Osseous abnormalities and early osteoarthritis: the role of hip impingement.
The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. In all three studies, a common etiology was identified. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. This impingement was caused by a pistol-grip deformity of the proximal femur in 97% of the cases in the arthroscopic labral study and 100% of the cases in the idiopathic arthritis study. The identification of anterior hip impingement as a cause of labral tears and idiopathic arthritis may allow surgeons to correct it early in its natural history and delay or prevent end-stage arthritis.
Tanzer
Michael
M
Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada. mtanz@canada.caom
Noiseux
Nicolas
N
D000077:Acetabulum / Q000002:abnormalities* / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005272:Femur Neck / Q000002:abnormalities* / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D025981:Hip Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D007873:Legg-Calve-Perthes Disease / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome