scholarly journals Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures

2021 ◽  
Vol 2 (11) ◽  
pp. 988-996
Author(s):  
Maryam Mohtajeb ◽  
Jolanda Cibere ◽  
Michelle Mony ◽  
Honglin Zhang ◽  
Emily Sullivan ◽  
...  
Keyword(s):  
Femoral Head ◽  
Internal Rotation ◽  
Femoroacetabular Impingement ◽  
Hip Osteoarthritis ◽  
Population Based ◽  
Joint Degeneration ◽  
Open Mri ◽  
Hip Flexion ◽  
Head Neck ◽  
Acetabular Rim

Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.

scholarly journals The Bipolar Hip: Combined Acetabular and Femoral Pathomorphology Determine Hip Motion

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0042
Author(s):  
Jessica Shin ◽  
Temitope F. Adeyemi ◽  
Taylor Hobson ◽  
Christopher L. Peters ◽  
Travis G. Maak
Keyword(s):  
Logistic Regression ◽  
Femoral Head ◽  
Internal Rotation ◽  
External Rotation ◽  
Alpha Angle ◽  
Acetabular Version ◽  
Femoral Version ◽  
Hip Flexion ◽  
Hip Internal Rotation ◽  
Head Neck

Objectives: Prior studies have suggested femoral version may outweigh the effect of cam impingement on hip internal rotation; however, the effects of acetabular morphology were considered. This study investigates the influences of acetabular and femoral morphology on hip range of motion (ROM) in patients with femoroacetabular impingement syndrome (FAIS). Methods: With IRB approval, a retrospective chart review and radiographic analysis was performed of patients presenting with hip pain to the clinic of a single surgeon. Patients were included in the study if their hip pain was thought to be intra-articular in origin, had full physical exam documentation (including bilateral hip evaluations and measurements of passive hip ROM), Tönnis grade ≤ 1, and had full imaging including: AP pelvis, 45⁰ Dunn lateral, and false profile radiographs and a CT scan with 3-D reconstructions of the affected hip. Patients were excluded if they had prior hip surgery, prior hip trauma or other underlying hip pathology. Femoral head/neck angle, femoral version, size and clock-face location of the maximum femoral alpha angle, mid-coronal center edge angle (CEA), mid-sagittal CEA, acetabular version at the 1, 2 and 3 o’clock positions and the McKibbin index were measured on CT scan. Univariable and multivariable logistic regression analyses were performed to determine which measurements correlated with hip ROM. Results: 200 hips from 200 patients were included in the final analysis. Mean age was 31.9 ±10 years, 145 (72%) patients were female, and mean BMI of the cohort was 25.2 ± 5. Univariable logistic regression analysis found femoral head/neck angle, mid-sagittal CEA, acetabular version at 1 and 2 o’clock, and McKibbin Index all significantly correlated with hip flexion (all q’s > 0.05 after adjusting for false discovery rate). Femoral head-neck angle, femoral version, and McKibbin index all significantly correlated with external rotation. Femoral neck version, mid-sagittal CEA, acetabular version at all three clock positions, McKibbin index, max femoral alpha angle, and alpha position all significantly correlated with internal rotation. In the multivariate logistic regression analysis mid-sagittal CEA was the only measurement correlating with flexion, femoral head/neck angle and McKibbin index were the only significant variables correlating with external rotation, and McKibbin index and maximum femoral alpha angle were the only variables correlating with internal rotation. The results of the logistic regressions are summarized in Figure 1. Conclusion: Our univariate data supported previous data that suggested femoral version significantly correlated with hip internal rotation. However, multivariate analysis including acetabular version demonstrated that combined acetabular and femoral version significantly correlated with internal and external rotation while femoral version in isolation did not. In contrast to prior studies, an increased cam deformity, as defined by max femoral alpha angle, remained a significant contributor to reduced internal rotation but did not affect hip flexion. Rather, the increased mid-sagittal CEA remained the sole significant contributor to reduced hip flexion in the multivariable analysis. These data suggest that hip ROM is affected in a bipolar fashion and careful multiplanar evaluation of the femoral and acetabular pathomorpohlogy should be conducted prior to attempting to increase hip ROM with corrective osteoplasty or osteotomy. [Figure: see text]

Distinct Pattern of Inflammation of Articular Cartilage and the Synovium in Early and Late Hip Femoroacetabular Impingement

2020 ◽  
Vol 48 (10) ◽  
pp. 2481-2488
Author(s):  
Masahiko Haneda ◽  
Muhammad Farooq Rai ◽  
Lei Cai ◽  
Robert H. Brophy ◽  
Regis J. O’Keefe ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Late Stage ◽  
Early Stage ◽  
Hip Osteoarthritis ◽  
Cartilage Degeneration ◽  
Control Group ◽  
Acetabular Cartilage ◽  
Similar Expression ◽  
Related Proteins ◽  
Head Neck

Background: The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. The expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, the characterization of intra-articular inflammation away from the cam deformity as well as the nature of adjacent synovial tissue have also not been extensively reported. Hypothesis: Early-stage FAI has a similar expression of inflammation-related markers in the head-neck and acetabular cartilage but less synovitis than late-stage FAI. Study Design: Controlled laboratory study. Methods: Head-neck cartilage, acetabular cartilage, and synovial samples were obtained from patients undergoing hip preservation surgery for the treatment of symptomatic cam FAI (early FAI group; n = 15) and advanced OA secondary to cam FAI (late FAI group; n = 15). Samples procured from healthy young adult donors served as the control group (n = 7). Cartilage degeneration was assessed by histology, and the expression of inflammation-related proteins (interleukin–1 beta [IL-1β], matrix metalloproteinase–13 [MMP-13], a disintegrin and metalloproteinase with thrombospondin motifs–4 [ADAMTS-4], type II collagen [COL2], and aggrecan neoepitope [NITEGE]) was measured by immunostaining. Synovial samples in the early and late FAI groups were examined for synovitis and the expression of IL-1β. Results: Head-neck cartilage in the early FAI group showed significantly more degeneration than the control group and an increased expression of inflammation-related proteins (IL-1β: 69.7% ± 18.1% vs 20.2% ± 4.9%, respectively; MMP-13: 79.6% ± 12.6% vs 25.3% ± 9.5%; ADAMTS-4: 83.9% ± 12.2% vs 24.3% ± 11.1%; NITEGE: 89.7% ± 7.7% vs 39.8% ± 20.5%) ( P < .001). Head-neck and acetabular cartilage in the early and late FAI groups showed a similar degree of degeneration. Moreover, a similar expression of inflammation-related proteins was observed between the early and late FAI groups for head-neck cartilage (IL-1β: 69.7% ± 18.1% vs 72.5% ± 13.2%; MMP-13: 79.6% ± 12.6% vs 71.4% ± 18.8%; ADAMTS-4: 83.9% ± 12.2% vs 82.6% ± 12.5%; COL2: 93.6% ± 3.9% vs 92.5% ± 5.8%; NITEGE: 89.7% ± 7.7% vs 95.7% ± 4.7%) and acetabular cartilage (IL-1β: 83.3% ± 24.8% vs 80.7% ± 15.6%; MMP-13: 94.3% ± 9.7% vs 85.2% ± 12.3%; ADAMTS-4: 98.5% ± 2.3% vs 98.4% ± 3.4%; COL2: 99.8% ± 0.7% vs 99.7% ± 1.1%; NITEGE: 96.7% ± 6.7% vs 99.2% ± 2.2%). In contrast, synovitis was minimal with a low expression of IL-1β in the early FAI group compared with the late FAI group. Conclusion: Hip cartilage exhibited an OA phenotype in patients with early-stage FAI, similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident with late-stage FAI. Clinical Relevance: This study supports the concept that early hip impingement is associated with cartilage degeneration and catabolism.

scholarly journals Joint preservation surgery: a priority to be thought of in selective hip osteoarthritis

2020 ◽  
Vol 6 (2) ◽  
pp. 404
Author(s):  
Subramaian Kanthalu Narayanan ◽  
Rajesh Sellappan
Keyword(s):  
Total Hip Replacement ◽  
Femoroacetabular Impingement ◽  
Hip Replacement ◽  
Severe Pain ◽  
Hip Osteoarthritis ◽  
Total Hip ◽  
Joint Preservation ◽  
Arthroscopic Excision ◽  
Oxford Hip Score ◽  
Acetabular Rim

<p class="abstract">Femoroacetabular impingement (FAI) is one of the causes of hip arthritis. If FAI diagnosed earlier and treated properly, arthritis of hip and eventual total hip replacement (THR) can be potentially avoided. We report 48 yr male who presented with left hip severe pain, limp, restricted movements and unable do daily day activities. He is diagnosed to have pincer type of lesion in the acetabular rim and we did arthroscopic excision of the protruding fragment. The patient now has a pain free joint and able to squat and sit cross leg. His pre-operative oxford hip score was 30 which improved to 54. </p>

The young arthritic hip

2011 ◽  
Author(s):  
Ahmad K. Malik ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Rheumatoid Arthritis ◽  
Juvenile Idiopathic Arthritis ◽  
Femoral Head ◽  
Femoroacetabular Impingement ◽  
Acetabular Fracture ◽  
Developmental Dysplasia ◽  
Neck Fracture ◽  
Slipped Upper Femoral Epiphysis ◽  
Dysplasia Of The Hip ◽  
Head Neck

♦ Impingement:• Primary femoroacetabular impingement:▪ Cam type▪ Pincer type▪ Combined cam and pincer• Secondary femoroacetabular impingement:▪ Slipped upper femoral epiphysis (cam type)▪ Protusio (pincer type)▪ Retroverted acetabulum (pincer type)▪ Malunited femoral head/neck fracture (cam type)▪ Acetabular fracture (pincer type)▪ Perthes disease (cam type)♦ Instability:• Developmental dysplasia of the hip (treated/residual and untreated)• Dislocation• Subluxation• Dysplasia♦ Inflammatory:• Juvenile idiopathic arthritis• Rheumatoid arthritis.

scholarly journals Differences in articular hip cartilage gene expression between femoroacetabular impingement (FAI) and end-stage hip osteoarthritis

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
John Reuter ◽  
Gillian Soles ◽  
Cheryl Ackert-Bicknell ◽  
Brian Giordano ◽  
Benjamin Kuhns
Keyword(s):  
Gene Expression ◽  
Femoral Head ◽  
Differential Expression ◽  
Rna Sequencing ◽  
Femoroacetabular Impingement ◽  
Molecular Mechanisms ◽  
Hip Osteoarthritis ◽  
Fold Change ◽  
Cam Deformity ◽  
End Stage

Objectives: The morphological deformities in Femoroacetabular Impingement (FAI) have been associated with hip osteoarthritis (OA), however the molecular mechanisms for OA initiation and progression are poorly understood. The purpose of this study was to use whole genome RNA sequencing to characterize differences in gene expression articular cartilage samples isolated from patients undergoing surgery for FAI and idiopathic OA. We hypothesized that there would be significant differences in genes expression in pathways related to inflammation as well as cartilage and bone turnover. Methods: 20 patients undergoing either hip arthroscopy for FAI (5 male, 5 female) or total hip arthroplasty (5 male, 5 female) for end-stage osteoarthritis were included in the study. FAI patients required a Cam deformity with an Alpha Angle greater than 55 while patients with dysplasia (LCEA<25) or prior hip surgery were excluded. Exclusion criteria for the THA cohort included dysplasia, and post-traumatic OA or inflammatory OA. Cartilage samples were obtained over the Cam deformity prior to femoroplasty in the FAI group or over anterosuperior femoral head-neck junction in the OA group following extraction of the femoral head. Following RNA isolation, Next Generation RNA sequencing was performed to evaluate gene expression. Differential expression data was incorporated into the Ingenuity Pathway Analysis (IPA) platform to identify differences in canonical signaling pathways associated with osteoarthritis. Results: There were 3531 genes that were significantly differentially expressed between the FAI and OA cohorts. Of these, there were 27 genes that were upregulated by a greater than 2 log-fold change in the OA cohort and 524 genes that were upregulated by a greater than 2 log-fold change in the FAI cohort. There was significant differential expression in genes related to cartilage metabolism (Table 1) and canonical osteoarthritis pathways involving BMP, TGFβ, and Wnt signaling. (Table 2). Additionally, FAI samples had significant upregulation of EGF-ERBB mediated signaling which compared to osteoarthritic tissue. Conclusion: The results of the present study support our hypothesis that there are significant differences in gene expression between FAI and OA samples in multiple pathways that are implicated in osteoarthritis. Osteoarthritis samples had increased expression of cartilage breakdown and inflammation while femoroacetabular impingement samples had greater expression of chondroprotective genes. Further study of cartilage samples from FAI patients may provide insight into the molecular mechanisms of osteoarthritis progression. [Table: see text][Table: see text]

Femoral head-neck offset measurements in 339 subjects: distribution and implications for femoroacetabular impingement

2012 ◽  
Vol 21 (5) ◽  
pp. 1212-1217 ◽  
Author(s):  
Christian R. Fraitzl ◽  
Thomas Kappe ◽  
Friederike Pennekamp ◽  
Heiko Reichel ◽  
Christian Billich
Keyword(s):  
Femoral Head ◽  
Femoroacetabular Impingement ◽  
Head Neck

scholarly journals Sclerotic lesions of the femoral head–neck junction for diagnosis of femoroacetabular impingement

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092416
Author(s):  
Takehito Hananouchi ◽  
Stephen Kenji Aoki
Keyword(s):  
Femoral Head ◽  
Femoroacetabular Impingement ◽  
Morphological Characteristics ◽  
Control Group ◽  
Diagnostic Feature ◽  
Pixel Intensity ◽  
Plain Radiographs ◽  
Sclerotic Lesions ◽  
Head Neck ◽  
Neck Junction

The morphological characteristics associated with a diagnosis of femoroacetabular impingement (FAI) observed on plain radiographs can also be seen in subjects without hip joint symptoms. Therefore, the purpose of this study was to investigate whether sclerotic lesions on femoral head–neck junction (FHNJ) could be used as a supplemental diagnostic feature. A total of 128 hips from 119 patients (43 male and 76 female) diagnosed with FAI and 24 hips from 21 patients (2 male and 19 female) with other hip pathologies as control were compared in this study. Using standing frog-leg plain radiographs, the prevalence of sclerotic lesions on the FHNJ was established. Additionally, the pixel intensity (PI) of the sclerotic lesions between the FAI and the control groups were quantitatively compared. Sclerotic lesions were present in 96.1% of FAI hips (123 of 128) and only 37.5% of control hips (9 of 24) ( p < 0.05). The ratio of PI in the FAI group was significantly higher (approximately 10%) than in the control group ( p < 0.05). The evaluation of sclerotic lesions may be used as a supplement to aid in the diagnosis of FAI.

scholarly journals Hip–spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain

2020 ◽  
Author(s):  
Anthony N Khoury ◽  
Munif Hatem ◽  
Joshua Bowler ◽  
Hal David Martin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Femoroacetabular Impingement ◽  
Hip Osteoarthritis ◽  
Low Back ◽  
Femoral Torsion ◽  
Hip Range Of Motion ◽  
Flexion Extension ◽  
Hip Flexion ◽  
Ischiofemoral Impingement

Abstract The term ‘hip–spine syndrome’ was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics. The purpose of this narrative review is to explain the mechanism by which these three abnormal hip pathologies contribute to increased low back pain in patients without hip osteoarthritis. This paper presents a thorough rationale of the anatomical and biomechanical characteristics of the aforementioned hip pathologies, and how each contributes to premature coupling and limited hip flexion/extension. The future of hip and spine conservative and surgical management requires the implementation of a global hip–spine–pelvis-core approach to improve patient function and satisfaction.

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