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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

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

Ganz R, Parvizi J, Beck M, et al (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 112–120. https://doi.org/10.1097/01.blo.0000096804.78689.c2

Mascarenhas V, Castro M, Afonso P et al (2021) The Lisbon Agreement on femoroacetabular impingement imaging—part 2: general issues, parameters, and reporting. Eur Radiol 31:4634–4651. https://doi.org/10.1007/s00330-020-07432-1 CrossRefPubMed

Agricola R, Heijboer M, Bierma-Zeinstra S et al (2013) Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis 72:918–923. https://doi.org/10.1136/annrheumdis-2012-201643 CrossRefPubMed

Griffin D, Dickenson E, O’Donnell J et al (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169–1176. https://doi.org/10.1136/bjsports-2016-096743 CrossRefPubMed

Baron J, Westermann R, Bedard N et al (2020) Is the actual failure rate of hip arthroscopy higher than most published series? An analysis of a private insurance database. Iowa Orthop J 40:135–142 PubMedPubMedCentral

Sogbein O, Shah A, Kay J et al (2019) Predictors of outcomes after hip arthroscopic surgery for femoroacetabular impingement: a systematic review. Orthop J Sports Med 7:2325967119848982. https://doi.org/10.1177/2325967119848982 CrossRefPubMedPubMedCentral

Mascarenhas V, Castro M, Rego P et al (2020) The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 30:5281–5297. https://doi.org/10.1007/s00330-020-06822-9 CrossRefPubMed

Hartigan D, Perets I, Yuen L, Domb B (2017) Results of hip arthroscopy in patients with MRI diagnosis of subchondral cysts-a case series. J Hip Preserv Surg 4:324–331. https://doi.org/10.1093/jhps/hnx034 CrossRefPubMedPubMedCentral

Krych A, King A, Berardelli R et al (2016) Is subchondral acetabular edema or cystic change on MRI a contraindication for hip arthroscopy in patients with femoroacetabular impingement? Am J Sports Med 44:454–459. https://doi.org/10.1177/0363546515612448 CrossRefPubMed

10.

Hanke M, Steppacher S, Anwander H et al (2017) What MRI findings predict failure 10 years after surgery for femoroacetabular impingement? Clin Orthop Relat Res 475:1192–1207. https://doi.org/10.1007/s11999-016-5040-8 CrossRefPubMed

11.

Schmaranzer F, Klauser A, Kogler M et al (2014) Improving visualization of the central compartment of the hip with direct MR arthrography under axial leg traction: a feasibility study. Acad Radiol 21:1240–1247. https://doi.org/10.1016/j.acra.2014.04.014 CrossRefPubMed

12.

Schmaranzer F, Klauser A, Kogler M, et al (2015) Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 25:1721–1730. https://doi.org/10.1007/s00330-014-3534-x

13.

Griffin D, Parsons N, Mohtadi N, et al (2012) A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28:611–616; quiz 616–618 https://doi.org/10.1016/j.arthro.2012.02.027

14.

Martin R, Kivlan B, Christoforetti J et al (2020) Defining variations in outcomes of hip arthroscopy for femoroacetabular impingement using the 12-Item International Hip Outcome Tool (iHOT-12). Am J Sports Med 48:1175–1180. https://doi.org/10.1177/0363546520906408 CrossRefPubMed

15.

Robinson P, Maempel J, Rankin C et al (2020) Evaluation of the patient acceptable symptom state following hip arthroscopy using the 12 item international hip outcome tool. BMC Musculoskelet Disord 21:5. https://doi.org/10.1186/s12891-019-3026-x CrossRefPubMedPubMedCentral

16.

Tannast M, Siebenrock K, Anderson S (2007) Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol 188:1540–1552. https://doi.org/10.2214/AJR.06.0921 CrossRefPubMed

17.

Schmaranzer F, Kallini J, Miller P et al (2020) The effect of modality and landmark selection on MRI and CT femoral torsion angles. Radiology 296:381–390. https://doi.org/10.1148/radiol.2020192723 CrossRefPubMed

18.

Schmaranzer F, Klauser A, Kogler M et al (2016) MR arthrography of the hip with and without leg traction: assessing the diagnostic performance in detection of ligamentum teres lesions with arthroscopic correlation. Eur J Radiol 85:489–497. https://doi.org/10.1016/j.ejrad.2015.11.027 CrossRefPubMed

19.

Bensler S, Agten C, Pfirrmann C, Sutter R (2018) Osseous spurs at the fovea capitis femoris-a frequent finding in asymptomatic volunteers. Skeletal Radiol 47:69–77. https://doi.org/10.1007/s00256-017-2763-x CrossRefPubMed

20.

Meier M, Lerch T, Steppacher S et al (2022) High prevalence of hip lesions secondary to arthroscopic over- or undercorrection of femoroacetabular impingement in patients with postoperative pain. Eur Radiol 32:3097–3111. https://doi.org/10.1007/s00330-021-08398-4 CrossRefPubMed

21.

Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174 CrossRefPubMed

22.

Mechlenburg I, Nyengaard J, Gelineck J et al (2012) Cyst volume in the acetabulum and femoral head decreases after periacetabular osteotomy. Hip Int 22:313–318. https://doi.org/10.5301/HIP.2012.9248 CrossRefPubMed

23.

Stetzelberger V, Zurmühle C, Hanauer M et al (2022) Reliability and reproducibility of a novel grading system for lesions of the ligamentous-fossa-foveolar complex in young patients undergoing open hip preservation surgery. Orthop J Sports Med 10:23259671221098750. https://doi.org/10.1177/23259671221098750 CrossRefPubMedPubMedCentral

24.

Ramkumar P, Helm J, Berrier A et al (2022) Preoperative magnetic resonance imaging offers questionable clinical utility, delays time to hip arthroscopy, and lacks cost-effectiveness in patients aged ≤40 years with femoroacetabular impingement syndrome: a retrospective 5-year analysis. Arthroscopy 38:3013–3019. https://doi.org/10.1016/j.arthro.2022.03.025 CrossRefPubMed

25.

Meier M, Wagner M, Brunner A, et al (2023) Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison. Eur Radiol. https://doi.org/10.1007/s00330-023-09586-0

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
Keywords: Arthrography
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Hip Arthroscopy
Hip-TEP
Hip-TEP
Femuroacetabular Impingement
Published in: European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10419-3

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

Abstract

Objectives

Methods

Results

Conclusion

Clinical relevance statement

Key Points

Graphical Abstract

Keynote Webinar | Spotlight on Diet and Diabetes

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Abstract

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Conclusion

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Graphical Abstract

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