Ganz R, Leunig M, Leunig-Ganz K, et al. The etiology of osteoarthritis of the hip: an integrated mechanical concept

University of Berne, Berne, Switzerland.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 03/2008; 466(2):264-72.
Source: PubMed


The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present. LEVEL OF EVIDENCE: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Available from: Michael Leunig, Dec 25, 2014
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    • "Osteoarthritis (OA) of hip can be divided into primary and secondary forms [1] [2] [3] [4] [5]. The primary OA is generally regarded to be associated with underlying abnormalities of articular cartilage without an anatomical abnormality or specific disease process, which is more common in Caucasians than in non-Caucasians [2] [3]. "
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    ABSTRACT: The values of hip rotation center (HRC) and femoral offset (FO) evaluated according to Caucasian anatomical landmarks have been regarded as a useful reference also for Japanese patients in total hip arthroplasty (THA). In a strict sense, however, since there can be racial differences among their anatomical morphologies, it is clinically important to reconsider those parameters for the Japanese. In the present study, in order to investigate correlations among hip and pelvic morphometric parameters, frontal radiographs were taken from 98 Japanese adults (60 males and 38 females) without acetabular dysplasia and arthropathy in the standing position. Their mean age was 62.0 ± 16.7 years. The horizontal position of HRC was significantly correlated with the pelvic width in both genders ( P = 0.0026 and 0.0010 for the males and the females, resp.). The vertical position of HRC was significantly correlated with the teardrop-sacroiliac distance in the males P = 0.0003 and with the pelvic cavity height in the females P = 0.0067 . However, in both genders, there were no correlations among FO and the other parameters analyzed in this study. Our present findings might contribute to theoretical implications of an appropriate HRC position for Japanese OA patients in THA.
    Full-text · Article · Nov 2015
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    • "In this condition, deviation from a round, circular femoral head, or over-coverage of the anterior acetabular rim, results in abnormal contacts between these two parts of the joint at the extremes of hip motion. With repetitive motion, this can lead to chondro-labral injury, and subsequently cartilage wear and osteoarthritis of the hip (Ganz et al., 2008). "
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    ABSTRACT: Gait analysis studies in patients with femoroacetabular impingement syndrome focused until today on alterations in pelvic and hip mechanics, but distal articulations in this syndrome were not explored. Viewing the inter-relationships between foot and hip mechanics and the importance of the subtalar joint in load attenuation at heel strike and during forward propulsion thereafter, alterations in hindfoot mechanics in this syndrome may have clinical significance. Three-dimensional gait kinematics were explored with emphasis on hindfoot mechanics in a group of 15 men with cam-type femoroacetabular impingement and compared to 15 healthy men. Subjects with femoroacetabular impingement had decreased pelvic internal rotation (effect size=0.70) and hip abduction (effect size=0.86) at heel strike, and increased sagittal pelvic range of motion during the stance (effect size=0.81), compared to controls. At the hindfoot level, subjects with femoroacetabular impingement had inverted position at heel strike compared to neutral position in controls (effect size=0.89), and reduced maximum hindfoot eversion during the stance (effect size=0.72). Range of motion from heel strike to maximum eversion was not different between the groups (effect size=0.21). Young adult men with cam-type femoroacetabular impingement syndrome present excessively inverted hindfoot at the moment of heel strike and reduction in maximum eversion during the stance phase. Viewing the deleterious effects of hindfoot malalignment on load attenuation during the stance, custom-designed insoles may be a consideration in this population and this should be investigated further. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Clinical biomechanics (Bristol, Avon)
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    • "Femoroacetabular impingement syndrome (FAI) is a clinical entity that has been recognized in recent years as a frequent cause of pain and the early development of hip arthrosis (Ganz et al., 2003). Structural abnormalities associated with the development of this disease include abnormal morphology of the femoral head-neck complex and the acetabulum, which causes chronic pain and functional limitation of the hip (Beck et al., 2005; Ganz et al., 2008). "
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    ABSTRACT: Femoroacetabular impingement syndrome (FAI) is a clinical entity that has been recognized in recent years as a frequent cause of pain and the early development of hip arthrosis. Subspine hip impingement is characterized by the prominent or abnormal morphology of the anteroinferior iliac spine (AIIS), which contributes to the development of a clinical picture that is similar to FAI. The aims of this study were to propose a new morphological classification of the AIIS, to determine the prevalence of the different AIIS morphologies based on this classification and to correlate the presence of said morphologies with different gender and age groups. The sample consisted of 458 hemipelvises from individuals of known age and sex (264 men and 194 women). Each specimen was analyzed to determine the prevalence of each of the different morphologies of the AIIS based on the classification proposed as Type 1: the presence of a concave surface between the AIIS and the acetabular rim; Type 2A: the presence of a flat surface between the AIIS and the acetabular rim; Type 2B the presence of a convex surface between the AIIS and the acetabular rim; and Type 3: the AIIS protrudes inferiorly toward the anterior acetabulum. A prevalence of 69.87% was determined for Type 1 AIIS (320/458). In regard to abnormal morphology, prevalences of 17.90% (82/458), 3.71% (17/458) and 8.52% (39/458) were determined for type 2A, Type 2B and Type 3, respectively. The prevalence of abnormal AIIS morphology was 30.30% (80/264) in male specimens and 29.90% (58/194) in female specimens. This study demonstrates the prevalence of the different morphologies of the AIIS, providing information that will be useful in determining the role of the AIIS in the emergence of subspine hip impingement.
    Full-text · Article · Jun 2015 · International Journal of Morphology
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