Paper #43 - ISHA Annual Scientific Meeting 2016
Relationship Between Central Acetabular Osteophytes and Femoral Head Articular Damage – A Cross-Sectional Study
Parth Lodhia CANADA
Chengcheng Gui, BSE, Westmont, IL UNITED STATES
Timothy J Martin, MA, Westmont, IL UNITED STATES
Carlos Suarez Ahedo, MD, Mexico City, DF MEXICO
Sivashankar Chandrasekaran AUSTRALIA
Lyall Ashberg, MD, Westmont, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES
American Hip Institute, Westmont, IL, UNITED STATES
FDA Status Not Applicable
Summary: This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls.
The articular surfaces of the hip joint have a spherical shape with the femoralhead and acetabulum complementing each other. Articular cartilage covers the entirety of the femoral head. In contrast, the acetabulum has a void in itscentral and inferior part that does not have any cartilage creating the cotyloid fossa, which can have osteophyte formation. These central acetabularosteophytes (CAO) have been suggested as an early manifestation of osteoarthritis (OA). However, their association with other intraarticular pathology and prognostic implications remain unknown. In order to understand the prognostic implications of CAO and the ramifications of its management, one needs to recognize concurrent pathology, if any, in the hip.
The primary purpose of this study was to report the prevalence of femoral headarticular damage in a matched cohort of patients with and without centralacetabular osteophyte (CAO) that was identified during hip arthroscopy. A secondary purpose was to identify the rates of co-existing intraarticular pathology in both patient groups.
Intraoperative data was collected prospectively on all patients undergoing hip arthroscopy at our institution between February 2008 to March 2015,. The inclusion criteria for this study were the presence of a CAO identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement (FAI). Exclusion criteria were revision surgeries, Tönnis grade 1 and higher, and previous hip conditions such as Legg-Calves-Perthes disease, avascular necrosis, and prior surgical intervention. The matched cohort control group was selected based on gender, age within 5 years, body mass index (BMI), and workers’ compensation claim on a 1:3 ratio to patients who underwent hip arthroscopy for a labral tear and/or FAI and did not have a CAO.
The CAO group consisted of 126 patients, which were matched to 378 patients in the control group. The grades of femoral and acetabular chondral damagewere significantly different between the two groups (p<0.0001). The prevalence of grades 2 and 3 chondral damage on the femoral head was significantly higher in the CAO group compared to the control group (p<0.0001). Acetabularchondral damage of grades 3 and 4 according to both the ALAD and Outerbridge classifications was significantly more prevalent in the CAO group compared to the control group (p<0.01). The mean size of the femoral chondraldamage was 3.2 cm2 in the CAO group and 1.7 cm2 in the control group. The mean size of acetabular chondral damage was 1.7 cm2 in the CAO group and 1.2 cm2 in the control group. Both femoral and acetabular chondral damagesizes were significantly larger in the CAO group (p<0.01). The ligamentum teres (LT) was intact in significantly fewer patients in the CAO group (19%) compared to the control group (33%) (p<0.01).
This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls.