Association of Femoroacetabular Impingement and Delayed Gadolinium‐Enhanced Magnetic Resonance Imaging of Cartilage: A Population‐Based Study

Guo, Yingying; Zhang, Honglin; Qian, Hong; Wilson, David R.; Wong, Hubert; Barber, M.; Forster, Bruce B.; Esdaile, John M.; Cibere, Jolanda

doi:10.1002/acr.23463

Cited by 8 publications

(8 citation statements)

References 40 publications

(54 reference statements)

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“…The IMPAKT-HIP cohort is a population-based sample of 500 Caucasian people aged 20 to 49 years recruited through random-digit dialling of households in greater Vancouver, Canada. 15 , 16 Hips were identified as having a cam morphology if the α angle 17 was greater than 55° on a standardized Dunn view radiograph. 18 Hips were identified as having a pincer morphology if the lateral centre edge (LCE) angle 19 was greater than 40° and/or a positive crossover sign was present on a standardized weightbearing anteroposterior radiograph.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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“…Among 3 types of FAI-related morphologies, cam or combined-type has been considered more clinically significant lesions in view of symptom or cartilage damage 2425. However, in our study, about 40% of patients with FAI syndrome showed radiographic findings of pincer morphology.…”

Section: Discussionmentioning

confidence: 50%

Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study

Lee

Kim²,

Chung

et al. 2018

J Korean Med Sci

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BackgroundHip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old.MethodsWe retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form.ResultsOverall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants.ConclusionMost (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

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“…BMLs were graded semiquantitatively according to the Hip OA MRI Scoring (HOAMS) system (26), which uses a scale of 0–3 (0 = absent, 1 = small [≤33% of the subregional volume], 2 = moderate [33–66% of the subregional volume], and 3 = severe [>66% of the subregional volume]) in 15 regions. Hip regions were identified using a modified HOAMS definition, which was slightly modified because of poor visualization of the medial acetabular rim (21) (Figure 2). Hips with at least 1 subchondral BML of any grade in any HOAMS region were included in the BML group.…”

Section: Methodsmentioning

confidence: 99%

“…Ethics approval was acquired for this study from the institution's ethics review board and complies with the Helsinki Declaration. In total, 128 study participants were recruited from the Investigations of Mobility, Physical Activity and Knowledge Translation in Hip Pain (IMPAKT-HiP) study, which is a crosssectional population-based study of 500 White subjects ages 20-49 years with and without hip pain (20,21). Participants were recruited for the parent study through random-digit dialing in Vancouver, British Columbia, Canada.…”

Section: Methodsmentioning

confidence: 99%

“…The study hip that was chosen for imaging was based on the presence of cam or pincer deformity, or, if deformity was detected in both hips or neither, the hip with more severe pain was chosen. If no hip pain was present, the hip was chosen randomly (21). dGEMRIC scans were acquired of the study hip from each participant using a 3T Integra MR scanner (Philips).…”

Section: Significance and Innovationsmentioning

confidence: 99%

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Delayed Gadolinium‐Enhanced Magnetic Resonance Imaging of Cartilage Values in Hips With Bone Marrow Lesions

Jones¹,

Cibere

Qian

et al. 2022

Arthritis Care & Research

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Objective. Bone marrow lesions (BMLs) are associated with painful and progressive osteoarthritis (OA). Quantitative magnetic resonance imaging (MRI) has been used to study early cartilage degeneration in knees with BML, but similar work has not been done in hips. The purpose of this study was to compare mean delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) relaxation values (T1Gd) in hips with BML to hips without BML in a population-based study. Reduced T1Gd suggests depleted glycosaminoglycan. Our hypothesis was that mean T1Gd is lower in hips with BML compared to hips without BML.Methods. Study participants (n = 128) were recruited from a cross-sectional population-based study of people ages 20-49 years with and without hip pain. dGEMRIC and proton density (PD)-weighted MRI scans of 1 hip from each participant were used for this analysis. BMLs were identified from PD-weighted fat-suppressed images. We applied a sampling-weighted linear regression model to determine the association of the presence of BMLs with mean cartilage T1Gd (significance: P < 0.05). The model was adjusted for age, sex, body mass index (BMI), hip pain, cam/pincer deformity, and physical activity.Results. Thirty-two (25%) of the 128 participants had at least 1 BML. Subjects with at least 1 BML, compared to those without, had similar weighted characteristics of age, BMI, physical activity levels, and frequency of hip pain. Mean T1Gd was 75.25 msec lower (95% confidence interval -149.69, -0.81; P = 0.048) (9%) in the BML compared to the no-BML group.Conclusion. Our results suggest that hips with BMLs are associated with hip cartilage degeneration early in the OA disease process.

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Association of Femoroacetabular Impingement and Delayed Gadolinium‐Enhanced Magnetic Resonance Imaging of Cartilage: A Population‐Based Study

Cited by 8 publications

References 40 publications

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

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

Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study

Delayed Gadolinium‐Enhanced Magnetic Resonance Imaging of Cartilage Values in Hips With Bone Marrow Lesions

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