Background: Cam-type femoroacetabular impingement (FAI) is becoming more recognized. Cartilage lesions of the acetabulum and labral tears are frequently encountered. The goal of this study was to accurately describe and communicate these injuries and thus providing a standard for reporting injury, management, and outcome. Methods: We evaluated acetabular cartilage lesions and labral tears found during hip arthroscopy in 52 patients with radiological signs of cam-type FAI. They were graded according to the morphology and extent of the lesion. The labral tears were described according to the classification by Lage. Results: Eleven patients (21.2%) had normal cartilage, 14 (26.9%) had a grade 1, 17 (32.7%) a grade 2, 6 (11.5%) a grade 3, and 4 (7.7%) a grade 4 lesion. Labral tears were found in 31 patients (59.6%). There was a high correlation between age and the presence and extent of acetabular cartilage and labral lesions (r=0.70; p< 0.0001 and r=0.45; p< 0.001 respectively). There was also a high correlation between the extent of the acetabular cartilage lesion and the presence of labral lesions (r=0.62; p< 0.0001). Conclusion: In our study there was a high prevalence of associated injuries (86.5%) in cam-type FAI. Despite the recognized consequences of associated lesions on treatment and outcome, no classification system includes this aspect of FAI. Based on our findings, we developed a system to grade acetabular cartilage lesions according to their morphology and extent. This should provide the surgeon with a standardized tool to better describe the full extent of the injury and treat it accordingly

Osteonecrosis of the femoral head can be caused by a variety of disorders and affects the relatively young patient. Most studies have concentrated on the femoral changes; the sites of early lesions of the labrum and acetabular cartilage have not been recorded. We studied 17 hips with osteonecrosis and a wide congruent joint space on radiographs and by direct inspection of the femoral head, labrum and acetabular cartilage during surgery. All of the femoral heads had some anterosuperior flattening which reduced the head-neck ratio in this area. A consistent pattern of damage to the labrum and the acetabular cartilage was seen in all hips. Intraoperatively, impingement and the cam-effect with its spatial correlation with lesions of the labrum and acetabular cartilage were observed. These findings could be helpful when undertaking conservative surgery for osteonecrosis, since the recognition of early radiologically undetectable acetabular lesions may require modification of the surgical technique

Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement caused by excessive acetabular cover. We hypothesised that both mechanisms result in different patterns of articular damage. Of 302 analysed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Both cam and pincer impingement lead to osteoarthritis of the hip. Labral damage indicates ongoing impingement and rarely occurs alone

Introduction: In order to investigate the relationship between the degeneration of the acetabular cartilage and the radiological staging of osteonecrosis of the femoral head, the following study was performed. Materials and Methods: Acetabular cartilage with sub-chondral bone was taken from the superior dome from 34 hips from 30 patients undergoing total hip arthroplasty due to osteonecrosis of the femoral head. The specimens were stained with hematoxylineosin and safranin-O, and were evaluated as to the thinning of cartilage, fibrillation, clefts, and proliferation of chondrocytes. There were 18 females and 12 males with an average age of 49 years. We used the radiological staging system proposed by the working group of the Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labor and Welfare. There were eight hips in stage IIIA disease (collapse of the femoral head less than 3 mm), 19 hips in stage IIIB disease (collapse 3 mm or greater), and seven stage IV disease hips. Results: All 34 specimens showed histological abnormalities. In eight stage IIIA hips, six hips were mild and two were moderate histological degeneration. In 19 stage IIIB hips, five hips were mild, six were moderate, and eight had severe arthrosis. Seven stage IV hips had severe arthrosis. Discussion: Although the radiographs cannot demonstrate early degeneration of cartilage, degenerative changes were present in all stage III hips. Histological degenerative changes in stage IIIB hips were more severe than those in stage IIIA hips. These findings should be kept in mind in treating patients with osteonecrosis of the femoral head

Introduction. Some patients complain ingrown pain or discomfort after implanting Co-Cr conventional endprosthesis of the hip. Some of this complaint may be attributable for effect on cartilage metabolism. It have been reported that ceramic is bioinert for biological tissue. On the other hand, metal including cobalt-chrome (Co-Cr) have some detrimental effect on biological tissue. However, there is no report concerning acetabular cartilage metabolism after hip endprosthesis implantation. In the present study, we hypothesized that ceramic head have small detrimental effect on cartilage cell metabolism. Specific aim of the study is to compare the protein level of inflammation related cytokines, amount of hyaluronic acid (HA) in culture media, and cartilage mRNA expression in organ culture model of hip end prosthesis implanted using ceramic head and Co-Cr head. Materials and Methods. Six acetabulum of 3 matured crossbred pig (average weight: 36 +/− 3.6kg) was retrieved. Animal experiment was performed under the rules of ethical committee of animal experiment. Average diameter of pig acetabulum was 26.3 +/− 0.6 mm. Just after sacrifice, mechanical loading using Instron testing machine with 26mm diameter of Co-Cr in right hip and Ceramic heads in left hip was performed in culture media. Ten thousand cycles of cyclic compression and rotation load (1.5kN to 0.15kN of compression and 12 degrees of rotation) to cartilage was applied at 1Hz (Figure 1). Culture media was analyzed for protein levels of inflammation related cytokines and amount of HA. Relative quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) from acetabular cartilage was performed as previously reported using specific primer sets for type II collagen, aggrecan, TNF-alpha, Interleukine-1 and 6, and MMP-1, 3, 13. Results. IL-1 beta protein level from culture media was significantly higher in Co-Cr than that in Ceramic (155+/−25.2 pg/ml vs. 86.3+/−9.6 pg/ml respectively). MMP-3 protein level had tendency to be higher in culture media from Co-Cr than that from Ceramic (16.3+/−10.6 ng/ml vs. 10.0+/−0.1 ng/ml respectively, p<0.05), however there was no significant difference. There were no significant differences of protein levels from culture media in MMP-1, IL-1a, and TNF between two groups. Amount of HA from culture media of Co-Cr group was significantly higher than that from Ceramic group (337+/−38.4 mg/ml versus 257+/−11.1 mg/ml respectively, p<0.05). Type II collagen mRNA expression was 3 times higher in Ceramic group than that in Co-Cr group. IL-1 beta mRNA expression was 4 times higher in Co-Cr group than that in Ceramic group. Other gene expression had no significant differences. Discussion. The present study showed that Co-Cr affects cartilage metabolism than Ceramic. Co-Cr group had higher protein level and mRNA expression of inflammation related cytokine, IL-1 beta, and higher HA. Concerning the mRNA expression from cartilage, type II collagen was significantly higher in Ceramic group. It has been reported that HA level is high in osteoarthritic joint. These report and our results showed that ceramic head have small detrimental effect on cartilage cell metabolism. There are limitations of the present study. Firstly, the sample size is small. Secondly, we did not evaluate synovial membrane metabolism

Introduction. In recent years, there has been a significant advancement in our understanding of femoro-acetabular impingement and associated labral and chondral pathology. Surgeons worldwide have demonstrated the successful treatment of these lesions via arthroscopic and open techniques. The aim of this study is to validate a simple and reproducible classification system for acetabular chondral lesions. Methods. In our classification system, the acetabulum is first divided into 6 zones as described by Ilizalithurri VM et al [Arthroscopy 24(5) 534-539]. The cartilage is then graded as 0 to 4 as follows: Grade 0 – normal articular cartilage lesions; Grade 1 softening or wave sign; Grade 2 - cleavage lesion; Grade 3 - delamination and Grade 4 –exposed bone. The site of the lesion is further typed as A, B or C based on whether the lesion is 1/3 distance from acetabular rim to cotyloid fossa, 1/3 to 2/3 distance from acetabular rim to cotyloid fossa and > 2/3 distance from acetabular rim to cotyloid fossa. For validating the classification system, six surgeons reviewed 14 hip arthroscopy video clips. All surgeons were provided with written explanation of our classification system. Each surgeon then individually graded the cartilage lesion. A single observer then compared results for observer variability using kappa statistics. Results. We observed a high inter-observer reliability of the classification system with a kappa coefficient of 0.89 (range 0.78 to 0.91) and high intra-observer reliability with a kappa coefficient of 0.91 (range 0.89 to 0.96). In conclusion we have developed a simple reproducible classification system for acetabular cartilage lesions seen at hip arthroscopy

Introduction: In recent years, there has been a significant advancement in our understanding of femoro-acetabular impingement and associated labral and chondral pathology. Surgeons worldwide have demonstrated the successful treatment of these lesions via arthroscopic and open techniques. The aim of this study is to validate a simple and reproducible classification system for acetabular chondral lesions. Methods: In our classification system, the acetabulum is first divided into 6 zones as described by Ilizalithurri VM et al [Arthroscopy 24(5) 534–539]. The cartilage is then graded as 0 to 4 as follows: Grade 0 – normal articular cartilage lesions; Grade 1 softening or wave sign; Grade 2 – cleavage lesion; Grade 3 – delamination and Grade 4 -exposed bone. The site of the lesion is further typed as A, B or C based on whether the lesion is 1/3 distance from acetabular rim to cotyloid fossa, 1/3 to 2/3 distance from acetabular rim to cotyloid fossa and > 2/3 distance from acetabular rim to cotyloid fossa. For validating the classification system, six surgeons reviewed 14 hip arthroscopy video clips. All surgeons were provided with written explanation of our classification system. Each surgeon then individually graded the cartilage lesion. A single observer then compared results for observer variability using kappa statistics. Results: We observed a high inter-observer reliability of the classification system with a kappa coefficient of 0.89 (range 0.78 to 0.91) and high intra-observer reliability with a kappa coefficient of 0.91 (range 0.89 to 0.96). Discussion: In conclusion we have developed a simple reproducible classification system for acetabular cartilage lesions

Purpose: The treatment and prognosis of labral tears secondary to femoroacetabular impingement depends on the severity of the labral injury and whether or not there is concomitant injury and delamination of the adjacent articular cartilage. At present, there is no simple and reproducible technique to determine if there is delamination of the adjacent articular cartilage. We undertook a study to determine if the preoperative presence of a previously undescribed radiographic finding, a “delamination cyst”, correlated with delamination of the articular cartilage at the time of hip arthroscopy. Method: The preoperative radiographs of 125 consecutive hip arthroscopies in which a labral tear was identified intraoperatively were retrospectively reviewed.. In each case an anteroposterior (AP) pelvis and AP, lateral and frog lateral hip radiographs were evaluated for the presence of delamination cysts, perilabral cysts, abnormalities of the femur and acetabulum, as well as arthritic changes. A “delamination cyst” was defined as a subchondral cyst either directly adjacent to a perilabral cyst, or in relation to a subchondral crack in the anterolateral portion of the acetabulum. These findings were then compared and correlated to the intraoperative arthroscopic findings. Results: We identified 16 patients with delamination cysts on radiographs and 15 patients with delamination of the acetabulum on arthroscopy. A strong correlation was found between the preoperative radiographic presence of a delamination cyst and acetabular delamination at the time of arthroscopy – sensitivity of 93.3%, specificity of 98.8%, positive predictive value of 93% and a negative predictive value of 99% (p=0.034). No other radiographic findings were associated with the status of the articular cartilage. Conclusion: A “delamination cyst” is a previously undescribed and novel radiographic sign that can accurately predict preoperatively which patients with labral tears have associated acetabular cartilage delamination or chondral damage. Delamination cysts can be easily identified on plain radiographs without performing any special imaging or invasive infiltrations. Identifying these cysts preoperatively can aid the surgeon in selecting the appropriate surgical procedure and help predict the patient’s prognosis following the planned surgical procedure

We investigated differences in the location and mode of labral tears between dysplastic hips and hips with femoroacetabular impingement (FAI). We also investigated the relationship between labral tear and adjacent cartilage damage. We retrospectively studied 72 symptomatic hips (in 68 patients: 19 men and 49 women) with radiological evidence of dysplasia or FAI on high-resolution CT arthrography. The incidence and location of labral tears and modes of tear associated with the base of the labrum (Mode 1) or body of the labrum (Mode 2) were compared among FAI, mildly dysplastic and severely dysplastic hips. The locations predominantly involved with labral tears were different in FAI and mild dysplastic hips (anterior and anterosuperior zones) and in severely dysplastic hips (anterosuperior and superior zones) around the acetabulum. Significant differences were observed in the prevalence of Mode 1 versus Mode 2 tears in FAI hips (72% (n = 13) vs 28% (n = 5)) and severe dysplastic hips (25% (n = 2) vs 75% (n = 6)). The frequency of cartilage damage adjacent to Mode 1 tears was significantly higher (42% (n = 14)) than that adjacent to Mode 2 tears (14% (n = 3)). Hip pathology is significantly related to the locations and modes of labral tears. Mode 1 tears may be a risk factor for the development of adjacent acetabular cartilage damage. Cite this article: Bone Joint J 2013;95-B:1320–5

Femoroacetabular impingement recently was recognized as cause for osteoarthritis of the hip. There are two mechanism of impingement: (1) cam impingement caused by a non-spherical head, and (2) pincer impingement due to acetabular overcover. We hypothesized that both mechanism result in different articular damage patterns. Of 302 analyzed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused anterosuperior acetabular cartilage damage with a separation between labrum and cartilage. During flexion the cartilage is sheared off the bone by the non-spherical part of the femoral head. In pincer impingement the cartilage damage was located circumferentially, invovolving only a narrow strip along the acetabular rim. During motion the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification of the labrum. Cam and pincer impingement are two basic mechanism that lead to osteoarthrosis of the hip. The articular damage pattern differs substantially. Isolated cam or pincer impingement is rare, in most hips a combination is present. Labral damage indicates ongoing impingement and rarely occurs alone

Four patients with injuries of the acetabular triradiate cartilage are presented. In three of them premature fusion of the cartilage occurred; two of these developed acetabular deformity and subluxation of the hip. In all patients the sacroiliac joint also was injured; in two, the joint was completely disrupted, leading to fusion and growth disturbance of the ilium. As injury of the triradiate cartilage is easily missed on the initial radiograph, it is advised that all patients with pelvic trauma should be followed clinically and radiographically for at least one year

Aims. Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods. 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. Results. Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. Conclusion. The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning. Cite this article: Bone Joint Res 2021;10(10):639–649

Damage to and repair of the acetabular labral-chondral complex are areas of clinical interest in the treatment of young adults with pain in the hip and in the prevention of degenerative arthritis of the hip. There are varying theories as to why most acetabular tears are located anterosuperiorly. We have studied the prenatal development of the human acetabular labral-chondral complex in 11 fetal hips, aged from eight weeks of gestation to term. There were consistent differences between the anterior and posterior acetabular labral-chondral complex throughout all ages of gestation. The anterior labrum had a somewhat marginal attachment to the acetabular cartilage with an intra-articular projection. The posterior labrum was attached and continuous with the acetabular cartilage. Anteriorly, the labral-chondral transition zone was sharp and abrupt, but posteriorly it was gradual and interdigitated. The collagen fibres of the anterior labrum were arranged parallel to the labral-chondral junction, but at the posterior labrum they were aligned perpendicular to the junction. We believe that in the anterior labrum the marginal attachment and the orientation of the collagen fibres parallel to the labral-chondral junction may render it more prone to damage than the posterior labrum in which the collagen fibres are anchored in the acetabular cartilage. The anterior intra-articular projection of the labrum should not be considered to be a pathological feature

This study aims to describe the characteristics and outcomes of patients who reported their pre-operative quality of life (QoL) was ‘worse than death’ (‘WTD’) prior to hip arthroscopy (HA) or peri-acetabular osteotomy (PAO). Adult patients who underwent HA or PAO between 1. st. January 2012 and 31. st. October 2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) and EuroQol-5 Dimensions (EQ-5D) index questionnaires were collected pre-operatively and at 6 and 12 months. WTD was defined as an EQ-5D score of less than zero. Chi-squared and t-tests were used to compare categorical and continuous variables respectively. 8493 procedures (6355 HA, 746 PAO) were identified in whom 7101 (84%) returned pre-operative EQ-5D questionnaires. 283 HA and 52 PAOs declared their pre-operative QoL to be ‘WTD’. Compared to those patients with pre-operative QoL ‘better than death’ (n=6072, control group) (EQ-5D ≥ zero) patients reporting ‘WTD’ function prior to HA were more likely to be female (66% vs 59%, p = 0.013), of higher body mass index (mean 27.6 kg/m. 2. (SD 5.9) vs 25.7 kg/m. 2. (4.5), p < 0.0001) however there were no statistically significant differences in mean age (36.8 vs 36.4 years), femoroacetabular impingement pattern, or femoral or acetabular cartilage lesion severity. There were no significant demographic differences for PAO. For HA, iHOT-12 scores in WTD patients were significantly poorer pre- [10.8 (95% CI 9.6 to 12.0) vs 33.3 (32.8 to 33.8)] and 12 months post-operatively [34.9 (29.0 to 40.8) vs 59.3 (58.2 to 60.4)] compared to controls. Whilst the majority of patients saw improvement in their scores (p <0.0001), a significantly smaller proportion achieved the minimum clinically important difference for iHOT-12 by 12 months. (51% in the WTD group vs 65% in the control group). Similar trends were observed for PAO. Patients with WTD quality of life may benefit less from hip preservation surgery and should be counselled accordingly regarding expectations. Although the scores improve, only 51% achieve scores beyond MCID

Summary. The dGEMRIC index correlates more strongly with the pattern of radiographic joint space narrowing in hip osteoarthritis at five year follow-up than morphological measurements of the proximal femur. It therefore offers potential to refine predictive models of hip osteoarthritis progression. Introduction. Longitudinal general population studies have shown that femoroacetabular impingement increases the risk of developing hip osteoarthritis, however, morphological parameters have a low positive predictive value. Arthroscopic debridement of impingement lesions has been proposed as a potential strategy for the prevention of osteoarthritis, however, the development of such strategies requires the identification of individuals at high risk of disease progression. We investigated whether delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) predicts disease progression. This imaging modality is an indirect measure of cartilage glycosaminoglycan content. Patients and Methods. 34 asymptomatic individuals from a longitudinal cohort study (sibkids) were assessed at baseline with the collection of Patient Reported Outcome Measures (PROMs), anteroposterior and cross-table lateral radiographs, 3D morphological MRI, and dGEMRIC at 3T of their index hip. A dGEMRIC index was calculated as a ratio of the anterosuperior acetabular cartilage T1 relaxation time and the total femoral and acetabular cartilage T1 relaxation time. 29 individuals were followed up at 5 years for repeat assessment (average age 51 years and range 36 to 67). Radiological measurements were made by a single observer using in house Hipmorf software. Radiographic disease progression was assessed using minimum joint space width (JSW), lateral sourcil JSW, and medial sourcil JSW. These were measured on baseline and five year follow-up anteroposterior radiographs with an intra-observer ICC of 0.916. Alpha angle measurements were made by the same observer on radiographs and MRI radial slices with an intra-observer ICC of 0.926. Results. Mean minimum JSW for the cohort fell by 0.16mm over five years (p=0.024). Baseline dGEMRIC index did not correlate with change in minimum JSW (r=0.031 p=0.873). There was a moderate correlation between baseline dGEMRIC and the direction of JSW loss (change in JSW at the lateral sourcil minus change in JSW at the medial sourcil) (r=0.561 p=0.002). There was a weak correlation between the change in Non-Arthritic Hip Score and baseline dGEMRIC (r=0.256 P=0.180). Maximum alpha angle measured on baseline MRI radial slices did not correlate with change in minimum JSW and weakly correlated with the direction of JSW narrowing (r=0.273 p=0.160). Conclusion. A low dGEMRIC index indicates reduced glycosaminoglycan concentration in the anterosuperior acetabular cartilage compared with the total femoral and acetabular cartilage. This correlates with lateral JSW narrowing relative to medial JSW narrowing as osteoarthritis progresses. The dGEMRIC index correlates better with osteoarthritis progression than alpha angle measurements and offers the potential to refine a predictive model for osteoarthritis progression to aid patient selection for clinical trials

Introduction. Modification in joint loading, and specifically shear stress, is found to be an important mechanical factor in the development of osteoarthritis (OA). Cartilage shear stresses can be investigated using finite element (FE) modelling, where typically in vivo joint loading as measured by an instrumented hip prosthesis is used as boundary condition. However, subject-specific gait characteristics substantially affect joint loading. The goal of this study is to investigate the effect of subject-specific joint loading as calculated using a subject-specific musculoskeletal model and integrated motion capture data on acetabular shear stress. Methods. Three healthy control subjects walked at self-selected speed while measuring marker trajectories (Vicon, Oxford Metrics, UK) and force data (two AMTI force platforms; Watertown, MA). A subject-specific MRI-based musculoskeletal model consisting of 14 segments, 19 degrees of freedom and 88 musculotendon actuators, and including wrapping surfaces around the hip joint, was used. All analyses were performed in OpenSim 3.1. The model was scaled to the dimensions of each subject using the marker positions of a static pose. A kalman smoother procedure was used to calculate joint angles. Muscle forces were calculated using static optimization, minimizing the sum of squared muscle activations, and hip contact forces (HCF) were calculated and normalized to body weight (BW). To calculate shear stress, HCFs and joint angles calculated during the stance phase of gait were imposed to a hip finite element model (hip_n10rb) using FFEbio 2.5. In the model, femoral and acetabular cartilage were represented using the Mooney-Rivlin formulation (c1=6.817, bulk modulus=1358.86) and the pelvis and femur bones as rigid bodies. Peak HCF as well as maximal acetabular shear stress, magnitude and location, and the HCF at the time of maximal shear stress were compared between subjects. Results. Maximal shear stress was lower for S3 compared to S1 and S2 (9.14, 9.48 and 7.14 MPa for S1, S2 and S3 respectively). Nevertheless, HCF at the time instance of peak stress as well as peak HCF were highest for S3 (S1: 2.40/4.54 BW, S2: 2.97/4.78 BW and S3: 3.13/6.46 BW respectively). Maximal shear stress also occurred earlier in the stance phase for S3 compared to S1 and S2 (31, 26 and 11% of the stance phase for S1, S2 and S3 respectively). In addition, the location of the peak maximal shear stress was found to be more superior for S3. Discussion. Subject-specific loading patterns clearly influence the calculated maximal shear stress in the acetabular cartilage, affecting both the magnitude and the location of the stress. In addition, higher shear stresses are not coinciding with higher HCFs. This finding highlights the need of subject-specific rather than generic loading patterns when assessing cartilage shear stresses and associated risk in OA development in individual patients

Background. Femoroacetabular impingement due to a reduced femoral head-neck-offset or excessive acetabular coverage will lead to early cartilage lesions of the hip joint. The purpose of the present study was to analyze the relationship between the extent of bony deformity and the presence and extent of cartilage lesions in femoroacetabular impingement. Methods. On the radiographs of 92 hip joints in 86 patients with a mean age of 36.5 ± 9.2 years who were operated on for with femoroacetabular impingement by surgical hip dislocation, the acetabular index of the weight-bearing zone, the center-edge-angle, the inclination of the acetabulum, the lateral-head-extrusion-index, retroversion signs of the acetabulum, the neck-shaft-angle, asphericity, superior and anterior alpha angles, and superior and anterior offset and offset ratios were assessed and correlated to the presence and extent of chondromalazia. Results. Acetabular chondromalazia was found in 60 hip joints. Full-thickness delamination of the acetabular cartilage was present in 42 of these hips with an average size of 1.1 ± 0.5 cm2. Femoral-sided chondromalazia was found in 9 hip joints. Hip joints with chondromalazia had a lower center-edge-angle (p = 0.014) and anterior offset ratio (p = 0.028) and a higher lateral-head-extrusion-index (p = 0.029). Hip joints with acetabular cartilage delamination had a significantly lower center-edge-angle (p = 0.012) and anterior offset (p = 0.03) and a significantly higher lateral-head-extrusion-index (p = 0.001) and superior (p = 0.006) and anterior alpha angles (p = 0.003). Conclusions. Marked cam-type femoral deformity and lesser coverage of the femoral head are associated with the acetabular cartilage lesions, arousing suspicion to the assumption that a large lateral aperture of the acetabulum abets proximal femora with cam-type deformity to inflict cartilage damage in femoroacetabular impingement

Purpose: Treatment of Ficat III and IV femoral head necrosis is a serious challenge and a controversial issue due to the young age of the patients and disappointing results obtained with total hip arthroplasty (THA). We reviewed our experience with the cemented adjusted cup to identify factors leading to surgical revision and assess long-term clinical outcome. Material and methods: Sixty hips presenting necrotic heads were treated by cemented adjusted cups. Mean age of the patients was 33.6 years (range 18–51); 23% women and 77% men. The Ficat classification was: grade II 6%, grade III 85%, grade IV 9%. Mean necrotic Kerboull angle was 192°. In addition, the status of the acetabular cartilage was recorded at surgery: grade I normal 17%, grade II fissuration 30%, grade IIIA fibrillation without osteophytes 28%, grade IIIB fibrillation with osteophytes 10%, grade IV partial erosion reaching subchondral bone 10%. Results: At mean follow-up of 7.8 years (range 1 – 21 years), there were no cases of dislocation, femur neck fracture, or osteolysis. Mean UCLA score showed significant improvement in pain (from 4.5 to 8.1), walking (6.1 to 8.8), function (5.3 to 7.6), and activity (4.2 to 5.8). Five-, ten-, and fifteen-year survival rates were 81, 57, and 40% respectively. Fifteen hips required THA, twelve for acetabular cartilage wear, one for femoral loosening, and one for infection. A positive correlation (p = 0.005) was observed between the duration of signs preoperatively and degradation of the acetabular cartilage, suggesting a relationship also with shorter prosthesis survival. The Kerboull necrosis angle and Ficat grade were not correlated with prosthesis survival. Discussion: Survival of the adjusted cup is better when symptoms have been perceptible for less than one year, probably because the acetabular cartilage is less damaged. These results are better than those with other conservative solutions such as osteotomy or vascularised graft which do not reach 80% survival at five years and which provide less effective pain relief. If necessary, conversion to a THA can be performed without compromising clinical outcome

Aims. Several studies have reported the safety and efficacy of subcapital re-alignment for patients with slipped capital femoral epiphysis (SCFE) using surgical dislocation of the hip and an extended retinacular flap. Instability of the hip and dislocation as a consequence of this surgery has only recently gained attention. We discuss this problem with some illustrative cases. Materials and Methods. We explored the literature on the possible pathophysiological causes and surgical steps associated with the risk of post-operative instability and articular damage. In addition, we describe supplementary steps that could be used to avoid these problems. Results. The causes of instability may be divided into three main groups: the first includes causes directly related to SCFE (acetabular labral damage, severe abrasion of the acetabular cartilage, flattening of the acetabular roof and a bell-shaped deformity of the epiphysis); the second, causes not related to the SCFE (acetabular orientation and poor quality of the soft tissues); the third, causes directly related to the surgery (capsulotomy, division of the ligamentum teres, shortening of the femoral neck, pelvi-trochanteric impingement, previous proximal femoral osteotomy and post-operative positioning of the leg). Conclusion. We present examples drawn from our clinical practice, as well as possible ways of reducing the risks of these complications, and of correcting them if they happen. Cite this article: Bone Joint J 2017;99-B:16–21