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Open Access 20-11-2023 | Arthrography | Musculoskeletal

Are degenerative findings detected on traction MR arthrography of the hip associated with failure of arthroscopic femoroacetabular impingement surgery?

Authors: Till D. Lerch, Andreas K. Nanavati, Alexander F. Heimann, Malin K. Meier, Simon D. Steppacher, Moritz Wagner, Alexander Brunner, Peter Vavron, Ehrenfried Schmaranzer, Joseph M. Schwab, Moritz Tannast, Florian Schmaranzer

Published in: European Radiology

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Abstract

Objectives

To identify preoperative degenerative features on traction MR arthrography associated with failure after arthroscopic femoroacetabular impingement (FAI) surgery.

Methods

Retrospective study including 102 patients (107 hips) undergoing traction magnetic resonance arthrography (MRA) of the hip at 1.5 T and subsequent hip arthroscopic FAI surgery performed (01/2016 to 02/2020) with complete follow-up. Clinical outcomes were assessed using the International Hip Outcome Tool (iHOT-12) score. Clinical endpoint for failure was defined as an iHOT-12 of < 60 points or conversion to total hip arthroplasty. MR images were assessed by two radiologists for presence of 9 degenerative lesions including osseous, chondrolabral/ligamentum teres lesions. Uni- and multivariate Cox regression analysis was performed to assess the association between MRI findings and failure of FAI surgery.

Results

Of the 107 hips, 27 hips (25%) met at least one endpoint at a mean 3.7 ± 0.9 years follow-up. Osteophytic changes of femur or acetabulum (hazard ratio [HR] 2.5–5.0), acetabular cysts (HR 3.4) and extensive cartilage (HR 5.1) and labral damage (HR 5.5) > 2 h on the clockface were univariate risk factors (all p < 0.05) for failure. Three risk factors for failure were identified in multivariate analysis: Acetabular cartilage damage > 2 h on the clockface (HR 3.2, p = 0.01), central femoral osteophyte (HR 3.1, p = 0.02), and femoral cartilage damage with ligamentum teres damage (HR 3.0, p = 0.04).

Conclusion

Joint damage detected by preoperative traction MRA is associated with failure 4 years following arthroscopic FAI surgery and yields promise in preoperative risk stratification.

Clinical relevance statement

Evaluation of negative predictors on preoperative traction MR arthrography holds the potential to improve risk stratification based on the already present joint degeneration ahead of FAI surgery.

Key Points

• Osteophytes, acetabular cysts, and extensive chondrolabral damage are risk factors for failure of FAI surgery.
• Extensive acetabular cartilage damage, central femoral osteophytes, and combined femoral cartilage and ligamentum teres damage represent independent negative predictors.
• Survival rates following hip arthroscopy progressively decrease with increasing prevalence of these three degenerative findings.

Graphical Abstract

Literature
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Metadata
Title
Are degenerative findings detected on traction MR arthrography of the hip associated with failure of arthroscopic femoroacetabular impingement surgery?
Authors
Till D. Lerch
Andreas K. Nanavati
Alexander F. Heimann
Malin K. Meier
Simon D. Steppacher
Moritz Wagner
Alexander Brunner
Peter Vavron
Ehrenfried Schmaranzer
Joseph M. Schwab
Moritz Tannast
Florian Schmaranzer
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10419-3