Femoroacetabular impingement (FAI) is increasingly recognized as a cause of hip pain in young adults. The condition leads to chondrolabral separation and chondral delamination and eventually predisposes to osteoarthritis of the hip. FAI that inflicts cartilage damage has been observed in hips with abnormal morphological characteristics and is related to a long-term evolution toward osteoarthritis. Arthroscopic surgery, which allows for correction of morphological characteristics and restores impingement-free motions, is the current standard of treatment.
Hypothesis:
Arthroscopic cam resection can restore the normal mechanical environment of the hip joint in cam-type FAI.
Study Design:
Descriptive laboratory study.
Methods:
Patient-specific discrete element models from 10 patients with cam-type FAI (all male; age, 18-40 years) were defined based on preoperative computed tomography scans and postoperative magnetic resonance imaging (MRI) scans. Complete cam resection postoperatively on MRI was confirmed with alpha angles <55°. The preoperative and postoperative peak contact stress findings during impingement testing were compared against a matched control group.
Results:
Peak contact stress was significantly elevated in patients with cam-type FAI during impingement testing, with increasing amounts of internal hip rotation (26.6 ± 11.64 MPa in cam patients preoperatively, 12.1 ± 4.62 MPa in those same patients postoperatively, and 11.4 ± 1.72 MPa in the virtual control group during impingement testing at 20° of internal hip rotation; P < .01). This effect was normalized after arthroscopic cam resection and loading patterns matched those of the control group.
Conclusion:
Accurate arthroscopic cam resection restored the normal peak joint contact stresses in the hip joint. This highlights the importance of early and complete cam resections in the face of a positive diagnosis of cam-type FAI.
Clinical Relevance:
Treatment of cam-type FAI effectively normalizes hip joint contact mechanics.
AbrahamCLMaasSAWeissJA, et al. A new discrete element analysis method for predicting hip joint contact stresses. J Biomech. 2013;46(6):1121-1127.
2.
AgricolaRHeijboerMPBierma-ZeinstraSMA, et al. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918-923.
3.
AgricolaRHeijboerMPRozeRH, et al. Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK). Osteoarthritis Cartilage. 2013;21(10):1514-1521.
4.
AgricolaRWeinansH.Femoroacetabular impingement: what is its link with osteoarthritis?Br J Sports Med. 2015;50(16):957-958.
5.
Alonso-RasgadoTJimenez-CruzDBaileyCGMandalPBoardT.Changes in the stress in the femoral head neck junction after osteochondroplasty for hip impingement: a finite element study. J Orthop Res. 2012;30(12):1999-2006.
6.
AmanatullahDFAntkowiakTPillayK, et al. Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics. 2015;38(3):185-199.
AteshianGAWardenWHKimJJGrelsamerRPMowVC.Finite deformation biphasic material properties of bovine articular cartilage from confined compression experiments. J Biomech. 1997;30(11-12):1157-1164.
9.
AudenaertESmetBPattynCKhandujaV.Imageless versus image-based registration in navigated arthroscopy of the hip: a cadaver-based assessment. J Bone Joint Surg Br. 2012;94(5):624-629.
10.
AudenaertEVan HouckeJMaesB, et al. Range of motion in femoroacetabular impingement. Acta Orthop Belg. 2012;78(3):327-332.
11.
AudenaertEABaeldeNHuysseWVigneronLPattynC.Development of a three-dimensional detection method of cam deformities in femoroacetabular impingement. Skeletal Radiol. 2011;40(7):921-927.
12.
AudenaertEAKhandujaVBauwensC, et al. A discrete element model to predict anatomy of the psoas muscle and path of the tendon: design implications for total hip arthroplasty. Clin Biomech (Bristol, Avon). 2019;70:186-191.
13.
AudenaertEAPattynCSteenackersG, et al. Statistical shape modeling of skeletal anatomy for sex discrimination: their training size, sexual dimorphism, and asymmetry. Front Bioeng Biotech. 2019;7:302.
14.
AudenaertEAPeetersIVigneronLBaeldeNPattynC.Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. Am J Sports Med. 2012;40(6):1329-1336.
15.
BrunnerAHorisbergerMHerzogRF.Evaluation of a computed tomography-based navigation system prototype for hip arthroscopy in the treatment of femoroacetabular cam impingement. Arthroscopy. 2009;25(4):382-391.
16.
CampanelliVHowellSMHullML.Morphological errors in 3D bone models of the distal femur and proximal tibia generated from magnetic resonance imaging and computed tomography determined using two registration methods. Comp Meth Biomech Biomed Eng. 2020;8(1):31-39.
17.
CheginiSBeckMFergusonSJ.The effects of impingement and dysplasia on stress distributions in the hip joint during sitting and walking: a finite element analysis. J Orthop Res. 2009;27(2):195-201.
18.
CooperRJWilliamsSMengoniMJonesAC.Patient-specific parameterised cam geometry in finite element models of femoroacetabular impingement of the hip. Clin Biomech. 2018;54:62-70.
19.
DwyerMKTumpowskyCBooneALeeJMcCarthyJC.What is the association between articular cartilage damage and subsequent THA 20 years after hip arthroscopy for labral tears?Clin Orthop Relat Res. 2019;477(5):1211-1220.
20.
GanzRParviziJBeckM, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112-120.
21.
GustafsonJAEliasJJDebskiREFarrokhiS.Development and validation of a kinematically-driven discrete element model of the patellofemoral joint. J Biomech. 2019;88:164-172.
22.
HellwigFLTongJHussellJG.Hip joint degeneration due to cam impingement: a finite element analysis. Comput Methods Biomech Biomed Engin. 2016;19(1):41-48.
23.
HeyworthBEShindleMKVoosJERudzkiJRKellyBT.Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23(12):1295-1302.
24.
HosnijehFSZuiderwijkMEVersteegM, et al. Cam deformity and acetabular dysplasia as risk factors for hip osteoarthritis. Arthritis Rheumatol. 2017;69(1):86-93.
25.
HuangC-YStankiewiczAAteshianGAMowVC.Anisotropy, inhomogeneity, and tension–compression nonlinearity of human glenohumeral cartilage in finite deformation. J Biomech. 2005;38(4):799-809.
26.
JorgeJPSimoesFMFPiresEB, et al. Finite element simulations of a hip joint with femoroacetabular impingement. Comput Methods Biomech Biomed Engin. 2014;17(11):1275-1284.
27.
KempJLCrossleyKMAgricolaRGeuskensFvan MiddelkoopM.Radiographic hip osteoarthritis is prevalent, and is related to cam deformity 12-24 months post-hip arthroscopy. Int J Sports Phys Ther. 2018;13(2):177-184.
28.
KempJLMacDonaldDCollinsNJHattonALCrossleyKM.Hip arthroscopy in the setting of hip osteoarthritis: systematic review of outcomes and progression to hip arthroplasty. Clin Orthop Relat Res. 2015;473(3):1055-1073.
29.
KernAMAndersonDD.Expedited patient-specific assessment of contact stress exposure in the ankle joint following definitive articular fracture reduction. J Biomech. 2015;48(12):3427-3432.
30.
KhandujaVBaeldeNDobbelaereA, et al. Patient-specific assessment of dysmorphism of the femoral head-neck junction: a statistical shape model approach. Int J Med Robot. 2016;12(4):765-772.
NakanoNAudenaertERanawatAKhandujaV.Review: current concepts in computer-assisted hip arthroscopy. Int J Med Robot. 2018;14(6):e1929.
35.
NgKCLamontagneMLabrosseMRBeaulePE.Hip joint stresses due to cam-type femoroacetabular impingement: a systematic review of finite element simulations. PLoS One. 2016;11(1):e0147813.
36.
NgKCGRouhiGLamontagneMBeaulePE. Finite element analysis examining the effects of cam FAI on hip joint mechanical loading using subject-specific geometries during standing and maximum squat. HSS J. 2012;8(3):206-212.
37.
NötzliHPWyssTFStoecklinCH, et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556-560.
38.
PalmerAJRGuptaVAFernquestS, et al. Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. BMJ. 2019;364:185.
39.
PhilipponMJSchenkerMLBriggsKK, et al. Revision hip arthroscopy. Am J Sports Med. 2007;35(11):1918-1921.
40.
ReurinkGJansenSPLBisselinkJM, et al. Reliability and validity of diagnosing acetabular labral lesions with magnetic resonance arthrography. J Bone Joint Surg Am. 2012;94(18):1643-1648.
41.
RolingMAVisserMIOeiEHG, et al. A quantitative non-invasive assessment of femoroacetabular impingement with CT-based dynamic simulation—cadaveric validation study. BMC Musculoskelet Disord. 2015;16:50.
42.
RothenfluhEZinggPDoraCSnedekerJGFavreP.Influence of resection geometry on fracture risk in the treatment of femoroacetabular impingement a finite element study. Am J Sports Med. 2012;40(9):2002-2008.
43.
RubinDA.Femoroacetabular impingement: fact, fiction, or fantasy?AJR Am J Roentgenol. 2013;201(3):526-534.
44.
Van HouckeJAudenaertEAAtkinsPRAndersonAE.A combined geometric morphometric and discrete element modeling approach for hip cartilage contact mechanics. Front Bioeng Biotechnol. 2020;8:318.
45.
Van HouckeJKhandujaVNakanoN, et al. Accuracy of navigated cam resection in femoroacetabular impingement: a randomised controlled trial. Int J Med Robot. 2017;13(4): e1839.
46.
VochtelooAJKrekelPRSandeMANagelsJ.Range of motion implications of proximal humerus fractures: a case study. Eur Orthop Traumatol. 2011;2(5-6):153-156.
47.
VolokhKYChaoEYArmandM.On foundations of discrete element analysis of contact in diarthrodial joints. Mol Cell Biomech. 2007;4(2):67-73.
