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Hip Preservation Surgery in Osteoarthritis Prevention: Potential Benefits of the Radiographic Angular Correction
José M Lamo-Espinosa1, Adrián Alfonso1, Elena Pascual2
1Orthopedic and Traumatology Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
Insights
Morphological differences in hip osteoarthritis (OA) vary by age. Younger patients with OA show specific hip angle characteristics, suggesting targeted hip preservation surgery for prevention, while FAI types correlate with later OA development.
Area of Science:
- Orthopedics
- Radiology
- Biomedical Engineering
Background:
- Osteoarthritis (OA) is a degenerative joint disease with complex etiological factors.
- Hip morphology plays a significant role in the development and progression of OA.
- Understanding age-related morphological changes is crucial for effective OA management and prevention.
Purpose of the Study:
- To delineate the specific morphological characteristics associated with hip osteoarthritis (OA) across three distinct age demographics.
- To identify key radiographic parameters indicative of early versus late-stage hip OA.
- To inform the development of targeted hip preservation surgical strategies for OA prevention.
Main Methods:
- A retrospective analysis of 400 hips from 377 patients undergoing primary total hip arthroplasty for idiopathic OA.
- Patients were stratified into three age groups: up to 60 years, 61-74 years, and 75+ years.
- Key hip angles (Tönnis, Wiberg, alpha) and head extrusion (extrusion index) were measured by five independent researchers, with mean values used for analysis.
Main Results:
- No significant differences in sex distribution or BMI were observed across the age groups.
- Early OA hips were characterized by reduced head coverage (extrusion index), higher Tönnis angles, and lower Wiberg and alpha angles.
- These morphological differences were more pronounced in older age groups, with significant variations noted between younger and middle-aged cohorts.
Conclusions:
- Specific hip morphologies, including elevated acetabular angle, head extrusion, and decreased Wiberg angle, are hallmarks of early hip OA and targets for hip preservation surgery.
- Pincer-type femoroacetabular impingement (FAI) and CAM-type FAI, indicated by specific angle measurements, are associated with the later development of OA.
- The findings question the universal applicability of hip preservation surgery for OA prevention in FAI patients, particularly those with Pincer-type FAI.
Abstract:
Objective: The aim of the study is to describe the morphology associated with the development of osteoarthritis (OA) in three different age groups. These data will contribute to defining the morphology associated with early and late hip OA. Methods: We studied 400 hips in 377 patients who had undergone primary THA due to idiopathic OA. Three groups were compared: group 1 (n = 147), younger patients, aged up to 60 years; group 2 (n = 155), patients aged between 61 and 74 years; and group 3 (n = 98), aged 75 or over. Five independent researchers measured the hip angles and the mean values were used to build a database. Results: No differences between groups in sex distribution and BMI were detected. Less coverage of the head (extrusion index), higher Tönnis angle, lower Wiberg and alpha angles characterized early OA hips. These differences increased with age, being greater between group 2 and group 3 (p < 0.01). However, significant differences were still present in the comparison between group 1 and group 2 (p < 0.01)). No differences were detected between group 2 and group 3. Conclusion: Elevated acetabular angle, head extrusion and decreased Wiberg angle characterize hip osteoarthritis at younger ages and should be the focus of hip preservation surgery in terms of osteoarthritis prevention. Pincer-type FAI (higher Wiberg and lower Tönnis angle) and higher alpha angle (CAM) are correlated with the development of later OA. These results shed doubt on applying the hip preservation surgery concept in terms of osteoarthritis prevention in FAI, especially in Pincer-type FAI patients.
