Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Eur Radiol. 2024 Jun;34(6):3555-3565. doi: 10.1007/s00330-023-10419-3. Epub 2023 Nov 20.
To identify preoperative degenerative features on traction MR arthrography associated with failure after arthroscopic femoroacetabular impingement (FAI) surgery.
Retrospective study including 102 patients (107 hips) undergoing traction magnetic resonance arthrography (MRA) of the hip at 1.5 T and subsequent hip arthroscopic FAI surgery performed (01/2016 to 02/2020) with complete follow-up. Clinical outcomes were assessed using the International Hip Outcome Tool (iHOT-12) score. Clinical endpoint for failure was defined as an iHOT-12 of < 60 points or conversion to total hip arthroplasty. MR images were assessed by two radiologists for presence of 9 degenerative lesions including osseous, chondrolabral/ligamentum teres lesions. Uni- and multivariate Cox regression analysis was performed to assess the association between MRI findings and failure of FAI surgery.
Of the 107 hips, 27 hips (25%) met at least one endpoint at a mean 3.7 ± 0.9 years follow-up. Osteophytic changes of femur or acetabulum (hazard ratio [HR] 2.5-5.0), acetabular cysts (HR 3.4) and extensive cartilage (HR 5.1) and labral damage (HR 5.5) > 2 h on the clockface were univariate risk factors (all p < 0.05) for failure. Three risk factors for failure were identified in multivariate analysis: Acetabular cartilage damage > 2 h on the clockface (HR 3.2, p = 0.01), central femoral osteophyte (HR 3.1, p = 0.02), and femoral cartilage damage with ligamentum teres damage (HR 3.0, p = 0.04).
Joint damage detected by preoperative traction MRA is associated with failure 4 years following arthroscopic FAI surgery and yields promise in preoperative risk stratification.
Evaluation of negative predictors on preoperative traction MR arthrography holds the potential to improve risk stratification based on the already present joint degeneration ahead of FAI surgery.
• Osteophytes, acetabular cysts, and extensive chondrolabral damage are risk factors for failure of FAI surgery. • Extensive acetabular cartilage damage, central femoral osteophytes, and combined femoral cartilage and ligamentum teres damage represent independent negative predictors. • Survival rates following hip arthroscopy progressively decrease with increasing prevalence of these three degenerative findings.
在关节镜下股骨髋臼撞击症（FAI）手术后，识别牵引磁共振关节造影术术前与失败相关的退行性特征。
回顾性研究纳入了 102 名患者（107 髋），这些患者在 1.5T 场强下进行了髋关节牵引磁共振关节造影术（MRA），并随后进行了髋关节镜下 FAI 手术（2016 年 1 月至 2020 年 2 月），并进行了完整的随访。采用国际髋关节结果工具（iHOT-12）评分评估临床结果。FAI 手术失败的临床终点定义为 iHOT-12<60 分或转为全髋关节置换术。两名放射科医生评估了 9 种退行性病变的存在，包括骨、软骨盂唇/圆韧带病变。进行单变量和多变量 Cox 回归分析，以评估 MRI 发现与 FAI 手术失败之间的关联。
在 107 髋中，27 髋（25%）在平均 3.7±0.9 年的随访中至少达到了一个终点。股骨或髋臼的骨赘改变（危险比[HR]2.5-5.0）、髋臼囊肿（HR 3.4）、广泛的软骨（HR 5.1）和盂唇损伤（HR 5.5）>时钟面上 2 小时是单变量危险因素（均 p<0.05）。多变量分析确定了三个失败的危险因素：时钟面上>2 小时的髋臼软骨损伤（HR 3.2，p=0.01）、中央股骨骨赘（HR 3.1，p=0.02）和股骨软骨损伤伴圆韧带损伤（HR 3.0，p=0.04）。
关节镜下 FAI 手术后 4 年，术前牵引 MRA 检测到的关节损伤与手术失败相关，并有望在术前进行风险分层。
在 FAI 手术之前，评估术前牵引 MRA 上的阴性预测因子有可能基于已经存在的关节退变来改善风险分层。
• 骨赘、髋臼囊肿和广泛的软骨盂唇损伤是 FAI 手术失败的危险因素。
• 广泛的髋臼软骨损伤、中央股骨骨赘以及股骨软骨和圆韧带损伤的联合存在是独立的阴性预测因子。
• 髋关节镜术后的生存率随着这三种退行性发现的患病率增加而逐渐降低。
