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Does Cartilage Degenerate in Asymptomatic Hips With Cam Morphology?

Grammatopoulos, George, BSc, MBBS, DPhil, FRCSC (Tr&Orth); Melkus, Gerd, PhD; Rakhra, Kawan, MD, FRCPC; Beaulé, Paul E., MD, FRCSC

Clinical Orthopaedics and Related Research®: May 2019 - Volume 477 - Issue 5 - p 962–971
doi: 10.1097/CORR.0000000000000629

Background The management of asymptomatic individuals with cam femoral morphology that predisposes their hips to femoroacetabular impingement has received little attention. Such hips may have subclinical articular damage; however, whether this cartilage damage will progress is unknown as is whether any particular bone morphologies are associated with this progression. Such knowledge could help determine the natural history and guide management of such individuals.

Questions/purposes The purpose of this study was to determine whether (1) asymptomatic hips with cam morphology are at risk of further cartilage degeneration (as evaluated by T1ρ); (2) T1ρ changes are predictive of symptom onset; and (3) bony morphologic parameters are associated with T1ρ signal changes.

Methods In a prospective, longitudinal study, 17 asymptomatic volunteers/hips (16 men; 33 ± 6 years) with cam morphology underwent two T1ρ MRI scans and functional assessment (WOMAC) at recruitment and at 4 years (range, 2–6 years). Volunteers were recruited from a previous study, which reported on the prevalence of cam morphology among asymptomatic individuals using hip MRI; cam morphology was defined as an α angle ≥ 60° anterolaterally and/or ≥ 50.5° anteriorly relative to the neck axis. The differences in T1ρ values (ΔT1ρ) and relative differences (%ΔT1ρ) were calculated as: ΔT1ρ = T1ρFollowup – T1ρInitial and %ΔT1ρ = ΔT1ρ/T1ρInitial. A %ΔT1ρ > 17.6% was considered clinically important. Using CT data, femoral, acetabular, and spinopelvic parameters were measured. Whether ΔT1ρ and/or %ΔT1ρ was associated with any of the bone morphologic parameters was tested using Spearman’s correlation coefficient.

Results The global T1ρ in these asymptomatic hips with cam morphology remained unchanged between initial (mean, 35 ± 5 ms) and followup scans (mean, 34 ± 3 ms; p = 0.518). No differences with the numbers available in T1ρ values were seen initially between the anterolateral and posterolateral (34 ± 6 ms versus 33 ± 4 ms; p = 0.734) regions; at followup, T1 values were higher posterolaterally (36 ± 5 ms versus 32 ± 5 ms; p = 0.031). The mean global ΔT1ρ was 1 ± 5 ms (95% confidence interval, -1 to +3 ms) and the mean global %ΔT1ρ was 2% ± 13%. Two volunteers reported lower WOMAC scores; one patient exhibited a clinically important increase in %ΔT1ρ (-26%). The degree of acetabular coverage correlated with %ΔT1ρ (rho = 0.59–0.61, p = 0.002); the lesser the acetabular coverage anterolaterally, the greater the corresponding area’s T1ρ at followup.

Conclusions Although signs of posterolateral joint degeneration were detected, these were not generally associated with symptoms, and only one of the two volunteers with the onset of symptoms had a clinically important increase in %ΔT1ρ. We found that reduced acetabular coverage may increase the likelihood that preclinical cartilage degeneration will arise within 2 to 6 years; thereby reduced acetabular coverage should be considered when stratifying asymptomatic hips at risk of degeneration. Future studies should be performed with a larger cohort and include femoral version among the parameters studied.

Level of Evidence Level II, diagnostic study.

G. Grammatopoulos, P. Beaulé, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada

G. Melkus, K. Rakhra, Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada

P. E. Beaulé, University of Ottawa, Division of Orthopaedic Surgery, The Ottawa Hospital–General Campus, 501 Smyth Road, Ottawa K1H 8L6, Canada, email:

This study was supported by The Canadian Institutes of Health Research (PB; MOP97778). One of the authors certifies that he (PB) has received or may receive personal fees, during the study period, in an amount of USD 10,000 to USD 100,000 from MicroPort (Arlington, TN, USA), personal fees in an amount of USD 10,000 to USD 100,000 from MatOrtho (Surrey, UK), personal fees in an amount of USD 10,000 to USD 100,000 from Zimmer Biomet (Warsaw, IN, USA), personal fees in an amount of USD 10,000 to USD 100,000 from Corin (Cirencester, UK), personal fees in an amount of USD 10,000 to USD 100,000 from Medacta (Castel San Pietro, Switzerland), and grants in an amount of USD 100,001 to USD 1,000,000 from Zimmer Biomet, all outside the submitted work.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Received May 08, 2018

Accepted December 12, 2018

© 2019 Lippincott Williams & Wilkins LWW
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