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Markhardt BK, Hund S, Rosas HG, Symanski JS, Mao L, Spiker AM, Blankenbaker DG. Comparison of MRI and arthroscopy findings for transitional zone cartilage damage in the acetabulum of the hip joint. Skeletal Radiol 2024; 53:1303-1312. [PMID: 38225402 DOI: 10.1007/s00256-024-04563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To assess the performance of morphologic and hypointense signal changes on MRI to predict grades and types of acetabular cartilage damage in the chondrolabral transitional zone (TZ) of the hip identified at arthroscopy. MATERIALS AND METHODS This retrospective single-center study reviewed conventional 3T MRI hip studies from individuals with symptomatic femoroacetabular impingement (FAI) and subsequent hip arthroscopy surgery within 6 months. Independent review was made by three radiologists for the presence of morphologic damage or a hypointense signal lesion in the TZ on MRI. Fleiss' kappa statistic was used to assess inter-reader agreement. The degree of TZ surfacing damage (modified Outerbridge grades 1-4) and presence of non-surfacing wave sign at arthroscopic surgery were collected. Relationship between sensitivity and lesion grade was examined. RESULTS One hundred thirty-six MRI hip studies from 40 males and 74 females were included (mean age 28.5 years, age range 13-54 years). MRI morphologic lesions had a sensitivity of 64.9-71.6% and specificity of 48.4-67.7% for arthroscopic surfacing lesions, with greater sensitivity seen for higher grade lesions. Low sensitivity was seen for wave sign lesions (34.5-51.7%). MRI hypointense signal lesions had a sensitivity of 26.3-62% and specificity of 43.8-78.0% for any lesion. Inter-reader agreement was moderate for morphologic lesions (k = 0.601) and poor for hypointense signal lesions (k = 0.097). CONCLUSION Morphologic cartilage damage in the TZ on MRI had moderate sensitivity for any cartilage lesion, better sensitivity for higher grade lesions, and poor sensitivity for wave sign lesions. The diagnostic value of hypointense signal lesions was uncertain.
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Affiliation(s)
- B Keegan Markhardt
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Wisconsin-Madison, Madison, WI, USA.
| | - Samuel Hund
- Department of Radiology, Musculoskeletal Section, University of Kansas Medical Center, Kansas City, KS, USA
| | - Humberto G Rosas
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - John S Symanski
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Lu Mao
- Departments of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Donna G Blankenbaker
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Wisconsin-Madison, Madison, WI, USA
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Welton KL, Kraeutler MJ, Garabekyan T, Mei-Dan O. Radiographic Parameters of Adult Hip Dysplasia. Orthop J Sports Med 2023; 11:23259671231152868. [PMID: 36874050 PMCID: PMC9983115 DOI: 10.1177/23259671231152868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/08/2022] [Indexed: 03/04/2023] Open
Abstract
As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician's ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others. The purpose of this narrative review was to detail various established criteria and parameters on anteroposterior pelvis plain radiographs, MRI/MRA, and CT that assist in defining the nature and severity of instability present in a dysplastic hip, thereby aiding in the development of patient-specific surgical treatment plans.
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Affiliation(s)
- K Linnea Welton
- MultiCare Orthopedics & Sports Medicine, Auburn, Washington, USA
| | - Matthew J Kraeutler
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | | | - Omer Mei-Dan
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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Samaan MA, Schwaiger BJ, Gallo MC, Sada K, Link TM, Zhang AL, Majumdar S, Souza RB. Joint Loading in the Sagittal Plane During Gait Is Associated With Hip Joint Abnormalities in Patients With Femoroacetabular Impingement. Am J Sports Med 2017; 45:810-818. [PMID: 28006109 PMCID: PMC5429741 DOI: 10.1177/0363546516677727] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a morphological abnormality of the hip joint that results in functional impairments during various activities of daily living (ADL) such as walking. Purpose/Hypothesis: The purpose of this study was to determine if lower extremity joint loading differed between patients with FAI and controls and to determine whether these altered biomechanical parameters were associated with intra-articular abnormalities. It was hypothesized that patients with FAI would exhibit altered lower extremity joint loading during walking when compared with healthy controls and that these altered joint loading patterns would be associated with intra-articular abnormalities. STUDY DESIGN Controlled laboratory study. METHODS Lower extremity kinetics was assessed during walking at a self-selected speed in 15 presurgical patients with FAI and 34 healthy controls matched for age and body mass index. All participants underwent unilateral hip magnetic resonance imaging (MRI) to assess hip joint abnormalities. Hip joint abnormalities were assessed using a semiquantitative MRI-based scoring system. Self-reported outcomes of pain and function were obtained using the Hip disability and Osteoarthritis Outcome Score (HOOS), and physical performance was measured using the 6-minute walk test (6MWT). Group differences were assessed using an independent t test and analysis of variance. In the patients with FAI, associations of joint kinetics with HOOS subscores and intra-articular abnormalities were assessed using the Pearson ( r) and Spearman (ρ) correlation coefficients, respectively. RESULTS Compared with the control group, the FAI group exhibited a significantly increased severity of acetabular (FAI: 1.87 ± 1.55; control: 0.47 ± 0.79; P < .001) and femoral (FAI: 3.27 ± 2.79; control: 1.21 ± 1.55; P = .002) cartilage abnormalities, increased levels of pain (FAI: 65.0 ± 18.8; control: 98.2 ± 3.4; P = .001), and reduced function (FAI: 67.2 ± 21.5; control: 98.9 ± 3.4; P < .001) but similar walking speeds (FAI: 1.55 ± 0.19 m/s; control: 1.63 ± 0.22 m/s; P = .20) and 6MWT performance (FAI: 628.0 ± 91.2 m; control: 667.2 ± 73.4 m; P = .13). The FAI group demonstrated increased hip flexion moment impulses (FAI: 0.14 ± 0.04 N·m·s/kg; control: 0.11 ± 0.03 N·m·s/kg; P = .03), peak ankle dorsiflexion moments (FAI: 1.64 ± 0.16 N·m/kg; control: 1.46 ± 0.31 N·m/kg; P = .04), and ankle dorsiflexion moment impulses (FAI: 0.39 ± 0.07 N·m·s/kg; control: 0.31 ± 0.07 N·m·s/kg; P = .01) compared with the control group. Within the FAI group, an increased hip flexion moment impulse during walking was significantly correlated with increased pain ( r = -0.60, P = .03), decreased ADL ( r = -0.57, P = .04), and increased severity of acetabular cartilage abnormalities (ρ = 0.82, P < .01). CONCLUSION Patients with FAI exhibited altered hip and ankle joint loading patterns during walking. These data suggest that patients with FAI demonstrate both local and distal joint alterations during walking and that hip joint loading is directly related to hip joint abnormalities. CLINICAL RELEVANCE The results of this study suggest that the hip flexion moment impulse may be an important biomechanical parameter to understand FAI, as the hip flexion moment impulse during walking was shown to be directly related to hip joint abnormalities on MRI.
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Affiliation(s)
- Michael A. Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA,Address correspondence to Michael A. Samaan, PhD, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA ()
| | - Benedikt J. Schwaiger
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Matthew C. Gallo
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Kiyoshi Sada
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
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Abstract
Hip arthroscopy has experienced unprecedented growth in recent years and remains an area of booming technology and interest in orthopedic surgery. As understanding of the pathologic state of femoroacetabular impingement (FAI) has grown, imaging modalities have increased. Careful consideration of all bony and soft tissue structures in concert with physical examination findings in nonarthritic patients is necessary before any surgical intervention. This article summarizes the authors' approach to imaging in patients suspected of FAI, which facilitates careful patient selection and preoperative planning.
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Schwaiger BJ, Gersing AS, Lee S, Nardo L, Samaan MA, Souza RB, Link TM, Majumdar S. Longitudinal assessment of MRI in hip osteoarthritis using SHOMRI and correlation with clinical progression. Semin Arthritis Rheum 2016; 45:648-55. [PMID: 27162009 DOI: 10.1016/j.semarthrit.2016.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the evolution of MR imaging findings in normal volunteers and subjects with hip osteoarthritis (OA) over 1.5 years described by the semi-quantitative Scoring Hip OA with MRI (SHOMRI) scoring system and their correlation with the evolution of clinical parameters. MATERIALS AND METHODS Hip MRI studies of 18 subjects with [Kellgren-Lawrence (KL) score = 2/3; mean age = 54.4 ± 11.2 years; 27.8% women] and 36 controls without radiographic OA [KL = 0/1; mean age = 43.7 ± 12.8 years; 50.0% women] were assessed at baseline and after 1.5 years by using SHOMRI, and their clinical status was evaluated by using Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS). Imaging and clinical parameters at baseline and their change over time were compared between groups using Mann-Whitney U and Fisher׳s exact tests. Spearman׳s rank correlations and generalized linear models adjusted for age, sex, BMI, and KL were used to assess associations between imaging and clinical findings. RESULTS At baseline, OA subjects had significantly higher SHOMRI total scores than controls [median (IQR): 12.5 (6-19.5) vs. 7 (4-13.5); p = 0.024]. Over 1.5 years, only the progression rate of subchondral cysts was significantly higher in OA subjects than in controls (16.7% vs. 0.0%; p = 0.033), while no significant differences were found for any of the other SHOMRI subscales. Baseline bone-marrow edema pattern (BMEP) was significantly associated with worsening pain (HOOS subscale; p = 0.018) and hip-related quality of life (HOOS subscale; p = 0.044). Progression of subchondral cysts was significantly associated with worsening symptoms other than pain (HOOS subscale, p = 0.030). Baseline KL did not significantly correlate with worsening of any clinical symptoms (each, p > 0.05). CONCLUSION In this relatively young study population without or with mild to moderate radiographic hip OA, only minimal differences were found between groups regarding the progression of hip abnormalities as assessed by SHOMRI over 1.5 years. However, BMEP predicted clinical worsening and subchondral cyst progression was associated with worsening symptoms. Although longer follow-up periods are required, this suggests that SHOMRI is a useful tool to monitor hip abnormalities and their progression longitudinally.
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Affiliation(s)
- Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107.
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sonia Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Michael A Samaan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
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