Imaging Structural Abnormalities in the Hip Joint: Instability and Impingement as a Cause of Osteoarthritis

ABSTRACT

Osteoarthritis is thought to be caused by a combination of intrinsic vulnerabilities of the joint, such as anatomic shape and alignment, and environmental factors, such as body weight, injury, and overuse. It has been postulated that much of osteoarthritis is due to anatomic deformities. Advances in surgical techniques such as the periacetabular osteotomy, safe surgical dislocation of the hip, and hip arthroscopy have provided us with effective and safe tools to correct these anatomical problems. The limiting factor in treatment outcome in many mechanically compromised hips is the degree of cartilage damage which has occurred prior to treatment. In this regard, the role of imaging, utilizing plain radiographs in conjunction with magnetic resonance imaging, is becoming vitally important for the detection of these anatomic deformities and pre-radiographic arthritis. In this article, we will outline the plain radiographic features of hip deformities that can cause instability or impingement. Additionally, we will illustrate the use of MRI imaging to detect subtle anatomic abnormalities, as well as the use of biochemical imaging techniques such as dGEMRIC to guide clinical decision making.

KEYWORDS

Hip - osteoarthritis - dysplasia - impingement - radiography - MRI

REFERENCES

• 1 Felson D T. Risk factors for osteoarthritis: understanding joint vulnerability.  Clin Orthop Relat Res. 2004;  (427 suppl) S16-S21
• 2 Aronson J. Osteoarthritis of the young adult hip: etiology and treatment.  Instr Course Lect. 1986;  35 119-128
• 3 Murray R O. The aetiology of primary osteoarthritis of the hip.  Br J Radiol. 1965;  38(455) 810-824
• 4 Stulberg S D, Cordell L D, Harris W H, Ramsey P L, MacEwen G D. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In Proceedings of the Third Open Scientific Meeting of the Hip Society. St. Louis, Mo; CV Mosby 1975: 212-228
• 5 Harris W H. Etiology of osteoarthritis of the hip.  Clin Orthop Relat Res. 1986;  213 20-33
• 6 Resnick D. The ‘tilt deformity’ of the femoral head in osteoarthritis of the hip: a poor indicator of previous epiphysiolysis.  Clin Radiol. 1976;  27(3) 355-363
• 7 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock K A. Femoroacetabular impingement: a cause for osteoarthritis of the hip.  Clin Orthop Relat Res. 2003;  417 112-120
• 8 Siebenrock K A, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy.  J Bone Joint Surg Am. 2003;  85-A(2) 278-286
• 9 Eijer H, Myers S R, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures.  J Orthop Trauma. 2001;  15(7) 475-481
• 10 Myers S R, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy.  Clin Orthop Relat Res. 1999;  363 93-99
• 11 Klaue K, Durnin C, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip.  J Bone Joint Surg Br. 1991;  73-B(3) 423-429
• 12 Leunig M, Casillas M M, Hamlet M et al.. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis.  Acta Orthop Scand. 2000;  71(4) 370-375
• 13 Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain.  J Bone Joint Surg Br. 1999;  81(2) 281-288
• 14 Ganz R, Klaue K, Vinh T S, Mast J W. A new periacetabular osteotomy for the treatment of hip dysplasia.  Clin Orthop Relat Res. 1988;  232 26-36
• 15 Murphy S B, Millis M B. Periacetabular osteotomy without abductor dissection using direct anterior exposure.  Clin Orthop Relat Res. 1999;  (364) 92-98
• 16 Ganz R, Gill T J, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.  J Bone Joint Surg Br. 2001;  83(8) 1119-1124
• 17 Glick J M. Hip arthroscopy using the lateral approach.  Instr Course Lect. 1988;  37 223-231
• 18 Glick J M, Sampson T G, Gordon R B, Behr J T, Schmidt E. Hip arthroscopy by the lateral approach.  Arthroscopy. 1987;  3(1) 4-12
• 19 Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: II. Midterm results of surgical treatment.  Clin Orthop Relat Res. 2004;  (418) 67-73
• 20 Spencer S, Millis M B, Kim Y J. Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique.  J Pediatr Orthop. 2006;  26(3) 281-285
• 21 Lequesne M, de Sèze S. False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies [in French].  Rev Rhum Mal Osteoartic. 1961;  28 643-652
• 22 Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint.  Acta Chir Scand. 1939;  58(suppl) 5-135
• 23 Murphy S B, Ganz R, Muller M E. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.  J Bone Joint Surg Am. 1995;  77(7) 985-989
• 24 Li P L, Ganz R. Morphologic features of congenital acetabular dysplasia: one in six is retroverted.  Clin Orthop Relat Res. 2003;  (416) 245-253
• 25 Dora C, Bühler M, Stover M D, Mahomed M N, Ganz R. Morphologic characteristics of acetabular dysplasia in proximal femoral focal deficiency.  J Pediatr Orthop B. 2004;  13(2) 81-87
• 26 Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia.  J Orthop Trauma. 2000;  14(7) 483-489
• 27 Goodman D A, Feighan J E, Smith A D, Latimer B, Buly R L, Cooperman D R. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip.  J Bone Joint Surg Am. 1997;  79(10) 1489-1497
• 28 Nötzli H P, Wyss T F, Stoecklin C H, Schmid M R, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.  J Bone Joint Surg Br. 2002;  84(4) 556-560
• 29 Ito K, Minka II M A, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset.  J Bone Joint Surg Br. 2001;  83(2) 171-176
• 30 Carlisle J C et al.. A systematic approach to radiographic evaluation of the young hip. American Academy of Orthopaedic Surgeons. 2008 San Francisco, CA;
• 31 Clohisy J C et al.. A systematic approach to the radiographic evaluation of the young hip.  J Bone Joint Surg. , In press
• 32 Tannast M, Zheng G, Anderegg C et al.. Tilt and rotation correction of acetabular version on pelvic radiographs.  Clin Orthop Relat Res. 2005;  438 182-190
• 33 Siebenrock K A, Kalbermatten D F, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers.  Clin Orthop Relat Res. 2003;  (407) 241-248
• 34 Murphy S, Deshmukh R. Periacetabular osteotomy: preoperative radiographic predictors of outcome.  Clin Orthop Relat Res. 2002;  (405) 168-174
• 35 Meyer D C, Berk M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity.  Clin Orthop Relat Res. 2006;  445 181-185
• 36 Eijer H, Leunig M, Mahomed M, Ganz R. Crosstable lateral radiograph for screening of anterior femoral head-neck offset in patients with femoroacetabular impingement.  Hip Int. 2001;  11 37-41
• 37 Clohisy J C, Nunley R M, Otto R J, Schoenecker P L. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities.  Clin Orthop Relat Res. 2007;  462 115-121
• 38 Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. With special reference to the complications of osteoarthritis.  Acta Chirurgica Scand. 1939;  58(suppl) 5-135
• 39 Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip.  J Bone Joint Surg Br. 2005;  87-B(7) 1012-1018
• 40 Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY; Springer 1987
• 41 Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain.  J Bone Joint Surg Br. 1999;  81-B(2) 281-288
• 42 Kalberer F, Sierra R J, Madan S S, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion.  Clin Orthop Relat Res. 2008;  466(3) 677-683
• 43 Peelle M W, Della Rocca G J, Maloney W J, Curry M C, Clohisy J C. Acetabular and femoral radiographic abnormalities associated with labral tears.  Clin Orthop Relat Res. 2005;  441 327-333
• 44 Yasunaga Y, Ikuta Y, Kanazawa T, Takahashi K, Hisatome T. The state of the articular cartilage at the time of surgery as an indication for rotational acetabular osteotomy.  J Bone Joint Surg Br. 2001;  83-B(7) 1001-1004
• 45 Trousdale R T, Ekkernkamp A, Ganz R, Wallrichs S L. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips.  J Bone Joint Surg Am. 1995;  77(1) 73-85
• 46 Yoon L S, Palmer W E, Kassarjian A. Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography.  Skeletal Radiol. 2007;  36(11) 1029-1033
• 47 Keeney J A, Peelle M W, Jackson J, Rubin D, Maloney W J, Clohisy J C. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology.  Clin Orthop Relat Res. 2004;  (429) 163-169
• 48 Wenger D E, Kendell K R, Miner M R, Trousdale R T. Acetabular labral tears rarely occur in the absence of bony abnormalities.  Clin Orthop Relat Res. 2004;  (426) 145-150
• 49 Pfirrmann C W, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients.  Radiology. 2006;  240(3) 778-785
• 50 Gray M L, Burstein D, Kim Y J, Maroudas A. 2007 Elizabeth Winston Lanier Award Winner. Magnetic resonance imaging of cartilage glycosaminoglycan: basic principles, imaging technique, and clinical applications.  J Orthop Res. 2008;  26(3) 281-291
• 51 Kim Y J, Jaramillo D, Millis M B, Gray M L, Burstein D. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced magnetic resonance imaging of cartilage.  J Bone Joint Surg Am. 2003;  85-A(10) 1987-1992
• 52 Cunningham T, Jessel R, Zurakowski D, Millis M B, Kim Y J. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia.  J Bone Joint Surg Am. 2006;  88(7) 1540-1548
• 53 Burstein D, Velyvis J, Scott K T et al.. Protocol issues for delayed Gd(DTPA)(2-)-enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage.  Magn Reson Med. 2001;  45(1) 36-41
• 54 Mamisch T et al.. Comparison of delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using inversion recovery and fast T1 mapping sequences.  Magn Reson Med. , In press