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Assessment of total hip arthroplasty as a predisposing factor for ischiofemoral impingement
Adriana L Oliveira1, Debora C Azevedo1, Alireza Eajazi1
1Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Insights
Total hip arthroplasty (THA) does not significantly alter ischiofemoral (IF) and quadratus femoris (QF) spaces, according to radiographic and MRI findings. These spaces remain stable post-surgery, regardless of THA design.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomedical Engineering
Background:
- Ischiofemoral (IF) and quadratus femoris (QF) spaces are critical anatomical regions around the hip joint.
- Total hip arthroplasty (THA) is a common procedure to treat hip joint pathologies.
- Potential effects of THA on surrounding soft tissues and spaces require thorough investigation.
Purpose of the Study:
- To evaluate the impact of total hip arthroplasty (THA) on the dimensions of the ischiofemoral (IF) and quadratus femoris (QF) spaces.
- To test the hypothesis that THA does not adversely affect IF and QF space relationships.
- To compare these spaces between native hips and post-THA hips, including different implant designs.
Main Methods:
- Retrospective analysis of MRI and radiographic examinations in adults screened for THA complications.
- Comparison of 162 post-THA hips with 88 native hips from the same individuals.
- Independent measurements of IF space (radiographic and MRI) and QF space (MRI) by two radiologists; statistical comparison using ANCOVA.
Main Results:
- No significant differences were observed in IF-MRI and QF spaces between native and post-THA hips (P > 0.12).
- Radiographic IF space (IF-RAD) was found to be higher in post-THA subjects (P = 0.01).
- No differences in IF-MRI and QF spaces were detected across various THA designs; however, metal-on-metal THA showed a higher IF-RAD compared to native hips.
Conclusions:
- Standard total hip arthroplasty does not lead to narrowing of the ischiofemoral (IF) and quadratus femoris (QF) spaces based on radiographic and MRI assessments.
- The findings support the hypothesis that THA maintains the integrity of these critical hip spaces.
- Implications for understanding potential impingement or nerve-related complications following THA.
Objective:
To examine the effect of total hip arthroplasty (THA) on ischiofemoral (IF) and quadratus femoris (QF) spaces with the hypothesis that THA does not affect ischiofemoral relationships.
Materials And Methods:
The study was IRB approved and complied with HIPAA guidelines. We identified consecutive MR examinations (pelvis and/or hip) obtained at our institution in adults (≥18 years old) screened for THA-related complications. Native hips from the same individuals served as controls. We collected medical record data including age, gender, surgical history, and THA designs. Two radiologists independently measured the IF-RAD and IF-MRI (IF space on radiographs and MR imaging, respectively) and QF space (on MR imaging). Groups were compared using ANCOVA controlled for gender.
Results:
The study group comprised 250 hips (132 subjects; 162 post-THA and 88 native hips). Subjects were aged 59 ± 10 years, with 66 males and 66 females. Comparison of IF-MRI and QF spaces between native and post-THA hips showed no differences (P > 0.12) and IF-RAD was higher in post-THA subjects (P = 0.01). No differences in the IF-MRI and QF spaces were present between native hips and different THA designs (P > 0.4). IF-RAD of metal-on-metal THA was higher than that of native hips (P = 0.01) and trended higher than ceramic-on-polyethylene THA (P = 0.08), with the remaining comparisons showing no significant differences (P > 0.4).
Conclusions:
Radiographic- and MRI-based measures in patients with standard THA do not show narrowing of IF and QF spaces.
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