Dumont Guillaume D, Menge Travis J, Money Adam J, Carmon Philip
Department of Orthopaedic Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina, USA.
Spectrum Health Medical Group Orthopedics & Sports Medicine, Grand Rapids, Michigan, USA.
Orthop J Sports Med. 2020 Jan 23;8(1):2325967119892330. doi: 10.1177/2325967119892330. eCollection 2020 Jan.
Femoroacetabular impingement (FAI) syndrome is a common source of hip pain associated with chondrolabral injury. There is a subset of patients with FAI syndrome who present with radiopaque densities (RODs) adjacent to the acetabular rim.
To evaluate the prevalence, characteristics, and patient-specific factors associated with RODs adjacent to the acetabulum in patients treated with hip arthroscopy for symptomatic FAI.
Case series; Level of evidence, 4.
Between November 2014 and March 2018, a total of 296 patients who underwent hip arthroscopy for FAI with a labral tear were reviewed retrospectively. Patient-specific variables were collected, including age, sex, lateral center-edge angle (LCEA), and alpha angle. Imaging (computed tomography) and surgical reports were reviewed for the location and characteristics of RODs, as well as subsequent labral treatment technique. Patients were excluded if they were treated for extra-articular hip pathology, had a revision procedure, or had a diagnosis other than FAI with a labral tear. No patient was excluded for any history of systemic inflammatory disease. Binary logistic regression was used to compare age, LCEA, and alpha angle for patients with or without radiopaque fragments. An alpha level of 0.05 was used to indicate statistical significance.
A total of 204 patients met inclusion criteria; 33 patients (16.2%; 16 males, 17 females) had para-acetabular RODs. There were no statistically significant differences in age ( = .82), sex ( = .92), LCEA ( = .24), or alpha angle ( = .10) among patients with or without an ROD. Of the 33 patients, 29 (87.9%) had fragments in the anterosuperior quadrant. Overall, 31 patients (93.9%) were treated with labral repair in addition to correction of the underlying bony impingement, while 2 patients (6.1%) underwent focal labral debridement owing to poor labral tissue quality around the RODs. Twenty-five patients (76%) had identifiable RODs, which were excised at the time of surgery. The mean (± SD) ROD size measured on axial and coronal computed tomography imaging was 6.3 ± 5.5 mm and 4 ± 4.5 mm, respectively.
Age, sex, LCEA, and alpha angle were not predictive of the presence of para-acetabular RODs. Approximately one-sixth of all patients with FAI had RODs identified on computed tomography, which were typically located at the anterosuperior acetabulum. The majority of hips with para-acetabular RODs were amenable to labral repair. The relative prevalence and lack of predictive patient-specific indicators for these fragments suggest that a high degree of suspicion is necessary when evaluating patients with FAI.
股骨髋臼撞击（FAI）综合征是与髋臼唇盂损伤相关的髋部疼痛的常见原因。有一部分FAI综合征患者在髋臼边缘附近出现不透射线密度影（RODs）。
评估因有症状的FAI接受髋关节镜治疗的患者中，髋臼旁RODs的患病率、特征及患者特异性因素。
病例系列；证据等级，4级。
回顾性分析2014年11月至2018年3月间共296例行髋关节镜治疗伴有盂唇撕裂的FAI患者。收集患者特异性变量，包括年龄、性别、外侧中心边缘角（LCEA）和α角。查阅影像学（计算机断层扫描）和手术报告，了解RODs的位置和特征以及后续的盂唇治疗技术。若患者接受关节外髋部病变治疗、进行翻修手术或诊断为除伴有盂唇撕裂的FAI以外的其他疾病，则将其排除。没有患者因任何全身炎症性疾病史而被排除。采用二元逻辑回归比较有或无不透射线碎片患者的年龄、LCEA和α角。采用α水平0.05表示统计学显著性。
共有204例患者符合纳入标准；33例患者（16.2%；16例男性，17例女性）有髋臼旁RODs。有或无ROD的患者在年龄（P = 0.82）、性别（P = 0.92）、LCEA（P = 0.24）或α角（P = 0.10）方面无统计学显著差异。在这33例患者中，29例（87.9%）的碎片位于前上象限。总体而言，31例患者（93.9%）在纠正潜在的骨撞击的同时接受了盂唇修复，而2例患者（6.1%）由于RODs周围盂唇组织质量差而接受了局限性盂唇清创术。25例患者（76%）有可识别的RODs，在手术时将其切除。在轴向和冠状位计算机断层扫描成像上测量的ROD平均（±标准差）大小分别为6.3±5.5 mm和4±4.5 mm。
年龄、性别、LCEA和α角不能预测髋臼旁RODs的存在。所有FAI患者中约六分之一在计算机断层扫描上发现有RODs，其通常位于髋臼前上方。大多数有髋臼旁RODs的髋关节适合进行盂唇修复。这些碎片的相对患病率以及缺乏预测性的患者特异性指标表明，在评估FAI患者时需要高度怀疑。
