Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Abstract

Background: Hip osteoarthritis (HOA) is the most common hip disorder and a major cause of disability in the adult population, with an estimated prevalence of end-stage disease and total hip replacement. Thus, the diagnosis, prevention, and treatment of the early stages of the disease in young adults are crucial to reduce the incidence of end-stage HOA. The purpose of this study was to determine whether (1) a relationship among the inflammatory status of labrum and synovium collected from patients with femoroacetabular impingement (FAI) would exist; and (2) to investigate the associations among the histopathological features of joint tissues, the pre-operative symptoms and the postoperative outcomes after arthroscopic surgery. Methods: Joint tissues from 21 patients undergoing hip arthroscopy for FAI were collected and their histological and immunohistochemical features were correlated with clinical parameters. Results: Synovial mononuclear cell infiltration was observed in 25% of FAI patients, inversely correlated with the hip disability and osteoarthritis outcome score (HOOS) pain and function subscales and with the absolute and relative change in total HOOS. All the labral samples showed some pattern of degeneration and 67% of the samples showed calcium deposits. The total labral score was associated with increased CD68 positive cells in the synovium. The presence of labral calcifications, along with the chondral damage worsened the HOOS post-op symptoms (adjusted R-square = 0.76 p = 0.0001). Conclusions: Our study reveals a relationship between the histologic labral features, the synovial inflammation, and the cartilage condition at the time of FAI. The presence of labral calcifications, along with the cartilage damage and the synovitis negatively affects the postoperative outcomes in patients with FAI.

The efficacy of intra-articular HYADD4-G injection in the treatment of femoroacetabular impingement: results at one year follow up

“…This pathological process eventually results in characteristic damage to the labrum and acetabular cartilage, and may predispose to hip osteoarthritis (OA) 7 , 8 . Growing evidence has recently mounted over the role of FAI in the development of early OA 9 , focusing on labral deterioration and labral calcification as part of this degenerative evolution 10 .…”

Response to “Letter to the editor: Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement”

“…We are writing in reply to Dr. Zhong's comments regarding our recent publication [1]. While we appreciate the discussion and feedback, we are also concerned that some of these comments are somewhat vague and may be misleading.…”

Elevated levels of TNF-α, IL-1β and IL-6 in the synovial tissue of patients with labral tear: a comparative study with hip osteoarthritis

“…Almost all reports published on the pathology of synovial inflammation have been conducted on the knee. However, a recent study reported that labral degeneration is positively correlated with synovial inflammation in patients with FAI [ 10 ]. Therefore, synovial inflammation may explain the occurrence of hip pain and OA progression in patients with LT.…”