Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation

Abstract

Objective To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). Design Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). Results Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations ( P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o’clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o’clock peripheral, 12 and 2 o’clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI ( P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement ( P = 0.751). Conclusion Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery.

Osteoarthritis of the hip: is radiography still needed?

“…Meta-analyses demonstrated a lower accuracy of conventional MRI for the detection of cartilage defects at the hip than at the knee [ 86 , 87 ]. Technical challenges for hip cartilage MRI include (a) deep and eccentric location of the hip, (b) absence of dedicated hip coils (c) thinness of the hip cartilage, (d) high congruency of the articular surfaces with no fluid between the two hyaline cartilage surfaces [ 18 , 88 ], and (e) complex anatomy with partial volume artifacts. MRI can demonstrate focal morphological changes of the cartilage, like signal alteration, substance loss, and delamination, before radiographic JSN occurs [ 89 , 90 ] (Fig.…”