Hip Chondropathy Research Articles

Quality of life impairments after hip arthroscopy in people with hip chondropathy.

Many young individuals undergoing hip arthroscopic surgery have hip chondropathy. The impact of mild or more severe hip chondropathy 1–2 years following arthroscopy is poorly understood. The purpose of this study was to (i) compare health-related quality of life (HRQoL), anxiety and depression scores between people who underwent arthroscopic treatment for hip chondropathy 1–2 years previously and pain-free controls; (ii) compare HRQoL, hip-related quality of life (QoL) and anxiety/depression scores in people with mild versus severe hip chondropathy and (iii) compare hip-related QoL items between chondropathy groups. The Hip disability and Osteoarthritis Outcome Score (HOOS), International Hip Outcome Tool (iHOT-33), EuroQol-5D and Hospital Anxiety and Depression Scale (HADS) were compared between 71 individuals aged 18–60 years following arthroscopic treatment for hip chondroplasty (12–24 months previously) and 46 healthy controls. Comparisons were also performed between people with mild (Outerbridge grade 1–2) and severe (Outerbridge grade 3–4) hip chondropathy. Participants following arthroscopic treatment for hip chondroplasty reported worse HRQoL, hip-related QoL and anxiety, compared with pain-free controls (all P < 0.05), but no difference in self-care (P = 0.20). There were differences between mild and severe chondropathy groups for pain during sport/recreation [median (IQR) 20 (5–80) versus 60 (25–90) P = 0.01), pain after activity (40 (20–75) versus 75 (50–90) P = 0.01), difficulty maintaining fitness (30 (10–70) versus 75 (35–85) P = 0.02) and reduced hip confidence. Hip chondropathy was associated with significant QoL impairment, with severe chondropathy associated with the greatest impairment. The identification of specific areas of QoL impairment provides avenues to target rehabilitation and support.

Parafoveal chondral defects and associated lesions in hip arthroscopy patients

Hip arthroscopy allows to accurately define and localize any chondral defect related to FAI. Both acetabular and femoral head CAM and PINCER associated lesions has been well described. To date, many concerns about their significance exist. More in detail, parafoveal chondral lesions (PCLs) are often associated with cartilage damage of other areas of the hip, and their presence could be a poor prognostic factor. We managed to define the arthroscopic characteristics of PCLs and to establish their importance as risk factor for other chondral defects. We retrospectively review a case-control analysis of 97 patients with a PCL artroscopic diagnosed compared to 438 patients undergoing hip arthroscopy with other hip lesions. We assessed the frequency and distribution of each cartilage damage with descriptive statistics for both groups. We conducted a contingency table analysis using Chi2 (and Fisher's exact) test to evaluate the relevance of the presence of a PCL as a risk factor for other hip lesions. We also compared the preoperative modified Harris Hip Scores between the groups in order to evaluate clinical differences. PCLs are more often associated with multiple hip chondral lesions in extensively damaged hips. Patients with PCLs are more symptomatic and have a worse quality of life. PCLs represent a risk factor for hip chondropathy and central osteophytes, labrum lesions and LT tears. PCLs are statistically related with PINCER morphotype of FAI. The presence of PCLs is a very helpful index to the hip surgeon: it uncovers a major hip cartilage damage and the subsequent need to look for other hip lesions, especially in PINCER-type FAI. We expect to find a PCL in symptomatic patients with painful hip.

Impairment of Dynamic Single‐Leg Balance Performance in Individuals With Hip Chondropathy

Impaired balance control has been reported in the elderly with hip osteoarthritis, yet this relationship has not been explored in young adults with hip chondropathy. This study aimed to determine whether people with hip chondropathy demonstrated impaired balance ability during a dynamic single-leg squat with eyes open (SquatEO) and a single-leg standing task with eyes closed (StandEC) and whether hip range of motion (ROM) and hip muscle strength were correlated with balance measures in adults with hip chondropathy. Sixty-three adults with hip chondropathy and 60 controls performed 2 tasks: SquatEO and StandEC while standing on a Nintendo Wii Balance Board. Center of pressure (COP) movement in mediolateral and anteroposterior directions was extracted. Hip ROM and muscle strength were measured with an inclinometer and dynamometer. Data were analyzed using an analysis of covariance and stepwise multiple regression model. During SquatEO, greater COP mediolateral range (P = 0.023) and anteroposterior SD (P = 0.043) were observed in those with hip chondropathy compared to controls. No significant between-group differences were observed for StandEC. Hip external rotation ROM was significantly associated with mediolateral range during SquatEO. Dynamic single-leg balance squat performance is reduced in people with hip chondropathy compared to healthy adults, but static single-leg standing balance is not. This may be reflective of reduced control of dynamic movements. Those with greater hip joint external rotation ROM appear to have worse single-leg squat balance performance. Further investigation into balance deficits associated with hip disease is necessary to establish early identification strategies and a tailored approach to rehabilitation.

Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes

BackgroundThis study aimed to describe chondropathy prevalence in adults who had undergone hip arthroscopy for hip pain. The relationships between chondropathy severity and (1) participant characteristics; and (2) patient-reported outcomes...

Knee cartilage and quadriceps muscle loss after posterior crucial ligament (PCL) injury

Knee cartilage and quadriceps muscle loss after posterior crucial ligament (PCL) injury

Large post-traumatic bone marrow lesions after ACL injury are not associated with knee pain and symptoms within 4 weeks of injury

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S178 may enable clinicians to provide targeted rehabilitation programs which could improve outcomes in people with hip chondropathy. 301 LARGE POST-TRAUMATIC BONE MARROW LESIONS AFTER ACL INJURY ARE NOT ASSOCIATED WITH KNEE PAIN AND SYMPTOMS WITHIN 4 WEEKS OF INJURY J.B. Driban y, L.S. Lohmander z, R. Frobell z. y Tufts Med. Ctr., Boston, MA, USA; zOrthopedics, Clinical Sci. Lund, Lund Univ., Lund, Sweden Purpose: Following an anterior cruciate ligament (ACL) tear most knees have a bone marrow lesion (BML); however, the clinical relevance of these post-traumatic lesions remains unclear. Previous studies have suggested that post-traumatic BMLs are associated with pain. We explored the cross-sectional associations between post-traumatic BML volume and self-reported knee pain and symptoms in individuals with acute ACL injury where almost everyone suffered from at least one posttraumatic BML. Our primary focus was the total BML volume of the injured knee, secondary focus was on the tibiofemoral compartments, and the separate condyles were exploratory. Methods: 121 young active adults (mean age 26 [SD 4.9] years) with an acute ACL tear to a previously uninjured knee were studied as part of a randomized clinical trial (The KANON-trial). BML volume was automatically segmented from 1.5 Tesla magnetic resonance (MR) images, obtained within 4 weeks of injury, using a composite dataset made up of a sagittal dual-echo turbo-spin echo and sagittal short tau inversion recovery sequences (Virtualscopics Inc., Rochester (NY), USA). Selfreported pain and symptoms of the injured knee was obtained at the same day as MR imaging using the KOOS questionnaire (0-100, worst to best). A depression fracture as visualized on MR imaging was shown to have a strong relation to BML volume but could influence pain through other mechanisms; thus we stratified our primary analysis for those with and without a depression fracture. We used multiple linear regression models to assess the cross-sectional association between KOOS pain or symptoms (outcome variables) and total knee BML volume (primary aim), medial and lateral tibiofemoral BML volume (secondary aims), and regional BML volumes (exploratory aims) collected within 4 weeks of injury. We present crude results and results adjusted for time from injury to MR imaging, age, body mass index, and sex. Results: The majority of participants were male (74%), had at least one BML in the knee (96%), and had a depression fracture in the knee (57%). The participants reported both knee pain (mean 57 [SD 17]) and knee symptoms (48 [17]) at the same day as MR imaging acquisition but total knee BML volume was not related to self-reported knee pain for the entire cohort (p 1⁄4 0.25, Table 1). Among those without a depression fracture, larger total knee BML volume was associated with increased knee pain scores (p1⁄4 0.02); however, no associationwas found for those with a depression fracture (p 1⁄4 0.96). Larger medial (p 1⁄4 0.02), but not lateral (p 1⁄4 0.77), tibiofemoral BML volume was associated with increased pain scores, specifically when BMLswere present in themedial femoral condyle (p 1⁄4 0.05, Table 1). We found no association between

Hip chondropathy is prevalent at arthroscopy and is associated with co-existing pathology, but not patient reported outcomes

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S138 Purpose: The aim of this study was to examine the association between trabecular bone texture with occurrence of knee joint replacement (KJR) using a variance orientation transform (VOT) method. Methods: The association of trabecular bone texture and knee joint replacement was tested in a six year prospective study of 123 subjects with symptomatic knee osteoarthritis (OA) of whom data regarding KJR was available for 114. At baseline weight-bearing anteroposterior tibiofemoral radiographs were acquired. Trabecular bone texture regions were selected from the medial and lateral tibia subchondral bone. The VOT method was applied to each bone region and five fractal bone texture parameters, i.e. mean fractal dimension (FDMEAN), fractal dimensions in the horizontal (FDH) and vertical (FDV) directions, and along the roughest part of trabecular bone (FDSta), and texture aspect ratio (Str) were calculated. The association of tertiles of baseline fractal parameters with risk of JR was analysed using logistic regression, adjusting for gender, age, body mass index, Kellgren and Lawrence grade and WOMAC pain score. Results: 28 participants’ study knees underwent knee joint replacement over 6 years. Participants who had a knee joint replacement had lower medial FDMEAN (p 1⁄4 0.04 for difference) and lower medial FDH (p 1⁄4 0.04 for difference). The relationship between measures of bone texture and knee joint replacement was examined. With increasing tertile of mean fractal dimension (FDMEAN), adjusted for age, gender, body mass index, Kellgren Lawrence grade and WOMAC pain score, the odds of knee joint replacement diminished significantly (p 1⁄4 0.04 for trend). There was also a suggestion that the upper tertiles of the fractal dimension in the horizontal direction (FDH), were associated with a significant reduction in risk of KJR compared to the lowest tertile (p 1⁄4 0.15 for trend). Conclusions: This study shows that the texture of medial tibial trabecular bone measured from plain radiographs is related to the risk of knee joint replacement. Specifically with increasing mean fractal dimension (FDMEAN) the risk of joint replacement was reduced, independent of other clinical predictors of joint replacement. Tibial trabecular bone texture may be useful as a marker of disease progression and a target of therapy to delay knee joint replacement. Ă 253 HIP CHONDROPATHY IS PREVALENT AT ARTHROSCOPY AND IS ASSOCIATED WITH CO-EXISTING PATHOLOGY, BUT NOT PATIENT REPORTED OUTCOMES J.L. Kemp y, M. Makdissi z, A.G. Schache z, M.G. Pritchard x, K.M. Crossley y. yUniv. of Queensland, Brisbane, Australia; zUniv. of Melbourne, Melbourne, Australia; xHip Arthroscopy Australia, Hobart,

Dynamic single-leg balance performance is impaired in individuals with hip chondropathy

were reduced by surgery while the non-operated knee remained unchanged (Figures 1 & 2). The limb differences in peak 1 and 2 of KAM were significant (p1⁄40.0028 and 0.005, respectively). Both before and after surgery, the non-operated knee did not differ significantly from healthy control in KVA or KAM. The knee was significantly worse than controls in pain scores and spatiotemporal parameters. Conclusions: The study's findings suggest that gait patterns in the nonoperated knee may not change after surgery. The study confirms that there is a limb asymmetry after surgery, with the non-operated limb bearing greater loads than the operated limb, but suggests that the asymmetry likely results from improvements in the operated knee rather than deterioration in the non-operated knee. As a whole, the findings indicated that the surgery itself might not be the catalyst for higher loading patterns postoperatively. Nevertheless, the non-operated knee may still be at risk for OA after surgery due to the limb asymmetry and the persistent higher levels of KAM. Clinicians should consider this when prescribing therapy to patients postoperatively. There should be a focus on caring for the non-operated knee in addition to the operated knee.

Arthroscopic Treatment of Hip Chondral Defects: Autologous Chondrocyte Transplantation Versus Simple Debridement—A Pilot Study

To compare the effectiveness of simple arthroscopic debridement versus arthroscopic autologous chondrocyte transplantation (ACT) for the treatment of hip chondral lesions. We carried out a controlled retrospective study of 30 patients affected by a post-traumatic hip chondropathy of the third or fourth degree, according to the Outerbridge classification, measuring 2 cm² in area or more. Of these patients, 15 underwent arthroscopic ACT, whereas the other 15 underwent arthroscopic debridement. The 2 groups were similar in age, sex, degree, and location of the pathology. All the patients were assessed before and after the procedure with the Harris Hip Score (HHS). In both groups the mean follow-up was approximately 74 months (range, 72 to 76 months). The mean size of the defect was 2.6 cm². The patients who underwent ACT (group A) improved after the procedure compared with the group that underwent debridement alone (group B). The mean HHS preoperatively was 48.3 (95% confidence interval [CI], 45.4 to 51.2) in group A and 46 (95% CI, 42.7 to 49.3) in group B (P = .428 [no significant difference]). The final HHS was 87.4 (95% CI, 84.3 to 90.5) in group A and 56.3 (95% CI, 54.4 to 58.7) in group B (P < .001 [significant difference]). This study indicates that an ACT procedure can be used in the hip for acetabular chondral defects. Level III, retrospective comparative study.