operative patients (92% female) with developmental dysplasia of the hip (DDH). Objectively measured function (6-min walk [6MWT], single leg hop [SLHT], Biodex sway [BST], hip abduction strength [HABST], and STAR excursion balance reach [STAR] tests), patient-reported function (UCLA Activity, Hip Outcome Score [HOS], Short Form 12 [SF-12], and Hip Disability and Osteoarthritis Outcome Score [HOOS]), and patient-reported pain (HOOS Pain, visual analogue scale (VAS), and a pain location scale) were collected during a pre-surgical clinic visit. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group correlations were analyzed using Spearman’s rank correlation coefficients. Statistical correlation strength was defined as low (r = ± 0.1–0.3), moderate (r = ± 0.3–0.5) and strong (r > ± 0.5). Results Patients with DDH reported greater pain and lower function compared to patients with FAIS. 6MWT distance was moderately-to-strongly correlated with a number of patient-reported measures of function (FAIS: r = 0.37 to 0.62, DDH: r = 0.36 to 0.55). Additionally, in patients with DDH, SLHT distance was well correlated with patient reported function (r = 0.37 to 0.60). Correlations between patient-reported pain and objectively measured function were sparse in both patient groups. In patients with FAIS, only 6MWT distance and HOOS Pain (r = -0.53) were significantly correlated. In patients with DDH, 6MWT distance was significantly correlated with VAS Average (r = -0.52) and Best (r = -0.53) pain. Conclusion Pain is greater and function is lower in patients with DDH compared to patients with FAIS. Moreover, the relationship between pain and function differs between patient groups. Understanding these differences is valuable for informing treatment decisions. We recommend these insights be incorporated within the clinical continuum of care, particularly during evaluation and selection of surgical and therapeutic interventions.

"The accuracy of the EOS imaging system to assess hip abnormalities in adolescents and adults:" a systematic review and meta-analysis

Article

Full-text available

Jun 2023
SKELETAL RADIOL

Objectives: To determine the accuracy of the EOS imaging system compared to the gold standard computed tomography (CT) scan, for the measurement of native and postoperative/prosthetic hip parameters in adolescents and adults. Methods: Medline, Cochrane Systematic Review, and Web of Science databases were searched to obtain relevant articles published between January 1964 and February 2021. All articles published in English. Inclusion and exclusion criteria were developed according to the Population, Intervention, Comparator, Outcome (PICO) framework. Three reviewers independently assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. A narrative synthesis of the articles and a meta-analysis were conducted. The heterogeneity exhibited by the effect sizes was obtained using a forest plot, the Q statistic and the I2 index. Reliability coefficients were transformed into Fisher's Z to normalise their distribution and stabilise the variances. For each meta-analysis, an effect size (average reliability coefficient) and a 95% confidence interval were calculated and presented in a forest plot. The amount of radiation dose between modalities was compared. Results: The search retrieved 75 articles, six of which met inclusion and exclusion criteria. The meta-analysis included five of these six studies (sample size from 20 to 90). Comparing EOS and CT, the estimated average correlation (effect size) for combined studies was significantly high (r = 0.84, 95% CI = 0.78 to 0.88, p-value < 0.001). With respect to Pearson's correlation between EOS and CT, the estimated average correlation for combined studies was significantly high (r = 0.86, 95% CI = 0.80 to 0.90, p-value < 0.001). Average radiation dose for EOS was 0.18 ± 0.05 mGy for the anteroposterior view (AP) and 0.45 ± 0.08 mGy for the lateral view; and for CT was 8.4 to 15.6 mGy. Conclusion: The EOS imaging system has a high correlation with CT for preoperative and postoperative/prosthetic hip measurements, with considerably lower irradiation of patients.

Hip muscle activity in people with hip-related pain compared to asymptomatic controls: A systematic review

Article

Jun 2023
J ELECTROMYOGR KINES

Background: Altered hip and thigh muscle activity have been observed across a spectrum of articular hip pathologies, including hip osteoarthritis, femoroacetabular impingement syndrome, and labral pathology. No systematic reviews have examined muscle activity associated with hip pathology and hip-related pain across the life span. A greater understanding of impairments in hip and thigh muscle activity during functional tasks may assist in the development of targeted treatment strategies. Methods: We conducted a systematic review using the PRISMA guidelines. A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO). Studies were included that (i) investigated people with hip-related pain (femoroacetabular impingement syndrome, labral tears) or hip osteoarthritis; and (ii) reported on muscle activity using electromyography of hip and thigh muscles during functional tasks such as walking, stepping, squatting, or lunging. Two independent reviewers performed data extraction and assessed risk of bias using a modified version of the Downs and Black checklist. Results: Non-pooled data demonstrated a limited level of evidence. Overall, differences in muscle activity appeared to be more prevalent in people with more advanced hip pathology. Conclusions: We found that impairments in muscle activity in those with intra-articular hip pathology measured using electromyography were variable but appeared to be greater in severe hip pathology (e.g., hip OA).

An Updated Review of Femoroacetabular Impingement Syndrome

Article

Aug 2022

Femoroacetabular impingement (FAI) is a chronic hip condition caused by femoral head and acetabular malformations resulting in abnormal contact across the joint. FAI often leads to labral, cartilaginous, and tissue damage that predispose this patient population to early osteoarthritis (OA). There are a variety of factors that increase the risk for FAI including younger age, Caucasian background, familial FAIS morphology, and competing in high-intensity sports during adolescence. Slow-onset, persistent groin pain is the most frequent initial presenting symptom. On physical examination, patients will typically have a positive FADIR test (flexion, adduction, internal rotation), also known as a positive impingement sign. FAI syndrome can be organized into three classifications; cam, pincer, or mixed. This classification refers to the characteristic morphological changes of the bony structures. The primary imaging modality for diagnosing FAI is a plain radiograph of the pelvis, which can be used to measure the alpha angle and the lateral center edge angle used to quantify severity. Conservative treatment is typically considered first-line treatment for mild to moderate FAI syndrome; however, the outcomes following postoperative surgical intervention have demonstrated excellent results. The most common surgical treatment option for FAI is done arthroscopically.

Influence of implantation of a total hip endoprosthesis on the ipsilateral leg alignment: the effect of sex and dysplasia of the hip

Article

Full-text available

Aug 2022
ARCH ORTHOP TRAUM SU

Introduction Differences in leg and hip morphology exist between sexes and developmental hip dysplasia is known to alter proximal femoral morphology. The purpose of this study was to determine whether existing differences in leg alignment due to sex or developmental hip dysplasia have an effect on changes in leg alignment after total hip arthroplasty. Materials and methods 30 hip osteoarthritis patients underwent biplanar full-length radiography in the standing position preoperatively and 3 months after total hip arthroplasty. Differences in leg alignment between men and women and between patients with primary hip osteoarthritis and patients with developmental dysplasia before and after surgery were tested using a general linear model for repeated measures. Results Implantation of a hip prosthesis had no differential effect on ipsilateral leg alignment in patients with hip osteoarthritis due to dysplasia and in patients with primary hip osteoarthritis. However, patients with hip osteoarthritis due to dysplasia had a 2.1° higher valgus both before and after surgery. After total hip arthroplasty, women had a significantly greater increase in varus angle (1.6° vs. 0°) and femoral offset (10.5 vs. 4.6 mm) compared with men. Because the change in acetabular offset was smaller (2.2 vs. 6.2 mm), the global femoral offset was only increased in women. Femoral torsion was constant for men (15.0° and 16.5°), whereas femoral torsion was significantly reduced in women (19.9° and 13.2°). Conclusions Hip arthroplasty has a greater effect on leg axis in women than in men. The axial leg alignment of women could change from a natural valgus to a varus alignment. Therefore, surgeons should consider the effects of total hip arthroplasty on leg alignment in patients with hip osteoarthritis. Whether these changes in leg alignment are also clinically relevant and lead to premature medial or lateral knee osteoarthritis should be investigated in future work. Trial registration This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Registered 1st of August 2018.

Long-Term Outcomes Following Nonoperative Treatment of Prearthritic or Extra-Articular Hip Pain in Women

Article

Full-text available

Aug 2022

Introduction: There is an abundance of literature focusing on morphological and surgical outcomes in women with arthritic and prearthritic hip pain. However, no studies have evaluated conservative treatment outcomes, such as physical therapy (PT) and injections, in women with prearthritic or extra-articular hip pain. The purpose of this study is to assess changes in long-term patient-reported outcome measures after nonoperative treatments in women with prearthritic or extra-articular hip pain. Methods: Twenty-nine female patients (35–65 years old) who presented to a single provider between December 1, 2012 and September 1, 2017 for prearthritic or extra-articular hip pain (Tonnis 1 or less) and had baseline patient-reported outcome data (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS] activities of daily living [ADL] and sport scores, International Hip Outcome Tool-33 [iHOT-33]) available from the institutional hip registry were included. Patients underwent nonoperative treatments for intra-articular or extra-articular hip pain. A follow-up questionnaire was prospectively administered at 3–5 years after the baseline visit. Results: Most patients underwent targeted PT (n = 27; 93%) to treat intra-articular or extra-articular hip pain. Targeted PT can be defined as primarily exercise-based therapy focusing on hip and lumbar stability. Twelve patients (41%) received injections; of these, 11 were also treated with PT. Overall, significant improvements in mHHS, HOS-ADL, and iHOT-33 scores were observed (p = 0.006, 0.022, and <0.001, respectively). HOS-ADL and iHOT-33 scores improved by a median of 10.3 and 18.0 points, respectively, and were clinically significant. HOS-sport scores also improved but were not statistically significant. There were no differences in patient-reported outcomes between patients who received both PT and injections versus those who received PT, injections, or other treatments. Conclusions: Nonoperative treatments for prearthritic or extra-articular hip pain in women, specifically PT and/or injections, were associated with sustained improvements in patient-reported outcomes at 3–5 years postbaseline.

The Impact of Hip Dysplasia on CAM Impingement

Article

Full-text available

Jul 2022

Predisposing factors for CAM-type femoroacetabular impingement (FAI) include acetabular protrusion and retroversion; however, nothing is known regarding development in dysplastic hips. The purpose of this study was to determine the correlation between CAM-type FAI and developmental dysplastic hips diagnosed using X-ray and rotational computed tomography. In this retrospective study, 52 symptomatic hips were included, with a mean age of 28.8 ± 7.6 years. The inclusion criteria consisted of consecutive patients who suffered from symptomatic dysplastic or borderline dysplastic hips and underwent a clinical examination, conventional radiographs and rotational computed tomography. Demographics, standard measurements and the rotational alignments were recorded and analyzed between the CAM and nonCAM groups. Among the 52 patients, 19 presented with CAM impingement, whereas, in 33 patients, no signs of CAM impingement were noticed. For demographics, no significant differences between the two groups were identified. On conventional radiography, the acetabular hip index as well as the CE angle for the development of CAM impingement were significantly different compared to the nonCAM group with a CE angle of 21.0° ± 5.4° vs. 23.7° ± 5.8° (p = 0.050) and an acetabular hip index of 25.6 ± 5.7 vs. 21.9 ± 7.3 (p = 0.031), respectively. Furthermore, a crossing over sign was observed to be more common in the nonCAM group, which is contradictory to the current literature. For rotational alignment, no significant differences were observed. In dysplastic hips, the CAM-type FAI correlated to a lower CE angle and a higher acetabular hip index. In contrast to the current literature, no significant correlations to the torsional alignment or to crossing over signs were observed.

Prevalence of femoroacetabular impingement in elite baseball players

Article

Full-text available

Jul 2022

CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.

Multifactorial pathomechanism of hip dysplasia and femoroacetabular impingement in young adults: the diamond concept

Article

Full-text available

Nov 2021
ANTHROPOL ANZ

Abstract: Hip dysplasia (DDH) as well as femoroacetabular impingement (FAI) are common causes of hip pain in young adults and lead to premature osteoarthritis (OA). However, not all patients with radiographic features of DDH or FAI develop symptoms and degenerative changes, which indicates that various factors play a role in the disease process. Here we use a diamond concept to illustrate anatomical factors that play a role in the pathomechanism of symptomatic DDH and FAI. This concept may help clinicians in the diagnosis of hip pain in young adults. For DDH, the following factors are included: (1) acetabular and (2) femoral morphology, (3) pelvic shape and geometry, (4) spinopelvic alignment and (5) soft tissue properties. For FAI, the following factors are included: (1) intraarticular acetabular and (2) intraarticular femoral morphology, (3) extraarticular pelvic and (4) extraarticular femoral morphology, (5) spinopelvic alignment and (6) soft tissue properties. Knowledge of these factors can help to identify an adequate treatment. Surgical treatment options include (1) extraarticular acetabular, (2) extraarticular femoral, (3) intraarticular acetabular and (4) intraarticular femoral procedures. Further research is warranted on the specific role and the interaction of the parameters presented in the diamond concept in the disease process of hip joint degeneration.

Prevalence of radiographic hip dysplasia in Japanese population-based study

Article

Apr 2021

Objectives The purpose of this study was to measure the indices of radiographic developmental dysplasia of the hip (DDH) in a cross-sectional study of an elderly Japanese population. Methods Hip radiographs of 427 informed, voluntary Japanese community-dwelling individuals (279 female and 148 male) aged 50 to 96 years-old were obtained from Miyagawa village in Japan through a health screening. The hip radiographs were measured by a custom-written, semi-automated MATLAB program. The center edge (CE) angle, acetabular roof obliquity (ARO), acetabular head index (AHI), and minimum joint space width (mJSW) were measured. We examined the associations between gender, side-of-hip, and age group on radiographic DDH and hip osteoarthritis (OA). Results The mean CE angle was 31.0°. The mean ARO was 5.8°. The mean AHI was 88.2%. The mean mJSW was 4.0 mm. Of the total population, 29.9% had DDH and 4.0% had hip OA. Of those who had hip OA, 41.2% were secondary OA, and 58.8% were primary OA. The relationship between DDH and OA was not significant. Conclusion DDH is unlikely to be an important cause of hip OA in the present population-based study.

Arthroscopy versus nonoperative treatment of symptomatic femoroacetabular impingement syndrome: A protocol for systematic review and meta-analysis

Article

Full-text available

Dec 2020

Background: Presently, hip arthroscopy is a widely adopted surgical intervention for the treatment of femoroacetabular impingement (FAI). However, there is insufficient evidence regarding which between arthroscopy and nonoperative treatment is more optimal for symptomatic FAI. Methods: MEDLINE, Embase, Web of Science, and the Cochrane Library were systematically searched for studies that compared arthroscopy and nonoperative interventions for FAI treatment from inception to August 4, 2020. We included studies that directly compared surgical and nonsurgical treatment for symptomatic FAI and excluded those that did not use arthroscopic treatment as a surgical technique and studies performed on patients with concomitant diagnoses instead of pure FAI. We compared the following clinical outcome scores at 6 and 12 months of follow-up: International Hip Outcome Tool 33 (iHOT-33), hip outcome score (HOS), EuroQol-visual analog scale (EQ-VAS), modified Harris hip score (mHHS), and nonarthritic hip score (NAHS). Results: Five studies totaling 838 patients were included in the qualitative and quantitative synthesis; 382 patients underwent hip arthroscopy, and 456 patients were treated by nonoperative interventions. At 6 months of follow-up, there were no statistically significant differences in iHOT-33 ratings (mean difference [MD] = 7.92, P = .15), HOS (MD of HOS-ADL = 5.15, P = .26 and MD of HOS-Sports = 2.65, P = .79, respectively), and EQ-VAS (MD = 1.22, P = .76) between the 2 treatment strategies. At 12 months of follow-up, the arthroscopy group had a greater mean improvement in iHOT-33 score than the conservative treatment group (MD = 8.42, P = .002), but there was no difference between the groups in terms of mHHS rating (MD = -0.24, P = .83) and NAHS (MD = -2.08, P = .09). Conclusion: Despite arthroscopy being associated with significantly superior iHOT-33 scores after 12 months of follow-up, we were unable to discern the difference between the treatment strategies using other scoring methods, such as HOS, EQ-VAS, mHHS, and NAHS. Further studies will be needed to conclusively determine if 1 strategy is superior to the other for treating FAI.

Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials

Article

Full-text available

Nov 2020

Objective To summarize the effects of surgical treatment compared to conservative treatment in femoroacetabular impingement syndrome in the short, medium, and long term. Study Design Systematic review Methods The following databases were searched on 14/09/2020: MEDLINE, EMBASE, CENTRAL, Web of Science, and PEDro. There were no date or language limits. The methodological quality assessment was performed using the PEDro scale and the quality of the evidence followed the GRADE recommendation. The outcomes pain, disability, and adverse effects were extracted. Results Of 6264 initial studies, three met the full-text inclusion criteria. All studies were of good methodological quality. Follow up ranged from six months to two years, with 650 participants in total. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a mean difference (MD) between groups of 3.91 points (95% CI –2.19 to 10.01) at six months, MD of 5.53 points (95% CI –3.11 to 14.16) at 12 months and 3.8 points (95% CI –6.0 to 13.6) at 24 months. The quality of the evidence (GRADE) varied from moderate to low across all comparisons. Conclusion There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term. Level of evidence Therapy, level 1a. Registration number PROSPERO CRD42019134118

Surgical Outcomes in the Treatment of Concomitant Mild Acetabular Dysplasia and Femoroacetabular Impingement: A Systematic Review

Article

Dec 2019
ARTHROSCOPY

Purpose: To analyse the current approaches and clinical outcomes in the surgical management of concomitant mild acetabular dysplasia and femoroacetabular impingement (FAI). Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method, the PubMed and Medline databases were searched in March 2019 for studies that reported on surgical outcomes in hips with concomitant mid acetabular dysplasia and FAI. Studies published in English that focused on the surgical outcomes after hip arthroscopy, open surgery or periacetabular osteotomy of concomitant acetabular dysplasia and FAI, in which the lateral centre-edge angle (LCEA) of all subjects was between 15° and 25°, were included. Articles that included subjects with LCEA <15°, with a minimum follow-up duration < 1 year, had <5 subjects, or were not original articles were excluded. Results: The initial search yielded 748 studies, and 5 studies met the inclusion criteria. All these 5 studies focused on hip arthroscopic treatment for patients with concomitant mild acetabular dysplasia and FAI. Three studies had level III evidence, while 2 studies had level IV evidence. The mean patient age range across the studies was 29.8-49.6 years, and the female to male ratio was 1.14. Improved patient-reported outcomes (HOS-ADL, HOS-Sport, mHHS, SF-12 PCS, WOMAC) at a minimum 2-year follow-up were obtained in 4 of the 5 studies. Two of these 4 studies had a comparative cohort of patients with FAI with normal acetabular coverage, and there was no significant difference in the postoperative outcomes and secondary procedure rate between patients with mild acetabular dysplasia and those with normal acetabular coverage. Conclusions: This systematic review indicates that improved patient-reported outcomes can be obtained with hip arthroscopy in the treatment of concomitant mild acetabular dysplasia and FAI at a minimum 2-year follow-up.

The Association between Periacetabular Osteotomy Reorientation and Hip Joint Reaction Forces in Two Subgroups of Acetabular Dysplasia

Article

Oct 2019
J BIOMECH

Acetabular dysplasia is primarily characterized by an altered acetabular geometry that results in deficient coverage of the femoral head, and is a known cause of hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical reorientation of the acetabulum to normalize coverage, yet its effect on joint loading is unknown. Our objective was to establish how PAO, simulated with a musculoskeletal model and probabilistic analysis, alters hip joint reaction forces (JRF) in two representative patients of two different acetabular dysplasia subgroups: anterolateral and posterolateral coverage deficiencies. PAO reorientation was simulated within the musculoskeletal model by adding three surgical degrees of freedom to the acetabulum relative to the pelvis (acetabular adduction, acetabular extension, medial translation of the hip joint center). Monte Carlo simulations were performed to generate 2000 unique PAO reorientations for each patient; from which 99% confidence bounds and sensitivity factors were calculated to assess the influence of input variability (PAO reorientation) on output (hip JRF) during gait. Our results indicate that reorientation of the acetabulum alters the lines of action of the hip musculature. Specifically, as the hip joint center was medialized, the moment arm of the hip abductor muscles was increased, which in turn increased the mechanical force-generating capacity of these muscles and decreased joint loading. Independent of subgroup, hip JRF was most sensitive to hip joint center medialization. Results from this study improve understanding of how PAO reorientation affects muscle function differently dependent upon acetabular dysplasia subgrouping and can be used to inform more targeted surgical interventions.

NON-OPERATIVE MANAGEMENT OF INDIVIDUALS WITH NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW

Article

Full-text available

Feb 2019
Int J Sports Phys Ther

Background: Non-arthritic hip pain is defined as being related to pathologies of the intra-articular structures of the hip that can be symptomatic. A trial of non-operative management is commonly recommended before consideration of surgery for individuals with non-arthritic hip conditions. There is a need to describe a non-operative or conservative treatment plan for individuals with non-arthritic hip pain. Purpose: The purpose of this literature review was to systematically examine the literature in order to identify and provide evidence for non-operative or conservative management of individuals with non-arthritic hip pain. A proposed home exercise program will be provided for individuals with non-arthritic hip pain. Study design: Review of the Literature. Materials/methods: A literature search of PubMed, Medline, SPORTSDiscus, and CINAHL was conducted. Keywords included: "hip" AND "femoroacetabular impingement" OR "labral tear." Studies were included if they described non-operative management for individuals with non-arthritic hip pain. Studies were excluded if they recommended a trial of conservative treatment without specific management or interventions and/or activity modification without specific details for intervention. Results: A total of 49 studies met the eligibility criteria and were included in the review. Rehabilitation recommendations were identified from manuscripts including clinical trials, case series, discussion articles, or systematic reviews related to the non-operative or conservative management of non-arthritic hip pain. Rehabilitation interventions focused on patient education, activity modification, limitation of aggravating factors, an individualized physical therapy protocol, and use of a home exercise program. Conclusions: Rehabilitation should address biomechanical deficiencies with neuromuscular training of the hip and lumbopelvic regions. While the current literature on non-operative management is limited, future randomized control trials will establish the effectiveness of specific physical therapy protocols for individuals with non-arthritic hip pain. Level of evidence: 3b.

Musculoskeletal models with generic and subject-specific geometry estimate different joint biomechanics in dysplastic hips

Article

Jan 2019

Optimizing the geometric complexity of musculoskeletal models is important for reliable yet feasible estimation of joint biomechanics. This study investigated the effects of subject-specific model geometry on hip joint reaction forces (JRFs) and muscle forces in patients with developmental dysplasia of the hip (DDH) and healthy controls. For nine DDH and nine control subjects, three models were created with increasingly subject-specific pelvis geometry, hip joint center locations and muscle attachments. Hip JRFs and muscle forces during a gait cycle were compared among the models. For DDH subjects, resultant JRFs from highly specific models including subject-specific pelvis geometry, joint locations and muscle attachments were not significantly different compared to models using generic geometry in early stance, but were significantly higher in late stance (p = 0.03). Estimates from moderately specific models using CT-informed scaling of generic pelvis geometry were not significantly different from low specificity models using generic geometry scaled with skin markers. For controls, resultant JRFs in early stance from highly specific models were significantly lower than moderate and low specificity models (p ≤ 0.02) with no significant differences in late stance. Inter-model JRF differences were larger for DDH subjects than controls. Inter-model differences for JRF components and muscle forces were similar to resultant JRFs. Incorporating subject-specific pelvis geometry significantly affects JRF and muscle force estimates in both DDH and control groups, which may be especially important for reliable estimation of pathomechanics in dysplastic hips. © 2019

Prediction of mechanical behavior of cartilaginous infant hips in Pavlik harness: a subject-specific simulation study on normal and dysplastic hips

Article

Jan 2019
J ORTHOP RES

In dysplastic infant hips undergoing abduction harness treatment, cartilage contact pressure is believed to have a role in therapeutic cartilage remodeling and also in the complication of femoral head avascular necrosis. To improve our understanding of the role of contact pressure in the remodeling and the complication, we modeled cartilage contact pressure in cartilaginous infant hips undergoing Pavlik harness treatment. In subject‐specific finite element modeling, we simulated contact pressure of normal and dysplastic hips in Pavlik harness at 90° flexion and gravity‐induced abduction angles of 40°, 60° and 80°. We demonstrated that morphologies of acetabulum and femoral head both affected contact pressure distributions. The simulations showed that in Pavlik harness, contact pressure was mainly distributed along anterior and posterior acetabulum, leaving the acetabular roof only lightly loaded (normal hip) or unloaded (dysplastic hip). From a mechanobiological perspective, these conditions may contribute to therapeutic remodeling of the joint in Pavlik harness. Furthermore, contact pressure increased with the angle of abduction, until at the extreme abduction angle (80°), the lateral femoral head also contacted the posterior acetabular edge. Contact pressure in this area could contribute to femoral head avascular necrosis by reducing flow in femoral head blood vessels. The contact pressure we simulated can plausibly account for both the therapeutic effects and main adverse effect of abduction harness treatment for developmental dysplasia of the hip. This article is protected by copyright. All rights reserved

Ptosis of the hip: a new radiographic finding in patients undergoing femoroacetabular osteoplasty

Article

Full-text available

Nov 2018

Ptosis is a newly described phenomenon appearing on AP radiographs of patients undergoing femoroacetabular osteoplasty (FAO), and refers to a reverse break down in Shenton’s Line. Thorough characterization of this phenomenon is needed to better understand the hip morphology and pathologic ramifications. Our goal was to define the radiographic hip parameters accompanying a break down in Shenton’s Line and to determine how these values compare with standard values in normal hips. Using two independent readers, we retrospectively reviewed the medical records and preoperative supine radiographs of 630 patients (1260 hips) who underwent FAO by a single surgeon between 2003 and 2016. Prevalence of hip pathology and 28 radiographic parameters in ptosis hips was measured, as well as a comparison between unilateral ptosis hips and contralateral normal hips. Of the 53 patients (106 hips) who fulfilled the criteria for the study, 94 hips had a Shenton’s Line break down of at least 5 mm. Sixty-nine percent of ptosis hips had femoroacetabular impingement (FAI), 70.2% had coxa profunda, and 52.1% had partial joint space narrowing. Ptosis hips had 1.05 mm less lateral subluxation (P = 0.012), 2.28° larger Center-edge angle (P = 0.046), 2.59° smaller Sharp angle (P = 0.011) and 2.49% smaller extrusion index (P = 0.016) compared with contralateral normal hips. FAI is prevalent in patients with a positive ptosis sign. The high prevalence of partial joint space narrowing could suggest eventual osteoarthritis. We believe our results demonstrate the importance of further investigation of a positive ptosis sign on AP pelvic radiographs.

The centre edge angle of wiberg of acetabulum in adult jordanian population

Article

Full-text available

May 2018

Objective: To measure the depth of acetabulum [the Centre edge (CE) angle] in adult normal Jordanian population. Design: Descriptive Case – Series Study. Setting: King Abdullah University hospital, Jordan University of Science and Technology, during the period May 2012 to May 2016. Participants: Antero – posterior (AP) radiographs of (400 hips) taken for adult non-orthopedic patients of various age groups, 105 were men and 95 were women. Main Outcome Measurements: The centre – edge (CE) angles of 400 hips were measured by Wiberg method. Results: The (CE) angle increased with age. There is no significant difference between men and women, nor is a significant difference between right and left. The distribution of (CE) angles is similar to other studies in Indians, Caucasians and Africans. Conclusion: The acetabular depth measured by the (CE) angle (acetabular dysplasia) could not be the main factor in etiology of osteoarthritis and congenital dislocation of the hip. Key words: CE angle, hip, and normal Jordanian adult.

Comparison of four parameters to assess acetabular dysplasia and acetabular dysplasia rates in primary hip osteoarthritis patients: A study in Turkish population

Article

Full-text available

May 2018

Introduction: Hip osteoarthritis is an important orthopedic problem frequently observed in the elderly. Acetabular dysplasia (AD) is one of the pathologies that cause coxarthrosis. Nearly 20-45% of primary or idiopathic hip osteoarthritis is linked to AD. In our country, there are few studies on this topic. We measured the center-edge (CE) angle, Sharp's angle, acetabular depth, and femoral head coverage ratio on pelvis anteroposterior radiographs of patients with primary coxarthrosis and calculated the dysplasia rates. Patients and method: Age at surgery and sex of the patients; and CE angle, Sharp's angle, acetabular depth, and femoral head coverage ratio for both operated and opposite hips were evaluated in 223 total hip prosthesis-performed patients with coxarthrosis. Also the distribution of mean age at surgery, sex of patients, dysplasia rates of operated hips, and bilateral dysplasia rates were calculated. Results: The right to left ratio of operated hips was 104/119. Female to male ratio was 163/60 (2.7/1), for those with CE angle below 20° it was 123/30 (4.1/1), and it was 40/30 (1.3/1) with CE angle above 20°. Mean age of patients at surgery was 56.9 (±11.4) years. CE angle less than 20° was found in 68.6% of patients, acetabulum depth less than 9 mm was found in 75.3%, Sharp's angle was more than 45° in 65.9%, and femoral head coverage ratio was less than 70% in 70.3% of patients. Conclusions: We identified a high rate of AD in primary coxarthrosis patients undergoing total hip arthroplasty in the study population.

INFLUENCE OF MODELING METHODS FOR CARTILAGE LAYER ON SIMULATION OF PERIACETABULAR OSTEOTOMY USING FINITE ELEMENT CONTACT ANALYSIS

Article

Mar 2018

Effects of Slide Squat on Pain, Abduction Strength, Dynamic Balance, and Q Angle in Chronic Hip Joint Pain Patients: A Single Subject Study

Article

Full-text available

Feb 2024

Deletion of Trps1 regulatory elements recapitulates postnatal hip joint abnormalities and growth retardation of Trichorhinophalangeal syndrome in mice

Article

Jun 2024

Trichorhinophalangeal syndrome (TRPS) is a genetic disorder caused by point mutations or deletions in the gene-encoding transcription factor TRPS1. TRPS patients display a range of skeletal dysplasias, including reduced jaw size, short stature, and a cone-shaped digit epiphysis. Certain TRPS patients experience early onset coxarthrosis that leads to a devastating drop in their daily activities. The etiologies of congenital skeletal abnormalities of TRPS were revealed through the analysis of Trps1 mutant mouse strains. However, early postnatal lethality in Trps1 knockout mice has hampered the study of postnatal TRPS pathology. Here, through epigenomic analysis we identified two previously uncharacterized candidate gene regulatory regions in the first intron of Trps1. We deleted these regions, either individually or simultaneously, and examined their effects on skeletal morphogenesis. Animals that were deleted individually for either region displayed only modest phenotypes. In contrast, the Trps1Δint/Δint mouse strain with simultaneous deletion of both genomic regions exhibit postnatal growth retardation. This strain displayed delayed secondary ossification center formation in the long bones and misshaped hip joint development that resulted in acetabular dysplasia. Reducing one allele of the Trps1 gene in Trps1Δint mice resulted in medial patellar dislocation that has been observed in some patients with TRPS. Our novel Trps1 hypomorphic strain recapitulates many postnatal pathologies observed in human TRPS patients, thus positioning this strain as a useful animal model to study postnatal TRPS pathogenesis. Our observations also suggest that Trps1 gene expression is regulated through several regulatory elements, thus guaranteeing robust expression maintenance in skeletal cells.

IIESC-Net: Incorporating Implicit and Explicit Structural Constraints for Hip Joint Landmark Detection in pelvic X-ray

Conference Paper

Dec 2023

Hip dysplasia as risk factor for clinically relevant and radiographic hip osteoarthritis: 10-year results from the CHECK cohort

Article

Dec 2023

Objectives To investigate hip dysplasia as a risk factor for clinically relevant and incident radiographic hip OA. Methods From a prospective cohort (CHECK) of 1002 middle-aged, new consulters for hip and/or knee pain, 468 hips (251 individuals) were selected based on hip pain, available lateral center edge angle (LCEA) and absence of definite radiographic hip OA (Kellgren and Lawrence [KL] grade <2) at baseline, as well as available follow-up measures. Clinically relevant hip OA was defined by an expert diagnosis based on clinical and radiographic data obtained between years 5 and 10 from baseline. Incident radiographic hip OA was defined by KL grade ≥2 or a total hip replacement at the 10-year follow-up. Associations between hip dysplasia (LCEA ≤20°) and outcomes were expressed as an odds ratio (OR) adjusted for age, sex and BMI. Results At baseline, participants had a mean age of 55.5 (5.4) years, 88% were female and, on hip level, the prevalence of hip dysplasia was 3.6% (n = 17). After 10 years, hip dysplasia was associated with an increased risk for clinically relevant hip OA (OR 2.80; 95% CI: 1.15, 6.79), but not for incident radiographic hip OA (OR 0.78; 95% CI: 0.26, 2.30). Conclusion In the long term, baseline hip dysplasia was associated with an increased risk for clinically relevant hip OA, but not for incident radiographic hip OA. With this in mind, we suggest that future research investigating the link between hip dysplasia and OA strives to include a definition for OA that is clinically relevant.

Hipology 2023: Science, Philosophy, and Craft

Article

Sep 2023

Michael B Millis

Acetabular dysplasia and the risk of developing hip osteoarthritis at 2,5,8, and 10 years follow-up in a prospective nationwide cohort study (CHECK)

Article

Mar 2023
SEMIN ARTHRITIS RHEU

Objective: To assess the relationship between acetabular dysplasia (AD) and the risk of incident and end-stage radiographic hip osteoarthritis (RHOA) over 2,5,8 and 10 years. Design: Individuals (n = 1002) aged between 45 and 65 from the prospective Cohort Hip and Cohort Knee (CHECK) were studied. Anteroposterior pelvic radiographs were obtained at baseline and 2,5,8, and 10-years follow-up. False profile radiographs were obtained at baseline. AD was defined as a lateral center edge angle, an anterior center edge angle, or both <25° at baseline. The risk of developing RHOA was determined at each follow-up moment. Incident RHOA was defined by Kellgren & Lawrence (KL) grade ≥2 or total hip replacement (THR), end-stage RHOA by a KL grade ≥3 or THR. Associations were expressed in odds ratios (OR) using logistic regression with generalized estimating equations. Results: AD was associated with the development of incident RHOA at 2 years follow-up (OR 2.46, 95% CI 1.00-6.04), 5 years follow-up (OR 2.28, 95% CI 1.20-4.31), and 8 years follow-up (OR 1.86, 95%CI 1.22-2.83). AD was only associated with end-stage RHOA at 5 years follow-up (OR 3.75, 95% CI 1.02-13.77). No statistically significant associations were observed between AD and RHOA at 10-years follow-up. Conclusion: Baseline AD in individuals between 45 and 65 years is associated with an increased risk of developing RHOA within 2- and 5 years. However, this association seems to weaken after 8 years and disappears after 10 years.

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

Preprint

Full-text available

Feb 2023

Background Patient-reported outcomes are commonly used to assess patient symptoms and track post-operative improvements. The effect that specific hip pathology has on the relationship between perceived and objectively measured symptoms remains unclear. The purpose of this study was (1) to evaluate differences of function and pain in FAIS and DDH patients, (2) to assess the correlation between perceived and true functional ability, and (3) to determine the influence of pain on measures of function. Methods This prospective cross-sectional study included 73 pre-operative patients with femoroacetabular impingement syndrome (FAIS) and developmental dysplasia of the hip (DDH), who were diagnosed based on clinical history, physical examination, and radiographic findings. Objectively measured function (6-minute walk test [6MWT], single leg hop test [SLHT], Biodex sway test [BST], hip abduction strength test [HABST], and STAR excursion balance reach tests [STAR] in multiple directions), patient-reported function (UCLA Activity scale, Hip Outcome Score [HOS] activities of daily living [ADL] and Sport subscales, Short Form 12 [SF-12] Physical Activity subscale, and the Hip Disability and Osteoarthritis Outcome Score [HOOS] ADL and Sport), and patient-reported pain data (HOOS Pain, visual analogue scale (VAS), and a pain location scale with eight bilateral body locations) were collected during pre-surgical clinic visits. Patient demographics were compared using independent two-sample t-tests. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group relationships between pairs of outcome variable were analyzed using Spearman’s rank correlation coefficients. The level of significance for all statistical tests was set at α = 0.05 (two-tailed). Results 6MWT was moderately-to-strongly correlated with nearly all patient-reported measures of function (FAIS: r = 0.34–0.62, DDH: r = 0.27–0.56). In FAIS patients, only HOOS Pain was significantly correlated with an objective measure of function, which was 6MWT (r=-0.53). However, in DDH patients, patient-reported pain scores were moderately correlated with a number of objective measures of function (r=-0.32–0.48). Conclusion FAIS patients reported significantly higher function and lower pain compared to DDH patients. No single patient-reported measure of function was broadly significantly correlated with objective measures of function in either patient group. Functional performance in patients with DDH appears to be influenced by self-perceived pain.

Cementless Hip Arthroplasty in Patients with Subchondral Insufficiency Fracture of the Femoral Head

Article

Nov 2021

Background: Subchondral insufficiency fracture of the femoral head (SIFFH) occurs in elderly patients and might be confused with osteonecrosis of the femoral head (ONFH). Subchondral insufficiency fracture of the femoral head is an insufficiency fracture at the dome of the femoral head and has been known to be associated with osteoporosis, hip dysplasia, and posterior pelvic tilt. This study's aims were to evaluate (1) surgical complications, (2) radiological changes, (3) clinical results, and (4) survivorship of THA in patients with SIFFH. Methods: From November 2010 to June 2017, 21 patients (23 hips); 5 men (5 hips) and 16 women (18 hips) underwent cementless THA due to SIFFH at our institution. Their mean age was 71.9 years (range, 57 to 86) at the time of surgery, and mean T-score was -2.2 (range, -4.2 to 0.2). The mean lateral center-edge angle, abduction, and anteversion of the acetabulum were 29.9° (range, 14.8° to 47.5°), 38.5° (range, 31° to 45°), and 20.0° (range, 12° to 25°), respectively. The mean pelvic incidence, lumbar kyphotic angle and posterior pelvic tilt were 56.4° (range, 39° to 79°), 14.7° (range, -34° to 43°), and 13.0° (range, 3° to 34°), respectively. Results: An intraoperative calcar crack occurred in 1 hip. The mean anteversion and abduction of cup were 29.0° (range, 17° to 43°) and 43.3° (range, 37° to 50°), respectively. One patient sustained a traumatic posterior hip dislocation 2 weeks after the procedure, and was treated with open reduction. At a mean follow-up of 35.4 months (range, 24 to 79 months), no hip had prosthetic loosening or focal osteolysis. At the latest follow-up, the mean modified Harris hip score was 79.1 (range, 60 to 100) points, and mean UCLA activity score was 4.2 (range, 2 to 7) points. The survivorship was 95.7% (95% CI, 94.9% to 100%) at 6 years. Conclusions: Cementless THA is a favorable treatment option for SIFFH in elderly patients. Level of evidence: 3.

Acetabular dysplasia

Chapter

Aug 2020

Joachim Feger

Hip muscle activity in male football players with hip-related pain; a comparison with asymptomatic controls during walking

Article

Sep 2021
PHYS THER SPORT

Objectives Compare muscle activity between male football players with and without hip-related pain. Morphological and intra-articular features of hip-related pain are proposed pre-cursors to hip OA. Altered muscle activity is a feature of severe hip OA, but it is not known whether differences exist earlier in the pathological spectrum. Design Cross-sectional; Setting University laboratory; Participants Forty-two male football players with hip-related pain; and 19 asymptomatic controls. Main outcome measures Hip muscle activity (Gluteus maximus, gluteus medius, tensor facia latae, adductor longus and rectus femoris) was recorded during walking using surface electromyography EMG. Results Men with hip-related pain had sustained rectus femoris activity prior to toe-off (47–51% of the gait cycle) (p = 0.01, ES = 0.51) unlike controls who had reduced activity. In men with severe hip-related pain, gluteus maximus EMG was sustained into mid-stance (12–20% of the gait cycle) (F = 6.15, p < 0.01) compared to controls. Conclusions Differences in rectus femoris and gluteus maximus activity were identified between male footballers with and without hip-related pain. The pattern of gluteus maximus EMG relative to peak, approaching mid-stance in severe hip-related pain, is consistent with observations in severe hip OA. This supports the hypothesis that symptom severity may influence muscle activity across the spectrum of hip degeneration.

Comparison between Movement Pattern Training and Strengthening on Muscle Volume, Muscle Fat and Strength in Patients with Hip‐related Groin Pain: An Exploratory Analysis

Article

Aug 2021

The purpose of this exploratory analysis was to compare the impact of movement pattern training (MoveTrain) and standard strength and flexibility training (Standard) on muscle volume, strength and fatty infiltration in patients with hip-related groin pain (HRGP). We completed a secondary analysis of data collected during an assessor-blinded randomized control trial. Data was used from 27 patients with HRGP, 15 to 40 years, who were randomized into MoveTrain or Standard groups. Both groups participated in their training protocol (MoveTrain, n = 14 or Standard, n = 13) which included 10 supervised sessions over 12 weeks and a daily home exercise program. Outcome measures were collected at baseline and immediately after treatment. Magnetic resonance images (MRI) data was used to determine muscle fat index (MFI) and muscle volume. A hand-held dynamometer was used to assess isometric hip abductor and extensor strength. The Standard group demonstrated a significant post-treatment increase in gluteus medius muscle volume compared to the MoveTrain group. Both groups demonstrated an increase in hip abductor strength and reduction in gluteus minimus and gluteus maximus MFI. The magnitude of change for all outcomes were modest. Statement of Clinical Significance: Movement pattern training or a program of strength/flexibility training may be effective at improving hip abductor strength and reducing fatty infiltration in the gluteal musculature among those with HRGP. Further research is needed to better understand etiology of strength changes and impact of muscle volume and MFI in HRGP and the effect of exercise on muscle structure and function. This article is protected by copyright. All rights reserved.

Is hip morphology a risk factor for developing hip osteoarthritis? A systematic review with meta-analysis

Article

Jun 2021
OSTEOARTHR CARTILAGE

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.

Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip

Article

Mar 2021
CLIN BIOMECH

Background Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage. Methods Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05). Findings During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking. Interpretation Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.

Statistical Shape Modeling of the Hip and the Association with Hip Osteoarthritis: a Systematic Review

Article

Full-text available

Dec 2020

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.

Effects of Aging on Impairment Ratings: Part 4: Musculoskeletal Issues

Article

Nov 2019

This article is the fourth of five in a series on the effects of age-related changes in impairment evaluations as defined by the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions. The present article addresses the musculoskeletal system and differs from the first three articles, which focused on apportionment of an impairment rating between aging and other causes. The medical literature supports the notion that age-related osteoarthritis (OA) changes in the hand and digits frequently are associated with injury and/or repetitive motion. Thus, apportionment is indicated, but deciding which came first, the imaging abnormality or the injury, requires consummate skill on behalf of the rating physician. OA also occurs in the knees and hips of older individuals. Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory disorder characterized by calcification and ossification of spinal ligaments and entheses and is unique, in the authors’ opinion, because of a positive correlation between aging and back pain caused by this condition. The article also addresses the association—or the lack thereof—between pathology and aging, as well as degenerative changes and symptoms, to facilitate causation analysis. For a fuller discussion of causation analysis for the spine, readers can consult the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition.

Feasibility of automatic measurements of hip joints based on pelvic radiography and a deep learning algorithm

Article

Sep 2020

Purpose: To develop and evaluate an automatic measurement model for hip joints based on anteroposterior (AP) pelvic radiography and a deep learning algorithm. Methods: A total of 1260 AP pelvic radiographs were included. 1060 radiographs were randomly sampled for training and validation and 200 radiographs were used as the test set. Landmarks for four commonly used parameters, such as the center-edge (CE) angle of Wiberg, Tönnis angle, sharp angle, and femoral head extrusion index (FHEI), were identified and labeled. An encoder-decoder convolutional neural network was developed to output a multi-channel heat map. Measurements were obtained through landmarks on the test set. Right and left hips were analyzed respectively. The mean of each parameter obtained by three radiologists was used as the reference standard. The Percentage of Correct Key points (PCK), intraclass correlation coefficient (ICC), Pearson correlation coefficient (r), root mean square error (RMSE), mean absolute error (MAE), and Bland-Altman plots were used to determine the performance of deep learning algorithm. Results: PCK of the model at 3 mm distance threshold range was from 87 % to 100 %. The CE angle, Tönnis angle, Sharp angle and FHEI of the left hip generated by the model were 29.8°±6.1°, 5.6°±4.2°, 39.0°±3.5° and 19 %±5 %, respectively. The parameters of the right hip were 30.4°±6.1°, 7.1°±4.4°, 38.9°±3.7° and 18 %±5 %. There were good correlation and consistency of the four parameters between the model and the reference standard (ICC 0.83-0.93, r 0.83-0.93, RMSE 0.02-3.27, MAE 0.02-1.79). Conclusions: The new developed model based on deep learning algorithm can accurately identify landmarks on AP pelvic radiography and automatically generate parameters of hip joint. It will provide convenience for clinical practice of measurement.

Movement pattern training compared with standard strengthening and flexibility among patients with hip-related groin pain: results of a pilot multicentre randomised clinical trial

Article

Full-text available

Mar 2020

Study design Pilot, multicentre randomised clinical trial (RCT). Objectives Assess viability of performing a definitive RCT and compare preliminary effects of movement pattern training (MoveTrain) and strengthening/flexibility (Standard) to improve function in people with chronic hip-related groin pain (HRGP). Background To determine the best physical therapist-led intervention for patients with HRGP, we must understand treatment effects of different treatment modes. Methods Forty-six patients (17M:29F; 29±5.3 years; body mass index 25.6±6.3 kg/m ² ) with HRGP were randomised. MoveTrain included task-specific training to optimise biomechanics during daily tasks. Standard included strengthening/flexibility. Treatment included 10 visits/12 weeks and home exercise programme (HEP). Primary outcomes for feasibility were recruitment, retention, treatment adherence and treatment fidelity. Secondary outcomes were patient-reported function (Hip disability and Osteoarthritis Outcome Score (HOOS)), lower extremity kinematics and hip muscle strength. Results We achieved target recruitment, and retention was excellent (91%). Patient session attendance was high (93%); however, reported HEP adherence (62%) was lower than expected. Physical therapists’ adherence to treatment protocols was high (90%). Patients demonstrated high treatment receipt; 91% of exercises performed were rated independent. Both groups demonstrated clinically important improvements in function (HOOS) and muscle strength; however, there were no between-group differences (HOOS subscales, p≥0.13, strength, p≥0.34). Compared with Standard, MoveTrain demonstrated greater reductions in hip adduction (p=0.016) and pelvic drop (p=0.026) during a single leg squat. No adverse events were noted. Conclusion Our experience in completing this RCT confirmed that a larger, multicentre RCT is feasible and highlighted modifications we will implement to optimise the future RCT. Trial registration number NCT02913222 .

How Good is the Evidence Linking Acetabular Dysplasia to Osteoarthritis?

Article

Jul 2019

Daniel R. Cooperman

Background: A common claim in the orthopaedic literature is that acetabular dysplasia (AD) exists when the center-edge angle of Wiberg (CE angle) is <20 degrees and that AD leads to osteoarthritis (OA). Our purpose is to evaluate the validity of the linkage between AD and OA. Methods: We assess and discuss the theories and the empirical evidence relating AD to OA. Moreover, we test the rule that hips with a CE angle <20 degrees will develop OA by 65 years of age, by looking for exceptions to this rule. Results: Wiberg and Cooperman and colleagues present 30 ideal patients for assessing the relationship between AD and OA. Each was arthritis free, with stable AD, CE angle <20 degrees, without signs of subluxation. They were all followed and all developed OA. In the studies by Stulberg and colleagues, and Jacobsen and colleagues, every patient presented with OA, making it difficult to be certain about the appearance of the hip before the onset of OA. In the study by Murphy and colleagues, we have the same problem, as an unknown number of patients already had OA at first assessment. All of these studies used different schemes for diagnosing OA, making the studies difficult to compare. Most of the patients in the studies were of Northern European ancestry, making the results difficult to generalize to other populations. Four patients had CE angles <20 degrees and did not develop severe arthritis by 65 years of age. Conclusions: Our conclusions apply directly to patients of Northern European ancestry. A few patients with stable, mild AD (CE angle 15 to 19 degrees) will be arthritis free at 65 years of age. Almost all patients with stable AD develop OA by 65 years of age. Unstable AD (CE angle <20 degrees, with subluxation) always leads to OA by 65 years of age. It is probably reasonable to extend these conclusions to other populations, but the reader must be prepared to re-evaluate them, as more data accumulates.

Effects of Postoperative Total Hip Arthroplasty on Axial Alignment of the Lower Limb in Patients with Unilateral Developmental Hip Dysplasia (Crowe type IV)

Article

Apr 2019
J ARTHROPLASTY

Background: The aim of this study was to evaluate the influence of total hip arthroplasty on axial alignment of the lower limb in adults with unilateral developmental hip dysplasia (Crowe type IV). Methods: We retrospectively reviewed medical records of 50 adults who underwent total hip arthroplasty, in which the acetabular cup was placed in the anatomical position. The following parameters were measured before surgery, immediately after surgery, and two years later: mechanical axis deviation (MAD), tibiofemoral angle (TFA), femoral offset, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle, height of medial femoral condyle, height of lateral femoral condyle, and leg lengthening. Length of the resected femoral segment was also recorded from medical records. Results: Preoperative MAD, TFA, HKA, and LDFA of the ipsilateral lower limb showed significant valgus deformity. MAD of the ipsilateral lower limb and valgus inclination were significantly smaller immediately after surgery than before, while TFA, HKA, femoral offset, and LDFA were significantly larger (P < 0.05). These parameters did not differ significantly between immediately after surgery and two years later (P > 0.05). Ipsilateral extremities were extended by a mean of 2.54 cm (range, 0 to 5.35 cm). The mean length of the femoral resected segment was 3.56 cm (range, 2.03 to 5.74 cm). The contralateral lower limb showed marginally smaller MAD and medial proximal tibial angle after surgery than before, but larger LDFA, TAF, and HKA. Conclusions: In patients with developmental hip dysplasia who underwent total hip arthroplasty with placement of the acetabular component at the level of the anatomic hip center, axial alignment of the ipsilateral lower limb was immediately altered, and valgus inclination was significantly reduced. The procedure only slightly altered the axial alignment of the contralateral lower limb.

3D-MRI versus 3D-CT in the evaluation of osseous anatomy in femoroacetabular impingement using Dixon 3D FLASH sequence

Article

Sep 2018

Objective To determine if hip 3D-MR imaging can be used to accurately demonstrate femoral and acetabular morphology in the evaluation of patients with femoroacetabular impingement. Materials and methods We performed a retrospective review at our institution of 17 consecutive patients (19 hips) with suspected femoroacetabular impingement who had both 3D-CT and 3D-MRI performed of the same hip. Two fellowship-trained musculoskeletal radiologists reviewed the imaging for the presence and location of cam deformity, anterior–inferior iliac spine variant, lateral center-edge angle, and neck–shaft angle. Findings on 3D-CT were considered the reference standard. The amount of radiation that was spared following introduction of 3D-MRI was also assessed. Results All 17 patients suspected of FAI had evidence for cam deformity on 3D-CT. There was 100% agreement for diagnosis (19 out of 19) and location (19 out of 19) of cam deformity when comparing 3D-MRI with 3D-CT. There were 3 type I and 16 type II anterior–inferior iliac spine variants on 3D-CT imaging with 89.5% (17 out of 19) agreement for the anterior–inferior iliac spine characterization between 3D-MRI and 3D-CT. There was 64.7% agreement when comparing the neck–shaft angle (11 out of 17) and LCEA (11 out of 17) measurements. The use of 3D-MRI spared each patient an average radiation effective dose of 3.09 mSV for a total reduction of 479 mSV over a 4-year period. Conclusion 3D-MR imaging can be used to accurately diagnose and quantify the typical osseous pathological condition in femoroacetabular impingement and has the potential to eliminate the need for 3D-CT imaging and its associated radiation exposure, and the cost for this predominantly young group of patients.

Does 3DMR provide equivalent information as 3DCT for the pre-operative evaluation of adult Hip pain conditions of femoroacetabular impingement and Hip dysplasia?

Article

Jul 2018

Objective: Femoroacetabular impingement (FAI) and hip dysplasia (HD) are frequently evaluated by isotropic CT (3DCT) for preoperative planning at the expense of radiation. The aim was to determine if isotropic MRI (3DMR) imaging can provide similar quantitative and qualitative morphological information as 3DCT. Methods: 25 consecutive patients with a final diagnosis of FAI or HD were retrospectively selected from December 2016-December 2017. Two readers (R1, R2) performed quantitative angular measurements on 3DCT and 3DMR, blinded to the diagnosis and each other's measurements. 3DMR and 3DCT of the hips were qualitatively and independently evaluated by a radiologist (R3), surgeon (R4), and fellow (R5). Interobserver and intermodality comparisons were performed. Results: The ICC was good to excellent for all measurements between R1 and R2 (ICC:0.60-0.98) and the majority of intermodality measurements for R1 and R2. Average inter-reader and inter-modality PABAK showed good to excellent agreement for qualitative reads. On CT, all alpha angles (AA) were significantly lower in dysplasia patients than in cam patients (p < 0.05). All lateral center-edge angle (LCEA) were significantly lower in dysplasia than in cam patients (p < 0.05). On MR, AA at 12, 1, and 2 o'clock, and LCEA at center were significantly lower in dysplasia patients than in cam patients (p < 0.05). Conclusion: 3DMR offers similar qualitative and quantitative analysis as 3DCT in adult painful hip conditions. Advances in knowledge: 3DMR has good potential to replace 3DCT and serve as a one-stop modality for bone and soft tissue characterizations in the pre-operative evaluation of FAI and HD.

Reduced Hip Adduction Is Associated With Improved Function After Movement-Pattern Training in Young People With Chronic Hip Joint Pain

Article

Mar 2018

Study Design Ancillary analysis, time-controlled randomized clinical trial. Background Movement-pattern training (MPT) has been shown to improve function among patients with chronic hip joint pain (CHJP). Objective To determine the association among treatment outcomes and mechanical factors associated with CHJP. Methods Twenty-eight patients with CHJP, 18 to 40 years of age, participated in MPT, either immediately after assessment or after a wait-list period. Movement-pattern training included task-specific training to reduce hip adduction motion during functional tasks and hip muscle strengthening. Hip-specific function was assessed using the Modified Harris Hip Score (MHHS) and Hip disability and Osteoarthritis Outcome Score (HOOS). Three-dimensional kinematic data were used to quantify hip adduction motion, dynamometry to quantify abductor strength, and magnetic resonance imaging to measure femoral head sphericity using the alpha angle. Paired t tests assessed change from pretreatment to posttreatment. Spearman correlations assessed associations. Results There was significant improvement in MHHS and HOOS scores (P≤.02), adduction motion (P = .045), and abductor strength (P = .01) from pretreatment to posttreatment. Reduction in hip adduction motion (r = −0.67, P<.01) and lower body mass index (r = −0.38, P = .049) correlated with MHHS improvement. Alpha angle and abductor strength change were not correlated with change in MHHS or HOOS scores. Conclusion After MPT, patients reported improvements in pain and function that were associated with their ability to reduce hip adduction motion during functional tasks. Level of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2018;48(4):316–324. doi:10.2519/jospt.2018.7810

Surgery for treating femoroacetabular impingement

Article

Nov 2013

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the benefits and safety of surgical interventions for treating FAI.

Hip preservation surgery – Can we change the natural history of osteoarthritis?

Article

Feb 2018
Semin Arthroplasty

Structural abnormalities of the hip including developmental dysplasia (DDH) and femoroacetabular impingement (FAI) are a predominant cause of primary osteoarthritis. While affected patients may have significant pain and functional limitations, many may remain asymptomatic and will likely incur intra-articular damage over time. The objective of this review is to explore the natural history of DDH, FAI, and the current outcomes of hip preservation surgery including peri-acetabular osteotomy, hip arthroscopy, and surgical hip dislocation.

Femoroacetabular impingement: A cause for osteoarthritis of the hip

Article

Full-text available

Jan 2003

Hip dysplasia and osteoarthrosis

Article

Full-text available

Jan 2005

Introduction Hip dysplasia (HD) is assumed to be an etiological factor in the development of premature hip osteoarthrosis (OA). We established the prevalences of HD and OA in adults according to qualified radio-graphic discriminators, and investigated the relationship between HD and OA. Methods Wiberg's CE angle (CE), Sharp's angle, the femoral head extrusion index, the acetabular depth ratio (ADR), the radiographic OA discriminators of Croft, and of Kellgren and Lawrence, and also minimum joint space width (JSW) ≤ 2 mm were applied to the standing, standardized pelvic radiographs of 1 429 men (22–93 years), and 2 430 women (22–92 years). Results The 4 HD discriminators were interrelated. A negligible sex-related difference in acetabular morphology was found, male acetabulae being slightly more dysplastic than female acetabulae. However, differences between the sexes for right and left CE angles were within 1.0°, and within 1.4° for right and left Sharp's angles. There were no cases of hip subluxation (breakage of Shenton's line ≥ 5 mm). Average CE angle was 34° in men (SD 7.3°), and 35° in women (SD 7.6°). Applying a CE cutoff value of 20° for designation of definite hip dysplasia, we found a prevalence of hip dysplasia of 3.4%. Approximately 2% of cases were unilateral and 1.4% of cases were bilateral. We found significant relationships between radiographic OA discriminators and the CE angle, femoral head extrusion index and ADR. Odds ratios ranged from 1.0 to 6.2. Compared to subjects with OA in morphologically normal hips, a trend towards younger age in subjects with HD and OA was noted, but this was not strictly significant.

Femoroace - tabular impingement: A cause for osteoarthritis of the hip

Article

Full-text available

Jan 2003
CLIN ORTHOP RELAT R

Mild acetabular dysplasia and risk of osteoarthritis of the hip: A case-control study

Article

Full-text available

Oct 2010
ANN RHEUM DIS

To determine whether mild variation in acetabular depth (AD) and shape is a risk factor for osteoarthritis (OA) of the hip. The unaffected contralateral hip of patients with unilateral hip OA was compared with hips of asymptomatic controls without hip OA, derived from the Nottingham Genetics Osteoarthritis and Lifestyle case-control study. Standardised anteroposterior x-rays of the pelvis were used to measure centre edge (CE) angle and AD. Cut-off points for narrow CE angle and shallow AD were calculated from the control group (mean -1.96 × SD). The relative risk of hip OA associated with each feature was estimated using OR and 95% CI and adjusted risks were calculated by logistic regression. In controls, both the CE angle and the AD were lower in the left hip than in the right hip. The CE angle related to age in both hips, and AD of the right hip was lower in men than in women. The contralateral unaffected hip in patients with unilateral hip OA had a decreased CE angle and AD compared with controls, irrespective of side. The lowest tertile of the CE angle in contralateral hips was associated with an eightfold risk of OA (aOR 8.06, 95% CI 4.87 to 13.35) and the lowest tertile of AD was associated with a 2.5-fold risk of OA (aOR 2.53, 95% CI 1.28 to 5.00). Significant increases in the risk of OA were also found as the CE angle and AD decreased. Constitutional mild acetabular dysplasia appears to increase the risk of hip OA.

The acetabular rim syndrome. A clinical presentation of dysplasia of the hip

Article

Full-text available

Jun 1991

The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. The symptoms are pain and impaired function. All our cases were treated by operation which consisted in most instances of re-orientation of the acetabulum by peri-acetabular osteotomy and arthrotomy of the hip. In all cases, the limbus was found to be detached from the bony rim of the acetabulum. In several instances there was a separated bone fragment, or 'os acetabuli' as well. In acetabular dysplasia, the acetabular rim is subject to abnormal stress which may cause the limbus to rupture, and a fragment of bone to separate from the adjacent bone margin. Dysplastic acetabuli may be classified into two radiological types. In type I there is an incongruent shallow acetabulum. In type II the acetabulum is congruent but the coverage of the femoral head is deficient.

Association of overweight, trauma and workload with coxarthrosis: A health survey of 7,217 persons

Article

Full-text available

Nov 1993
Acta Orthop Scand

In a population sample health survey, body mass, previous trauma and physical stress were studied for associations with coxarthrosis. A sample of 8,000 persons representative of the Finnish population aged 30 or over was invited for examination, and 90 percent participated. On the basis of a standardized clinical examination, a physician diagnosed coxarthrosis in 6 percent of the women and 4 percent of the men. The prevalence rose with age. In persons with a past traumatic lower-limb injury, the odds ratio of unilateral coxarthrosis was 2.1 and of bilateral coxarthrosis 1.5, as adjusted for sex, age and other determinants using logistic regression. The sum index reflecting self-reported features of physical stress in present or previous occupations was directly proportional to the prevalence of coxarthrosis. Body mass index (kg/m2) was closely associated with bilateral coxarthrosis; the adjusted odds ratio (95 percent confidence intervals) for indices > 35, compared to those < 25, was 2.8 (1.4-5.7). In terms of the population attributable fraction, prior trauma, physical stress and body mass were estimated to explain 59 percent of the prevalence of coxarthrosis. The potential for primary prevention may be great, but longitudinal population studies are necessary to elucidate causal significance of the risk factors.

Acetabular dysplasia and osteoarthritis of the hip in elderly white women

Article

Full-text available

Nov 1997

To examine the association of acetabular dysplasia and osteoarthritis (OA) of the hip among elderly white women. Pelvic radiographs from a sample of 165 white women aged 65 and above with radiographic hip OA and 88 white women aged 65 and above without radiographic changes of hip OA were read for evidence of acetabular dysplasia by a single trained investigator. Acetabular dysplasia was assessed using measurements of the centre edge angle and the acetabular depth, which are both reduced in this condition. Odds ratios for the association between acetabular dysplasia and hip OA were estimated using logistic regression analysis. Fourteen (3.4%) hips had a centre edge angle < 25 degrees, 46 (11.2%) hips had an acetabular depth of < 9 mm, and 54 (13.2%) hips had acetabular dysplasia defined as either of the above. Hips with OA had a small, but not statistically significant, increased prevalence of abnormal centre edge angle (odds ratio: 1.43; 95% confidence intervals: 0.46, 4.46), abnormal acetabular depth (1.47; 0.78, 2.77) and acetabular dysplasia (1.33; 0.74, 2.40). These results do not support the hypothesis that mild acetabular dysplasia accounts for a substantial proportion of hip OA in elderly white women. A study with a much larger sample size would be required to rule out a weak association between dysplasia and hip OA of the magnitude actually observed in our study.

Retroversion of the acetabulum. A cause of hip pain

Article

Full-text available

Apr 1999

We describe a little-known variety of hip dysplasia, termed ‘acetabular retroversion’, in which the alignment of the mouth of the acetabulum does not face the normal anterolateral direction, but inclines more posterolaterally. The condition may be part of a complex dysplasia or a single entity. Other than its retroversion, the acetabulum is sited normally on the side wall of the pelvis, and its articular surface is of normal extent and configuration. The retroverted orientation may give rise to problems of impingement between the femoral neck and anterior acetabular edge. We define the clinical and radiological parameters and discuss pathological changes which may occur in the untreated condition. A technique of management is proposed.

Retroversion of the acetabulum

Article

Full-text available

Aug 1999

Martin Bircher

Prevalence of hip osteoarthritis and acetabular dysplasia in French and Japanese adults

Article

Full-text available

Aug 2000

: To determine ethnic variations of acetabular morphology, and to delineate their relationship with hip osteoarthritis (OA). : Radiographs of 283 French men, 118 French women, 414 Japanese men and 368 Japanese women, aged 20-79 yr, who underwent intravenous urography were assessed by a single observer for morphometric measurement and hip OA scoring. : The standardized morbidity ratio (SMR) for hip OA was highest in French men and lowest in Japanese men, whereas the SMR for acetabular dysplasia was highest in Japanese women and lowest in French men. French men and women had the highest centre-edge angle, followed by Japanese men then Japanese women. : In a large number of subjects assessed by a single observer, this study confirms other previous reports that the relationship between acetabular dysplasia and risk of hip OA is negative.

Assessment of a genetic contribution to osteoarthritis of the hip: Sibling study

Article

Full-text available

Dec 2000

To study the influence of genetics on the development of hip osteoarthritis as determined by structural change on plain radiographs. Sibling study. Nottinghamshire, England. 392 index participants with hip osteoarthritis of sufficient severity to warrant total hip replacement, 604 siblings of the index participants, and 1718 participants who had undergone intravenous urography. Odds ratios for hip osteoarthritis in siblings. The age adjusted odds ratios in siblings were 4.9 (95% confidence interval, 3.9 to 6.4) for probable hip osteoarthritis and 6.4 (4.5 to 9.1) for definite hip osteoarthritis. These values were not significantly altered by adjusting for other risk factors. Siblings have a high risk of hip osteoarthritis as shown by structural changes on plain radiographs. One explanation is that hip osteoarthritis is under strong genetic influence.

The contour of the femoral head-neck junction as a predictor for the risk of anterior impingment

Article

Full-text available

May 2002

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination. MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle (alpha). In addition, the width of the femoral head-neck junction was measured at two sites. Repeated measurements showed good reproducibility among four observers. The angle alpha averaged 74.0 degrees for the patients and 42.0 degrees for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites. Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips. This test may be of value in patients with loss of internal rotation for which a cause is not found.

Syndrome of symptomatic adult acetabular dysplasia (SAAD syndrome)

Article

Full-text available

May 2003

To determine the prevalence of acetabular dysplasia in subjects presenting with hip pain to primary care and its relationship with radiographic osteoarthritis (OA) of the hip. Cross sectional analysis of a prospective cohort. 35 general practices across the UK. 195 patients (63 male, 132 female) aged 40 years and over presenting with a new episode of hip pain The prevalence of acetabular dysplasia in this study of new presenters with hip pain was high (32%). There was no significant relationship between acetabular dysplasia and radiographic OA overall. The high prevalence of acetabular dysplasia across all grades of OA severity suggests that dysplasia itself may be an important cause of hip pain ("symptomatic adult acetabular dysplasia").

Influence of hip dysplasia on the development of osteoarthritis of the hip

Article

Full-text available

Jul 2004

It has been suggested that in some patients with primary hip osteoarthritis (OA), the disease occurs as a consequence of acetabular dysplasia or hip dysplasia (HD). To carry out a systematic review to investigate the association between acetabular dysplasia and hip OA. A database search of Medline, Embase, and the Cochrane library was carried out, and articles that aimed at studying the relationship between HD and hip OA were identified. The methodological quality of the selected studies was assessed using a standardised set of criteria, and a best evidence synthesis was used to summarise the results from the individual studies. Five cohort studies and four case-control studies were included in this review. One cohort study had the correct design to answer the question and was considered to be a high quality study. This study reported a positive association between HD and hip OA. Overall, limited evidence was found for a positive association between HD and hip OA. Most studies included older people. In younger age groups the relation between HD and OA or hip complaints may be much higher. The evidence for the influence of HD on the occurrence of hip OA, at age 50-60 or older, is limited.

An in vitro investigation of the acetabular labral seal in hip joint mechanics

Article

Full-text available

Mar 2003
J BIOMECH

Labrum pathology may contribute to early joint degeneration through the alteration of load transfer between, and the stresses within, the cartilage layers of the hip. We hypothesize that the labrum seals the hip joint, creating a hydrostatic fluid pressure in the intra-articular space, and limiting the rate of cartilage layer consolidation. The overall cartilage creep consolidation of six human hip joints was measured during the application of a constant load of 0.75 times bodyweight, or a cyclic sinusoidal load of 0.75+/-0.25 times bodyweight, before and after total labrum resection. The fluid pressure within the acetabular was measured. Following labrum resection, the initial consolidation rate was 22% greater (p=0.02) and the final consolidation displacement was 21% greater (p=0.02). There was no significant difference in the final consolidation rate. Loading type (constant vs. cyclic) had no significant effect on the measured consolidation behaviour. Fluid pressurisation was observed in three of the six hips. The average pressures measured were: for constant loading, 541+/-61kPa in the intact joint and 216+/-165kPa following labrum resection, for cyclic loading, 550+/-56kPa in the intact joint and 195+/-145kPa following labrum resection. The trends observed in this experiment support the predictions of previous finite element analyses. Hydrostatic fluid pressurisation within the intra-articular space is greater with the labrum than without, which may enhance joint lubrication. Cartilage consolidation is quicker without the labrum than with, as the labrum adds an extra resistance to the flow path for interstitial fluid expression. However, both sealing mechanisms are dependent on the fit of the labrum against the femoral head.

Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey

Article

Feb 2005

The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement

Article

May 2002

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination. MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle (α). In addition, the width of the femoral head-neck junction was measured at two sites. Repeated measurements showed good reproducibility among four observers. The angle α averaged 74.0° for the patients and 42.0° for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites. Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips. This test may be of value in patients with loss of internal rotation for which a cause is not found.

The prognosis in untreated dysplasia of the hip

Article

Jan 1995

To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had a total hip replacement for osteoarthrosis secondary to dysplasia. The initial radiographic findings in seventy-four patients in whom advanced osteoarthrosis later developed in the contralateral hip were compared with those in forty-three patients who had reached the age of sixty- five years without having had severe osteoarthrosis. No patient in whom the hip functioned well until the age of sixty-five years had had a center-edge angle of less than 16 degrees, an acetabular index of depth to width of less than 38 per cent, an acetabular index of the weight-bearing zone of more than 15 degrees, uncovering of the femoral head of more than 31 per cent, or an acetabulum in which the most proximal point of the dome had been at the lateral edge (zero peak-to-edge distance).

Acetabular dysplasia and hip osteoarthritis in Britain and Japan

Article

Nov 1998
Rheumatology

N Yoshimura

SUMMARY Objective. Geographic diVerences in the prevalence of hip osteoarthritis (OA) have been ascribed to diVerences in the frequency of acetabular dysplasia among diVerent ethnic groups. However, there are few data on the shape of the acetabulum in various populations around the world. We examined this issue in samples of pelvic radiographs from Britain and Japan. Methods. Measurements were made on the pelvic radiographs of 1303 men and 195 women, aged 60‐75 yr, who attended for i.v. urography in two British centres. These were compared with 99 men and 99 women aged 60‐79 yr who were included in a population-based study in a rural community in Japan, and who agreed to undergo standardized pelvic radiography. Acetabular dysplasia was assessed by morphometric measurement of the centre‐edge (CE ) angle and acetabular depth. Results. The mean CE angle among men was 36° (95% CI 35‐37°) in Britain and 31° (95% CI 29‐32°) in Japan; that in women was 37° (95% CI 36‐38°) in Britain and 31° (95% CI 29‐33°) in Japan. The mean values of acetabular depth were also significantly (P< 0.001) lower in Japan than in Britain. However, the prevalence of hip OA was lower in Japan (0% in men, 2% in women) than in Britain (11% in men, 4.8% in women). In a random eVects model, there were negative relationships between measures of acetabular dysplasia and minimum joint space among individuals. Conclusions. We conclude that there are marked diVerences in pelvic morphometry between Britain and Japan. The acetabular dimensions of Japanese subjects are considerably shallower than those of their British counterparts of similar age and sex. Nevertheless, hip OA is more frequent in Britain than in Japan. Further studies are required on the risk factors for hip OA in Oriental populations, in order that the aetiology of this disorder can be better understood.

Assessment of a genetic contribution to osteoarthritis of the hip: sibling study

Article

Nov 2000

Peter Lanyon

Objectives: To study the influence of genetics on the development of hip osteoarthritis as determined by structural change on plain radiographs. Design: Sibling study. Setting: Nottinghamshire, England. Participants: 392 index participants with hip osteoarthritis of sufficient severity to warrant total hip replacement, 604 siblings of the index participants, and 1718 participants who had undergone intravenous urography. Main outcome measure: Odds ratios for hip osteoarthritis in siblings. Results: The age adjusted odds ratios in siblings were 4.9 (95% confidence interval, 3.9 to 6.4) for probable hip osteoarthritis and 6.4 (4.5 to 9.1) for definite hip osteoarthritis. These values were not significantly altered by adjusting for other risk factors. Conclusion: Siblings have a high risk of hip osteoarthritis as shown by structural changes on plain radiographs. One explanation is that hip osteoarthritis is under strong genetic influence.

Osseous Abnormalities and Early Osteoarthritis

Article

Dec 2004

The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. In all three studies, a common etiology was identified. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. This impingement was caused by a pistol-grip deformity of the proximal femur in 97% of the cases in the arthroscopic labral study and 100% of the cases in the idiopathic arthritis study. The identification of anterior hip impingement as a cause of labral tears and idiopathic arthritis may allow surgeons to correct it early in its natural history and delay or prevent end-stage arthritis.

The Prevalence of Acetabular Retroversion Among Various Disorders of the Hip

Article

Feb 2006

Masamitsu Ezoe

Background: Acetabular retroversion can result from posterior wall deficiency in an otherwise normally oriented acetabulum or from excessive anterior coverage secondary to a malpositioned acetabulum, or both. Theoretically, a retroverted acetabulum, which adversely affects load transmission across the hip, may occur more frequently in hips with degenerative arthritis. The aim of this study was to assess the prevalence of acetabular retroversion in normal hips and in hips with osteoarthritis, developmental dysplasia, osteonecrosis, and Legg-Calvé-Perthes disease. Methods: We retrospectively examined anteroposterior radiographs of the pelvis of 250 patients (342 hips). Fifty-six patients (112 hips) had normal findings; sixty-six patients (seventy hips) had osteoarthritis; sixty-four (seventy-four hips), developmental dysplasia; thirty (thirty-six hips), osteonecrosis of the femoral head; and thirty-four (fifty hips), Legg-Calvé-Perthes disease. The sole criterion for a diagnosis of acetabular retroversion was the presence of a so-called cross-over sign on the anteroposterior radiograph of the pelvis. Results: The prevalence of acetabular retroversion was 6% (seven of 112 hips) in the normal group, 20% (fourteen of seventy hips) in the osteoarthritis group, 18% (thirteen of seventy-four hips) in the developmental dysplasia group, 6% (two of thirty-six hips) in the group with osteonecrosis of the femoral head, and 42% (twenty-one of fifty hips) in the group with Legg-Calvé-Perthes disease. In patients with Legg-Calvé-Perthes disease, the prevalence of acetabular retroversion was 68% in twenty-five hips with Stulberg class-III, IV, or V involvement. In contrast, only four (16%) of twenty-five hips with Stulberg class-I or II involvement had acetabular retroversion. The difference was significant (p = 0.0002). Patients with osteoarthritis, developmental dysplasia, or Legg-Calvé-Perthes disease are significantly more likely to have acetabular retroversion than are normal subjects (p < 0.05). Conclusions: Acetabular retroversion occurs more commonly in association with a variety of hip diseases, in which the prevalence of subsequent degenerative arthritis is increased, than has been previously noted.

Radiological Assessment of OsteoArthrosis

Article

Dec 1957

The Economic Burden of Osteoarthritis

Article

Sep 2009
AM J MANAG CARE

Ryan Bitton

As the most common form of joint disease, osteoarthritis (OA) is associated with an extremely high economic burden. This burden is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. Although typically associated with less severe effects on quality of life and per capita expenditures than rheumatoid arthritis, OA is nevertheless a more costly disease in economic terms because of its far higher prevalence. At the same time, the burden of OA is increasing. While direct and indirect per capita costs for OA have stabilized in recent years, the escalating prevalence of the disease-partly a function of the rapid increase in 2 major risk factors: aging and obesity-has led to much higher overall spending for OA. Approximately one-third of direct OA expenditures are allocated for medications, much of which goes toward pain-related agents. Hospitalization costs comprise nearly half of direct costs, although these expenditures are consumed by only 5% of OA patients who undergo knee or hip replacement surgery. However, while these surgeries are costly, they also appear to be quite cost-effective in the long term. Indirect costs for OA are also high, largely a result of work-related losses and home-care costs. Despite the need for wide-ranging and up-to-date data on the economics of OA treatment to clarify the most effective treatments and the best use of resources, this area of study has received insufficient research attention.

Acetabular and femoral anteversion: Relationship with osteoarthritis of the hip

Article

Dec 1999

Individual Risk factors for Hip Osteoarthritis: Obesity, Hip Injury and Physical Activity

Article

Mar 1998
AM J EPIDEMIOL

Hip osteoarthritis is a major cause of pain and disability. The authors explored individual risk factors for hip osteoarthritis in a population-based case-control study. The study was performed in two English health districts (Portsmouth and North Staffordshire) from 1993 to 1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period were compared with an equal number of controls selected from the general population and individually matched for age, sex, and family practitioner. Information about suspected risk factors was obtained by a questionnaire administered at interview and a short physical examination. Obesity (odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.3-2.4; highest vs. lowest third of body mass index), previous hip injury (OR = 4.3, 95% CI 2.2-8.4), and the presence of Heberden's nodes (OR = 1.6, 95% CI 1.2-2.2) were independent risk factors for hip osteoarthritis among men and women. Hip injury was more closely related to unilateral as compared with bilateral disease. There were a negative association between cigarette smoking and osteoarthritis among men and a weak positive association with prolonged regular sporting activity. Obesity and hip injury are important independent risk factors for hip osteoarthritis, which might be amenable to primary prevention. Hip osteoarthritis may also arise as part of the polyarticular involvement found in generalized osteoarthritis.

Systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases

Article

Oct 2010

To create a comprehensive evaluation of checklists and scales used to evaluate observational studies that examine incidence or prevalence and risk factors for diseases. We did a literature search of several databases to abstract format, content, development, and validation of the tools. We identified 46 scales and 51 checklists. Forty-seven of these tools were created for therapeutic studies, 48 for risk factors, and 5 for incidence studies. Forty-seven percent were modifications of previously published peer-reviewed appraisals, 18% were developed based on methodological standards, and 35% did not report development. Twenty-two percent reported reliability and 10% the validation procedure. Tools did not discriminate poor reporting vs. methodological quality of studies or external vs. internal validity; 35% categorize quality by the presence of predefined major flaws in design or by total score from the scale. Level of evidence was proposed in 22% of the tools by criteria of causality or internal validity of the studies. Evaluation required different degrees of subjectivity. Format, length, and content varied substantially across available checklists and scales. Development, validation, and reliability were not consistently reported. Transparent objective quality assessments should be developed in the future.

Prevalence of Malformations of the Hip Joint and Their Relationship to Sex, Groin Pain, and Risk of Osteoarthritis A Population-Based Survey

Article

May 2010
J BONE JOINT SURG AM

Although the clinical consequences of femoroacetabular impingement have been well described, little is known about the prevalence of the anatomical malformations associated with this condition in the general population, the natural history of the condition, and the risk estimates for the development of osteoarthritis. The study material was derived from a cross-sectional population-based radiographic and questionnaire database of 4151 individuals from the Copenhagen Osteoarthritis Substudy cohort between 1991 and 1994. The subjects were primarily white, and all were from the county of Østerbro, Copenhagen, Denmark. The inclusion criteria for this study were met by 1332 men and 2288 women. On the basis of radiographic criteria, the hips were categorized as being without malformations or as having an abnormality consisting of a deep acetabular socket, a pistol grip deformity, or a combination of a deep acetabular socket and a pistol grip deformity. Hip osteoarthritis was defined radiographically as a minimum joint-space width of <or=2 mm. The male and female prevalences of hip joint malformations in the 3620 study subjects were 4.3% and 3.6%, respectively, for acetabular dysplasia; 15.2% and 19.4% for a deep acetabular socket; 19.6% and 5.2% for a pistol grip deformity; and 2.9% and 0.9% for a combination of a deep acetabular socket and pistol grip deformity. The male and female prevalences of a normal acetabular roof were 80.5% and 77.0%. We found no significantly increased prevalence of groin pain in subjects whose radiographs showed these hip joint malformations (all p > 0.13). A deep acetabular socket was a significant risk factor for the development of osteoarthritis (risk ratio, 2.4), as was a pistol grip deformity (risk ratio, 2.2). Acetabular dysplasia and the subject's sex were not found to be significant risk factors for the development of hip osteoarthritis (p = 0.053 and p = 0.063, respectively). The prevalence of hip osteoarthritis was 9.5% in men and 11.2% in women. The prevalence of concomitant malformations was 71.0% in men with hip osteoarthritis and 36.6% in women with hip osteoarthritis. In our study population, a deep acetabular socket and a pistol grip deformity were common radiographic findings and were associated with an increased risk of hip osteoarthritis. The high prevalence of osteoarthritis in association with malformations of the hip joint suggests that an increased focus on early identification of malformations should be considered.

Hip osteoarthritis and risk factors in elderly Korean population

Article

Nov 2009
OSTEOARTHR CARTILAGE

To investigate the prevalence of hip osteoarthritis (OA) in a community-based elderly Korean population and to identify its risk factors. Radiographs of hip and knee were evaluated in 288 men and 386 women (age>or=65 years) that participated in the Korean Longitudinal Study on Health and Aging (KLoSHA). Minimum joint space widths (JSW), center-edge angles (CEA), and neck-shaft angles were measured on hip radiographs, and tibio-femoral angles on knee radiographs. Hip OA was defined as minimum JSW of <or=2mm or <or=2.5mm. The following potential risk factors of OA were examined; demographic data, acetabular dysplasia, large CEA (>or=40 degrees) and deformities of femoral neck and knee joint. Multivariate analysis with generalized estimating equation (GEE) model was performed to exclude confounding factors. When hip OA was defined as JSW<or=2mm, the overall prevalence of the disease was 2.1% (95% confidence interval [CI], 1.0-3.2%), and only older age (>or=70 years) was identified as a significant risk factors with an odds ratio (OR) of 10.0. However, when hip OA was defined as a JSW of <or=2.5mm, the overall prevalence of the disease was 13.1% (95% CI, 10.5-15.6%), and older age (>or=70 years), female, large CEA (>or=40 degrees), and acetabular dysplasia (CEA<20 degrees) were identified as significant risk factors with ORs of 2.1, 2.1, 2.3, and 10.2, respectively. The prevalence of hip OA in elderly Korean was 2.1% (JSW<or=2mm) in community-based population. Older age (>or=70 years), female, large CEA (>or=40 degrees), and acetabular dysplasia (CEA<20 degrees) appeared to be significant risk factors of hip OA.

Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia

Article

Jun 2009
J BONE JOINT SURG AM

Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. The purpose of this study was to investigate the anatomic and demographic factors associated with the early onset of osteoarthritis in dysplastic hips by utilizing the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index as a marker of the disease. Ninety-six symptomatic dysplastic hips in seventy-four patients were assessed with standard radiographs and a dGEMRIC scan. The lateral center-edge angle of Wiberg, the acetabular index of Tönnis, and the break in the Shenton line were measured on a standing anteroposterior radiograph. Anterior undercoverage was assessed by measuring the anterior center-edge angle on a Lequesne false-profile view. A labral tear was considered to be present when contrast agent was seen through the entire thickness of the labrum on magnetic resonance arthrography. Osteoarthritis was defined as a dGEMRIC value of <390 msec (two standard deviations below the dGEMRIC index in normal hips). The mean dGEMRIC index (and standard deviation) for this cohort (473 +/- 104 msec) was significantly lower than that of a morphologically normal hip (570 +/- 90 msec). The anterior center-edge angle, the joint space width, and the presence of a labral tear were all found to be associated with osteoarthritis in the univariate analysis. Multivariate analysis identified age, the anterior center-edge angle, and the presence of a labral tear as independent factors associated with osteoarthritis. A second model was fitted with omission of the anterior center-edge angle because the lateral and anterior center-edge angles were highly correlated and the lateral center-edge angle is a more common clinical measure. This model identified age, the lateral center-edge angle, and the presence of a labral tear as significant independent factors associated with osteoarthritis. As has been demonstrated in previous studies of the hip, this investigation showed osteoarthritis to be associated with increasing age and the severity of dysplasia, as demonstrated both by the Wiberg lateral center-edge angle and the Lequesne anterior center-edge angle. Additionally, we identified a labral tear as being a risk factor for osteoarthritis.

Osteoarthritis of the hip and acetabular dysplasia

Article

Jun 1991

The relation between acetabular dysplasia and osteoarthritis of the hip was examined in a series of 1516 pelvic radiographs taken for non-skeletal indications. Osteoarthritis was assessed by measuring joint space, and dysplasia by the centre-edge angle and acetabular depth. In contrast with previous studies of patients with symptomatic osteoarthritis of the hip, no evidence that dysplasia predisposes to osteoarthritis was found. Possible reasons for the discrepancy are discussed. It was concluded that although acetabular dysplasia may lead to osteoarthritis of the hip in some subjects, it is unlikely to be an important cause of the disease in men.

The Aetiology of Primary Osteoarthritis of the Hip

Article

Dec 1965

R O Murray

In most reports on osteoarthritis of the hip approximately half the patients have presented in adult life with no relevant antecedent history. In order to assess, in such cases of so-called primary osteoarthritis, the presence of any minor pre-existing anatomical abnormality, the pelvic radiographs of 200 cases of this type were examined. No case in which the changes could be attributed to symptomatic disorder earlier in life was accepted. In this connection a few cases showing a protrusio acetabuli deformity were arbitrarily regarded as being secondary to inflammatory change of a rheumatoid nature and were therefore excluded. The cases were divided by visual assessment into those arising in the presence of (a) normal anatomy; (b) abnormal anatomy. The variations in the latter group included imperfect acetabular development—acetabular dysplasia—and an abnormal relationship of the femoral head to the femoral neck, comparable to the residual adult deformity of epiphysiolysis in adolescence. This abnormality was designated the tilt deformity. These different types showed somewhat different radiological features. Each hip, together with a control series of 100 hips, was then subjected to geometrical measurement. To assess acetabular dysplasia, the well recognised C E angle of Wiberg was used, but this was supplemented by a new measurement, the acetabular depth, which is considered to be simpler and more reliable when the joint architecture is disturbed by osteoarthritis. The tilt deformity required a new measurement—the femoral head ratio (FHR). The techniques for these measurements are described. These measurements, compared with the control series, were statistically significant (P<0·001) in the case of each of these anatomical abnormalities. Osteoarthritis arising in the presence of normal anatomy, here described as idiopathic, was found in 35 per cent with a female to male preponderance of approximately 4:1. The average age of onset of symptoms was 57·7 years. Osteoarthritis arising in the presence of abnormal anatomy accounted for the remaining 65 per cent. That associated with acetabular dysplasia represented 25·5 per cent of the whole series and also showed a female to male preponderance of approximately 4:1 with a rather earlier average age of onset of symptoms—50·8 years. This type appears to be a forme fruste of congenital dislocation of the hip. The tilt deformity was found in 39·5 per cent with a marked variation in sex incidence, approximately six males being affected for every female. The age of onset of symptoms in this group was 51·5 years. The balance of evidence suggests that this anatomical variation results from minor and unrecognised trauma in adolescence. It is considered that these minor anatomical variations can be recognised from more critical examination of pelvic radiographs and that their presence should indicate joint incongruity and potential osteoarthritic change. Conversely a normal adult pelvic radiograph makes the subsequent development of osteoarthritis of the hip much less likely. Earlier recognition of degenerative change may permit earlier treatment by osteotomy and arrest of the process of deterioration.

Acetabular Dysplasia in the Adult

Article

Jun 1983

Twenty adults (32 hips) with acetabular dysplasia were followed up for an average of 22 years to determine the natural history of the disorder. Initially, all hips had a center-edge (CE) angle of Wiberg of 20 degrees or less and an essentially intact Shenton's line with no roentgenographic evidence of osteoarthritis. Average patient age initially was 43 years (range, 27-57 years) and at final follow-up examination, 65 years. Various parameters of hip integrity were measured, including the CE angle of Wiberg, acetabular angle of Sharp, percentage of the femoral head covered by the acetabulum, acetabular depth, and inclination of the lateral lip of the acetabulum. None of these indicators proved a reliable prognostic aid for predicting the rate at which the osteoarthritis process supervened in any one case.

The Prognosis in Untreated Dysplasia of the Hip. A Study of Radiographic Factors That Predict the Outcome

Article

Aug 1995

To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had a total hip replacement for osteoarthrosis secondary to dysplasia. The initial radiographic findings in seventy-four patients in whom advanced osteoarthrosis later developed in the contralateral hip were compared with those in forty-three patients who had reached the age of sixty-five years without having had severe osteoarthrosis. No patient in whom the hip functioned well until the age of sixty-five years had had a center-edge angle of less than 16 degrees, an acetabular index of depth to width of less than 38 per cent, an acetabular index of the weight-bearing zone of more than 15 degrees, uncovering of the femoral head of more than 31 per cent, or an acetabulum in which the most proximal point of the dome had been at the lateral edge (zero peak-to-edge distance).

Osteoarthritis of the hip joint and acetabular dysplasia

Article

Mar 1995

Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

Abstract

No full-text available