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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 2,
162-169.
doi: 10.1302/0301-620X.91B2.21137 Copyright © 2009 by British Editorial Society of Bone and Joint Surgery Predictors of progression of osteoarthritis in femoroacetabular impingementA RADIOLOGICAL STUDY WITH A MINIMUM OF TEN YEARS FOLLOW-UPN. V. Bardakos, MD, Fellow in Hip Surgery1; and R. N. Villar, MS, FRCS, Consultant Orthopaedic Surgeon11 The Richard Villar Practice, The Wellington Hospital, South Building, 8a Wellington Place, St John’s Wood, London NW8, 9LE, UK. Correspondence should be sent to Mr N. V. Bardakos; e-mail: nbardakos{at}yahoo.com
Although the association between femoroacetabular impingement and osteoarthritis is established, it is not yet clear which hips have the greatest likelihood to progress rapidly to end-stage disease. We investigated the effect of several radiological parameters, each indicative of a structural aspect of the hip joint, on the progression of osteoarthritis. Pairs of plain anteroposterior pelvic radiographs, taken at least ten years apart, of 43 patients (43 hips) with a pistol-grip deformity of the femur and mild (Tönnis grade 1) or moderate (Tönnis grade 2) osteoarthritis were reviewed. Of the 43 hips, 28 showed evidence of progression of osteoarthritis. There was no significant difference in the prevalence of progression between hips with initial Tönnis grade 1 or grade 2 osteoarthritis (p = 0.31). Comparison of the hips with and without progression of arthritis revealed a significant difference in the mean medial proximal femoral angle (81° vs 87°, p = 0.004) and the presence of the posterior wall sign (39% vs 7%, p = 0.02) only. A logistic regression model was constructed to predict the influence of these two variables in the development of osteoarthritis. Mild to moderate osteoarthritis in hips with a pistol-grip deformity will not progress rapidly in all patients. In one-third, progression will take more than ten years to manifest, if ever. The individual geometry of the proximal femur and acetabulum partly influences this phenomenon. A hip with cam impingement is not always destined for end-stage arthritic degeneration. This article has been cited by other articles:
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