title: Is Subchondral Acetabular Edema or Cystic Change on MRI a Contraindication for Hip Arthroscopy in Patients With Femoroacetabular Impingement?
abstract: BACKGROUND
  The outcome for arthroscopic treatment of femoroacetabular impingement (FAI) can worsen with increasing arthritis. However, there remains a subset of hips with relatively maintained joint space but with acetabular subchondral edema and cystic change with unknown outcome on magnetic resonance imaging (MRI).
  
  
  OBJECTIVE
  (1) To correlate MRI findings of subchondral acetabular edema/cystic change with arthroscopy grading of articular cartilage and (2) to determine whether postoperative outcome was worse for patients with subchondral edema/cystic change compared with a matched control group.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  The records of all patients who underwent arthroscopic hip surgery for FAI at a single institution between 2007 and 2013 were reviewed for subchondral edema/cyst on preoperative MRI. Lesions were characterized by grade using an established classification system and were correlated with arthroscopic articular cartilage changes. A matched cohort of patients without evidence of subchondral edema or cyst was identified. Minimum 2-year outcomes were compared using prospectively collected Hip Outcome Score (HOS) activities of daily living and sport subscales as well as the modified Harris Hip Score (mHHS).
  
  
  RESULTS
  Overall, 104 patients were included. Thirty-six patients (18 men, 18 women) with a mean age of 41 years (range, 19-67 years) had subchondral edema, with or without the presence of cystic acetabular changes, at minimum 2-year follow-up (range, 24-60 months). Two patients who underwent total hip replacement were excluded in the outcome score comparison. Thirty-one of 34 patients (91%) had a grade 4 full-thickness cartilage lesion at the time of diagnostic arthroscopy. The mean mHHS was inferior for all patients with subchondral edema/cystic change (79.9 ± 18.7 vs 86.6 ± 12.5; P = .03), and the HOS was also lower (69.1 ± 27.0 vs 79.5 ± 21.4; P = .02). The overall success rate was 67% for all patients with subchondral edema/cystic change compared with 85% in the control group (P = .04).
  
  
  CONCLUSIONS
  The presence of a subchondral edema with an acetabular cyst on MRI is indicative of a full-thickness cartilage lesion at the time of arthroscopy. These patients have inferior outcomes for arthroscopic treatment of FAI compared with patients with similar age and activity level without MRI subchondral cystic changes.
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA krych.aaron@mayo.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Krych
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: King
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Berardelli
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Sousa
authors.affiliation: Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Levy
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D001845:Bone Cysts / Q000473:pathology / Q000601:surgery; D002358:Cartilage, Articular / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D000075202:Contraindications; D061887:Conversion to Open Surgery; D004487:Edema / Q000473:pathology*; D005260:Female; D057925:Femoracetabular Impingement / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: acetabular cyst; acetabular edema; femoroacetabular impingement; hip; hip labral tear