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OBJECTIVE: To appraise the highest evidence on hip morphology as a risk factor for developing hip osteoarthritis (OA). DESIGN: We searched for studies evaluating the association between radiological hip morphology parameters and the prevalence, incidence or progression of hip OA (based on different radiographic and clinical criteria) in the MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library and PEDro databases from inception until June 2020. Prospective and cross-sectional studies were separately evaluated. Data are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: We included 9 prospective and 21 cross-sectional studies in the meta-analysis, and evaluated 42,831 hips from 25,898 individuals (mean age: 59 years). Prospective studies showed that, compared with control hips, hips with cam morphology (alpha angle >60°; OR = 2.52, 95% CI: 1.83 to 3.46, P < 0.001) or hip dysplasia (lateral center-edge angle (LCEA) <25°; OR = 2.38, 95% CI: 1.84 to 3.07, P < 0.001), but not hips with pincer morphology (LCEA >39°; OR = 1.08, 95% CI: 0.57 to 2.07, P = 0.810), were more likely to develop hip OA than hips without these morphologies. Cross-sectional studies showed a greater prevalence of pincer morphology (LCEA >39°, OR = 3.71, 95% CI: 2.98 to 4.61, P < 0.001) and acetabular retroversion (crossover sign; OR = 2.65, 95% CI: 1.17 to 6.03, P = 0.020) in hips with OA than in control hips. CONCLUSION: Cam morphology and hip dysplasia were consistently associated with the development of hip OA. Pincer morphology was associated with hip OA in cross-sectional but not in prospective studies. The heterogeneous quantification of pincer morphology on radiographs limits a clear conclusion on its association with hip OA.
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Articulación de la Cadera/anatomía & histología , Articulación de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/etiología , Estudios Transversales , Progresión de la Enfermedad , Humanos , Incidencia , Prevalencia , Estudios Prospectivos , Radiografía , Factores de RiesgoRESUMEN
OBJECTIVE: To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS). DESIGN: This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS. RESULTS: Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS. CONCLUSIONS: A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.
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Artralgia , Atletas , Pinzamiento Femoroacetabular , Osteoartritis de la Cadera , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Artralgia/diagnóstico por imagen , Artralgia/fisiopatología , Australia , Estudios de Casos y Controles , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/fisiopatología , Ingle , Imagen por Resonancia Magnética , Osteoartritis de la Cadera/diagnóstico por imagen , Fútbol , Sinovitis/diagnóstico por imagen , Sinovitis/fisiopatología , Deportes de EquipoRESUMEN
OBJECTIVE: To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN: We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS: Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS: Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
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Articulación de la Cadera/diagnóstico por imagen , Modelos Estadísticos , Osteoartritis de la Cadera/diagnóstico por imagen , Humanos , Análisis de Componente Principal , RadiografíaRESUMEN
PURPOSE: The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated with cam morphology or (2) precede cam morphology development. METHODS: Young male football players participated at baseline (n = 89, 12-19 years of age), 2.5-year (n = 63) and 5-year follow-up (n = 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck-shaft angle (NSA), epiphyseal extension (EE), lateral center-edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively. RESULTS: A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development. CONCLUSION: Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology. LEVEL OF EVIDENCE: Level II.
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Pinzamiento Femoroacetabular/diagnóstico por imagen , Fémur/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Radiografía/métodos , Adolescente , Niño , Estudios Transversales , Epífisis/diagnóstico por imagen , Ejercicio Físico , Cuello Femoral/diagnóstico por imagen , Estudios de Seguimiento , Placa de Crecimiento/diagnóstico por imagen , Humanos , Masculino , Rango del Movimiento Articular , Rotación , Fútbol , Deportes , Estrés Mecánico , Adulto JovenRESUMEN
OBJECTIVE: To design an automated workflow for hip radiographs focused on joint shape and tests its prognostic value for future hip osteoarthritis. DESIGN: We used baseline and 8-year follow-up data from 1,002 participants of the CHECK-study. The primary outcome was definite radiographic hip osteoarthritis (rHOA) (Kellgren-Lawrence grade ≥2 or joint replacement) at 8-year follow-up. We designed a method to automatically segment the hip joint from radiographs. Subsequently, we applied machine learning algorithms (elastic net with automated parameter optimization) to provide the Shape-Score, a single value describing the risk for future rHOA based solely on joint shape. We built and internally validated prediction models using baseline demographics, physical examination, and radiologists scores and tested the added prognostic value of the Shape-Score using Area-Under-the-Curve (AUC). Missing data was imputed by multiple imputation by chained equations. Only hips with pain in the corresponding leg were included. RESULTS: 84% were female, mean age was 56 (±5.1) years, mean BMI 26.3 (±4.2). Of 1,044 hips with pain at baseline and complete follow-up, 143 showed radiographic osteoarthritis and 42 were replaced. 91.5% of the hips had follow-up data available. The Shape-Score was a significant predictor of rHOA (odds ratio per decimal increase 5.21, 95%-CI (3.74-7.24)). The prediction model using demographics, physical examination, and radiologists scores demonstrated an AUC of 0.795, 95%-CI (0.757-0.834). After addition of the Shape-Score the AUC rose to 0.864, 95%-CI (0.833-0.895). CONCLUSIONS: Our Shape-Score, automatically derived from radiographs using a novel machine learning workflow, may strongly improve risk prediction in hip osteoarthritis.
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Articulación de la Cadera/patología , Osteoartritis de la Cadera/etiología , Anciano , Algoritmos , Área Bajo la Curva , Artrografía , Automatización , Femenino , Articulación de la Cadera/diagnóstico por imagen , Humanos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/patología , Pronóstico , Factores de RiesgoRESUMEN
OBJECTIVE: To assess the ability of radiography-based bone texture variables in proximal femur and acetabulum to predict incident radiographic hip osteoarthritis (rHOA) over a 10 years period. DESIGN: Pelvic radiographs from CHECK at baseline (987 hips) were analyzed for bone texture using fractal signature analysis (FSA) in proximal femur and acetabulum. Elastic net (machine learning) was used to predict the incidence of rHOA (including Kellgren-Lawrence grade (KL) ≥ 2 or total hip replacement (THR)), joint space narrowing score (JSN, range 0-3), and osteophyte score (OST, range 0-3) after 10 years. Performance of prediction models was assessed using the area under the receiver operating characteristic curve (ROC AUC). RESULTS: Of the 987 hips without rHOA at baseline, 435 (44%) had rHOA at 10-year follow-up. Of the 667 hips with JSN grade 0 at baseline, 471 (71%) had JSN grade ≥ 1 at 10-year follow-up. Of the 613 hips with OST grade 0 at baseline, 526 (86%) had OST grade ≥ 1 at 10-year follow-up. AUCs for the models including age, gender, and body mass index (BMI) to predict incident rHOA, JSN, and OST were 0.59, 0.54, and 0.51, respectively. The inclusion of bone texture variables in the models improved the prediction of incident rHOA (ROC AUC 0.68 and 0.71 when baseline KL was also included in the model) and JSN (ROC AUC 0.62), but not incident OST (ROC AUC 0.52). CONCLUSION: Bone texture analysis provides additional information for predicting incident rHOA or THR over 10 years.
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Acetábulo/diagnóstico por imagen , Fémur/diagnóstico por imagen , Fractales , Aprendizaje Automático , Osteoartritis de la Cadera/epidemiología , Área Bajo la Curva , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Osteofito/diagnóstico por imagen , Osteofito/epidemiología , Estudios Prospectivos , Curva ROC , RadiografíaRESUMEN
Osteoarthritis is a major source of pain, disability, and socioeconomic cost worldwide. The epidemiology of the disorder is complex and multifactorial, with genetic, biological, and biomechanical components. Aetiological factors are also joint specific. Joint replacement is an effective treatment for symptomatic end-stage disease, although functional outcomes can be poor and the lifespan of prostheses is limited. Consequently, the focus is shifting to disease prevention and the treatment of early osteoarthritis. This task is challenging since conventional imaging techniques can detect only quite advanced disease and the relation between pain and structural degeneration is not close. Nevertheless, advances in both imaging and biochemical markers offer potential for diagnosis and as outcome measures for new treatments. Joint-preserving interventions under development include lifestyle modification and pharmaceutical and surgical modalities. Some show potential, but at present few have proven ability to arrest or delay disease progression.
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Osteoartritis/diagnóstico , Osteoartritis/terapia , Biomarcadores/metabolismo , Progresión de la Enfermedad , Diagnóstico Precoz , Humanos , Estilo de Vida , Osteoartritis/epidemiologíaRESUMEN
OBJECTIVE: To investigate differences in MRI features between two etiologically distinct subtypes of knee osteoarthritis (OA): one group with metabolic syndrome and one lean group with frequent physical activity. METHODS: We included two groups of 50 subjects of the Osteoarthritis Initiative (OAI) incidence subcohort, with KL ≥ 2 in at least one knee at 48 months follow-up. Inclusion criteria for the metabolic syndrome group were a body mass index (BMI) ≥ 30 kg/m(2) and two out of three of the following criteria: hypertension (RR > 130/85 mm Hg or hypertension medication), insulin resistance (high blood sugar or diabetic medication) or dyslipidemia (lipid lowering medication). Inclusion criteria for the active lean group were a BMI < 25 kg/m(2) and a Physical Activity Scale for the Elderly (PASE) score ≥ 2. MRI scans were scored using MR Imaging Osteoarthritis Knee Score (MOAKS). Differences in MOAKS items between groups were tested using generalized linear models adjusted for sex and age. RESULTS: Scores for cartilage damage were significantly higher in the patella, trochlea and lateral femur in the metabolic syndrome group. Osteophyte scores were higher for all compartments in the metabolic syndrome group, though only significant for the patella, trochlea and medial tibia. Hoffa synovitis was significantly more prevalent in the active lean group while prepatellar bursa signal was more prevalent in the metabolic syndrome group. CONCLUSION: Metabolic OA and OA related to physical activity showed differences in MRI features, depending on knee compartment. These results show that different etiological processes in knee OA can lead to differences in structural degradation.
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Osteoartritis de la Rodilla/diagnóstico por imagen , Anciano , Índice de Masa Corporal , Cartílago Articular/lesiones , Ejercicio Físico , Femenino , Estudios de Seguimiento , Humanos , Traumatismos de la Rodilla/complicaciones , Imagen por Resonancia Magnética/métodos , Masculino , Síndrome Metabólico/complicaciones , Persona de Mediana Edad , Osteoartritis de la Rodilla/etiología , Osteofito/etiología , Lesiones de Menisco Tibial/complicacionesRESUMEN
The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
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Pinzamiento Femoroacetabular/diagnóstico , Pinzamiento Femoroacetabular/terapia , Acetábulo/fisiopatología , Congresos como Asunto , Consenso , Articulación de la Cadera/fisiopatología , Humanos , SociedadesRESUMEN
OBJECTIVE: First, to study how markers of matrix metabolism, inflammation markers, and adipokines relate to (superior) cam deformity and (possible) cam impingement of the hip. Second, to investigate whether they can identify subjects with cam deformity that are at risk of future hip osteoarthritis (OA). METHOD: In a cohort of 1002 subjects (CHECK), (superior) cam deformity was defined by an alpha angle >60° on anteroposterior pelvic radiographs and (possible) cam impingement by a cam deformity together with internal hip rotation ≤20°. Hip OA at 5-year follow-up was defined by Kellgren and Lawrence grade ≥2 or total hip replacement. RESULTS: Subjects with (superior) cam deformity and (possible) cam impingement showed lower levels of bone turnover markers (uCTX-I, uNTX-I, sPINP, sOC) than those without. Cam deformity was positively associated with future hip OA, but associations were weaker at high levels of bone turnover. sCOMP and sHA levels were higher in subjects with cam deformity, while other cartilage and synovium markers were not. Some markers of inflammation (pLeptin, pAdiponectin, and erythrocyte sedimentation rate) were lower in presence of cam deformity and cam impingement, but high-sensitivity C-reactive protein was not. Most associations depended largely on gender differences. CONCLUSION: Bone metabolism may be relevant in the pathogenesis of (superior) cam deformity and in the development of (superior) cam deformity into hip OA. Subjects with cam deformity and cam impingement surprisingly showed lower levels of inflammation markers and adipokines. Associations of cartilage turnover markers with cam deformity and cam impingement were less obvious.
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Adipoquinas/metabolismo , Remodelación Ósea/fisiología , Articulación de la Cadera/metabolismo , Inflamación/metabolismo , Deformidades Adquiridas de la Articulación/metabolismo , Proteínas Matrilinas/metabolismo , Osteoartritis de la Cadera/etiología , Anciano , Biomarcadores/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Articulación de la Cadera/patología , Humanos , Deformidades Adquiridas de la Articulación/complicaciones , Deformidades Adquiridas de la Articulación/diagnóstico , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/metabolismoRESUMEN
Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions.
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Enfermedades de los Cartílagos/diagnóstico , Cartílago Articular/patología , Articulación de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/diagnóstico , Osteofito/diagnóstico , Enfermedades de los Cartílagos/etiología , Articulación de la Cadera/patología , Humanos , Imagen por Resonancia Magnética , Osteoartritis de la Cadera/complicaciones , Osteofito/etiología , Tomografía de Emisión de Positrones , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: A cam-type deformity drastically increases the risk of hip osteoarthritis (OA). Since this type of skeletal anomaly is more prevalent among young active adults, it is hypothesized that the loading conditions experienced during certain types of vigorous physical activities stimulates formation of cam-type deformity. We further hypothesize that the growth plate shape modulates the influence of mechanical factors on the development of cam-type deformity. DESIGN: We used finite element (FE) models of the proximal femur with an open growth plate to study whether mechanical factors could explain the development of cam-type deformity in adolescents. Four different loading conditions (representing different types of physical activities) and three different levels of growth plate extension towards the femoral neck were considered. Mechanical stimuli at the tissue level were calculated by means of the osteogenic index (OI) for all loading conditions and growth plate shape variations. RESULTS: Loading conditions and growth plate shape influence the distribution of OI in hips with an open growth plate, thereby driving the development of cam-type deformity. In particular, specific types of loads experienced during physical activities and a larger growth plate extension towards the femoral neck increase the chance of cam-type deformity. CONCLUSIONS: Specific loading patterns seem to stimulate the development of cam-type deformity by modifying the distribution of the mechanical stimulus. This is in line with recent clinical studies and reveals mechanobiological mechanisms that trigger the development of cam-type deformity. Avoiding these loading patterns during skeletal growth might be a potential preventative strategy for future hip OA.
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Pinzamiento Femoroacetabular/complicaciones , Cuello Femoral/anomalías , Fenómenos Biomecánicos , Niño , Placa de Crecimiento/anomalías , Humanos , Masculino , Soporte de PesoRESUMEN
INTRODUCTION: Cam impingement is characterized by abnormal contact between the proximal femur and acetabulum caused by a non-spherical femoral head, known as a cam deformity. A cam deformity is usually quantified by the alpha angle; greater alpha angles substantially increase the risk for osteoarthritis (OA). However, there is no consensus on which alpha angle threshold to use to define the presence of a cam deformity. AIM: To determine alpha angle thresholds that define the presence of a cam deformity and a pathological cam deformity based on development of OA. METHODS: Data from both the prospective CHECK cohort of 1002 individuals (45-65 years) and the prospective population-based Chingford cohort of 1003 women (45-64 years) with respective follow-up times of 5 and 19 years were combined. The alpha angle was measured at baseline on anteroposterior radiographs, from which a threshold for the presence of a cam deformity was determined based on its distribution. Further, a pathological alpha angle threshold was determined based on the highest discriminative ability for development of end-stage OA at follow-up. RESULTS: A definite bimodal distribution of the alpha angle was found in both cohorts with a normal distribution up to 60°, indicating a clear distinction between normal and abnormal alpha angles. A pathological threshold of 78° resulted in the maximum area under the ROC curve. CONCLUSION: Epidemiological data of two large cohorts shows a bimodal distribution of the alpha angle. Alpha angle thresholds of 60° to define the presence of a cam deformity and 78° for a pathological cam deformity are proposed.
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Pinzamiento Femoroacetabular/patología , Anciano , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Pinzamiento Femoroacetabular/complicaciones , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/epidemiología , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/etiología , Osteoartritis de la Cadera/patología , Radiografía , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: Determining the relation between acetabular coverage, especially overcoverage which may lead to pincer impingement, and development of osteoarthritis (OA) of the hip. DESIGN: From a prospective cohort study of 1,002 individuals with symptoms of early OA (Cohort Hip and Cohort Knee, CHECK), 720 participants were included. Standardized anteroposterior pelvic radiographs and false profile lateral radiographs were obtained at baseline and 5 years follow-up. Acetabular undercoverage (mild dysplasia) and overcoverage (pincer deformity) were measured by a centre edge angle of <25° and >40° respectively in both radiographic views. The strength of association between those parameters at baseline and development of incident OA (Kellgren and Lawrence (K&L) grade >2 or total hip replacement), or joint space narrowing within 5 years was expressed in odds ratio (OR) adjusted for K&L grade, age, body mass index (BMI), and sex using generalized estimating equations. RESULTS: At baseline, 76% of the included hips had no signs of radiographic OA (K&L = 0) whereas 24% had doubtful OA (K&L = 1). Within 5 years, 7.0% developed incident OA. Acetabular dysplasia was significantly associated with development of incident OA with ORs between 2.62 (95% confidence interval (CI) 1.44-4.77) and 5.45 (95% CI 2.40-12.34), dependent on the radiographic view. A pincer deformity was not associated with any outcome measure, except for a significantly protective effect on incident OA when a pincer deformity was present in both radiographic views OR 0.34 (95% CI 0.13-0.87). CONCLUSION: Acetabular dysplasia was significantly associated with development of OA. However, a pincer deformity was not associated with OA, and might even have a protective effect on its development, which questions the supposed detrimental effect of pincer impingement.
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Acetábulo/anomalías , Pinzamiento Femoroacetabular/complicaciones , Luxación Congénita de la Cadera/complicaciones , Osteoartritis de la Cadera/etiología , Acetábulo/diagnóstico por imagen , Acetábulo/patología , Anciano , Estudios de Cohortes , Femenino , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/patología , Pinzamiento Femoroacetabular/fisiopatología , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/patología , Luxación Congénita de la Cadera/fisiopatología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/patología , Osteoartritis de la Cadera/fisiopatología , Dimensión del Dolor/métodos , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To investigate the association between baseline hip shape and both clinical hip osteoarthritis (OA) and total hip replacement (THR) at 5-year follow-up. DESIGN: Individuals from the Cohort Hip and Cohort Knee (CHECK) study, with early symptomatic OA, having standardized anteroposterior pelvic radiographs at baseline and 5-year follow-up (n = 723) were included. Hip shape on the radiographs was assessed using statistical shape modeling (SSM). Hips fulfilling the American College of Rheumatology (ACR) criteria at follow-up were classified as clinical OA. The association between each mode of shape variation and both outcome measures was calculated by Generalized Estimating Equations (GEE). RESULTS: The included individuals comprised 575 females and 148 males (mean age 55.9 ± 5.2 years). At baseline, 8% fulfilled the ACR criteria, 76% had no radiographic hip OA [Kellgren & Lawrence (K&L) = 0] and 24% had doubtful OA (K&L = 1). At follow-up, 147 hips (10.4%) fulfilled the ACR criteria and 35 hips (2.5%) had received THR. Five shape variants (modes) at baseline associated significantly with THR within 5 years. When combined in one GEE model, these shape variants resulted in a predictive power indicated by an area under the curve of 0.81. No shape variants associated with the presence of clinical OA at follow-up. CONCLUSION: The shape of the hip as quantified by an SSM has a good predictive value for THR, whereas variation in shape cannot predict clinical OA. Minor shape variants may be used as a radiographic biomarker to predict the future risk of THR.
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Artroplastia de Reemplazo de Cadera , Articulación de la Cadera/patología , Osteoartritis de la Cadera/patología , Anciano , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/patología , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Pronóstico , Estudios Prospectivos , Radiografía , Factores de RiesgoRESUMEN
OBJECTIVES: To examine the validity and reliability of the Dutch language short Anterior Cruciate Ligament-Return to Sport after Injury scale (short ACL-RSI-NL) in recreational athletes undergoing rehabilitation after ACL injury or ACL reconstruction (ACLR). METHODS: The original 12-item version of the ACL-RSI had been translated into Dutch. Short ACL-RSI-NL items were derived from this 12-item Dutch version. Content validity was evaluated by a team consisting of eight ACL experts and eight athletes. A cohort of 115 athletes with ACL injury or after ACLR completed the short ACL-RSI-NL and related questionnaires at various time points during their rehabilitation. Construct validity (hypothesis testing using Spearman correlations), internal consistency (Cronbach's alpha), floor and ceiling effects (percentage of athletes having the lowest or highest score possible), and structural validity (exploratory factor analysis) were evaluated in the entire ACL athlete group. Test-retest reliability (using intra-class correlation, ICC; standard error of measurement, SEM; smallest detectable change, SDC, at both group and individual levels) was investigated in a subgroup of athletes with a stable outcome on psychological readiness within a two-week interval (n â= â27). RESULTS: The short ACL-RSI-NL demonstrated good construct validity (83% of hypotheses confirmed). Internal consistency was excellent (Cronbach's alpha 0.84), and there were no floor and ceiling effects (≤13.9% lowest or highest score). Test-retest reliability was good (ICC 0.89 with 95% CI 0.77-0.95, SEM 6.93, SDC individual level 19.2, SDC group level 3.7). Exploratory factor analysis confirmed the presence of a single underlying factor (accounting for 56.4% of the total variance of the score). CONCLUSION: The short ACL-RSI-NL exhibited good to excellent construct validity, internal consistency, and test-retest reliability. An averaged score ranging from 0 to 100 can be used to measure psychological readiness to return to sport. The short ACL-RSI-NL has potential for use in day-to-day practice to assess the psychological readiness of recreational athletes to return to sport after ACL injury or ACLR during their rehabilitation process. LEVEL OF EVIDENCE: Level II.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Humanos , Lesiones del Ligamento Cruzado Anterior/cirugía , Ligamento Cruzado Anterior/cirugía , Volver al Deporte/psicología , Reproducibilidad de los Resultados , Traducciones , Atletas/psicología , LenguajeRESUMEN
OBJECTIVES: Investigate point prevalence (second half season 2018-2019) and incidence (season 2017-2018 and first half season 2018-2019) of non-time-loss and time-loss hip/groin pain in male field hockey players. Secondary aims were to study associations between: current/previous hip/groin pain and hip muscle strength, patient reported outcome measures (PROM) and hip muscle strength, and previous hip/groin pain and PROMs. Additionally we studied normal values for the PROMs (Hip and Groin Outcome Score (HAGOS)). DESIGN: Cross-sectional study. SETTING: Testing at field hockey clubs. PARTICIPANTS: 100 male field hockey players (elite, sub-elite and amateur). MAIN OUTCOME MEASURES: Point prevalence and incidence of hip/groin pain, strength: eccentric adduction and abduction, adductor squeeze, HAGOS. RESULTS: Hip/groin pain point prevalence was 17% (time-loss: 6%) and incidence was 36% (time-loss: 12%). Presence of current or previous hip/groin and lower HAGOS-values were not associated with lower hip muscle strength. Previous hip/groin pain was associated with a significant lower HAGOS-values in all domains, except for the 'participation in physical activities' domain. CONCLUSIONS: Hip/groin pain is common in field hockey. One fifth of players have hip/groin pain and one third had pain in the previous season. Previous hip/groin pain was associated with worse ongoing patient reported outcomes in most domains.
Asunto(s)
Fútbol Americano , Hockey , Humanos , Masculino , Ingle/fisiología , Prevalencia , Incidencia , Estudios Transversales , Fuerza Muscular , Dolor Pélvico , Artralgia , Medición de Resultados Informados por el PacienteRESUMEN
OBJECTIVE: To assess the relationship between acetabular dysplasia (AD) and the risk of incident and end-stage radiographic hip osteoarthritis (RHOA) over 2,5,8 and 10 years. DESIGN: Individuals (n = 1002) aged between 45 and 65 from the prospective Cohort Hip and Cohort Knee (CHECK) were studied. Anteroposterior pelvic radiographs were obtained at baseline and 2,5,8, and 10-years follow-up. False profile radiographs were obtained at baseline. AD was defined as a lateral center edge angle, an anterior center edge angle, or both <25° at baseline. The risk of developing RHOA was determined at each follow-up moment. Incident RHOA was defined by Kellgren & Lawrence (KL) grade ≥2 or total hip replacement (THR), end-stage RHOA by a KL grade ≥3 or THR. Associations were expressed in odds ratios (OR) using logistic regression with generalized estimating equations. RESULTS: AD was associated with the development of incident RHOA at 2 years follow-up (OR 2.46, 95% CI 1.00-6.04), 5 years follow-up (OR 2.28, 95% CI 1.20-4.31), and 8 years follow-up (OR 1.86, 95%CI 1.22-2.83). AD was only associated with end-stage RHOA at 5 years follow-up (OR 3.75, 95% CI 1.02-13.77). No statistically significant associations were observed between AD and RHOA at 10-years follow-up. CONCLUSION: Baseline AD in individuals between 45 and 65 years is associated with an increased risk of developing RHOA within 2- and 5 years. However, this association seems to weaken after 8 years and disappears after 10 years.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Osteoartritis de la Cadera , Humanos , Persona de Mediana Edad , Anciano , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/etiología , Estudios de Cohortes , Estudios de Seguimiento , Estudios ProspectivosRESUMEN
Objective: To explore the relationship between radiographic hip shape and features of early hip osteoarthritis (OA) on magnetic resonance imaging (MRI) in young male and female football players without radiographic hip OA. Design: We used baseline data from a cohort of symptomatic and asymptomatic football players aged 18-50 years. Hip shape was assessed on anteroposterior radiographs with statistical shape modeling (SSM) for men and women separately. Cartilage defects and labral tears were graded using the Scoring Hip Osteoarthritis with MRI (SHOMRI) system. We used logistic regression with generalized estimating equations to estimate associations between each hip shape variant, called shape modes, and cartilage defects or labral tears. Results: We included 229 participants (446 hips, 77.4% male). For each sex, 15 shape modes were analyzed. In men, three shape modes were associated with cartilage defects: adjusted odds ratios (aOR) 0.75 (95%CI 0.58-0.97) per standard deviation (SD) for mode 1; 1.34 (95%CI 1.05-1.69) per SD for mode 12; and 0.61 (95%CI 0.48-0.78) per SD for mode 15; and one also with labral tears: aOR 1.30 (95%CI 1.01-1.69) per SD for mode 12. These modes generally represented variations in the femoral neck and subtypes of cam morphology, with and without pincer morphology. For women, there was no evidence for associations with the outcomes. Conclusions: Several hip shape variants were associated with cartilage defects on MRI in young male football players. Specifically, one subtype of cam morphology was associated with both cartilage defects and labral tears. Hip shape was not associated with early OA features in women.