Abstract
Therapeutic hip arthroscopy for the treatment of chondral degeneration remains controversial. A retrospective cohort study examined 70 patients of mean age 47 (range 22–87) years who had undergone hip arthroscopy and assessed them for evidence of chondral degeneration using radiological and arthroscopic means. Clinical outcome was assessed using a modified Farjo and Glick classification. Thirty-nine patients had evidence of chondral degeneration on arthroscopy with or without radiological diagnosis, and 31 had alternative pathology. If patients were found to have chondral degeneration at arthroscopy, they were significantly more likely to have a poor clinical result than if an alternative diagnosis such as a loose body or labral tear was made (p<0.0001). Patients with evidence of degenerative changes on plain hip radiographs were significantly more likely to have a poor clinical result following hip arthroscopy than patients with unremarkable hip radiographs (p<0.0001). Therapeutic hip arthroscopy for osteoarthritis should be used with caution, as a poor clinical result is significantly more likely compared to other pathologies such as a labral tear or loose body.
Résumé
L’arthroscopie thérapeutique de la Hanche pour le traitement des chondropathies reste controversé. Une étude rétrospective d’une cohorte de 70 malades d’âge moyen 47 ans (22–87) qui avait subi arthroscopie de la hanche a été faite avec étude de la chondropathie à partir des données radiologiques et arthroscopiques. Le résultat clinique a été noté en utilisant une classification modifié de Farjo et Glick. Thirty-nine malades avaient une chondropathie arthroscopique, avec ou sans diagnostic radiologique, et 31 avaient une pathologie alternative. Si les malades avaient une chondropathie, ils avaient significativement un plus mauvais résultat clinique que s’ils avaient une autre pathologie, comme un corps étranger ou une déchirure du labrum (p<0.0001). Les patients avec des signes radiologiques dégénératifs avaient un plus mauvais résultat clinique que ceux avec une radiographie normale (p<0.0001). Les arthroscopies thérapeutiques pour arthrose devraient être utilisées avec prudence car le résultat cinique est moins bon que dans les autres pathologies comme les corps étrangers ou les déchirures du labrum.
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References
- 1.Baber YF, Robinson AH, Villar RN. Is diagnostic arthroscopy of the hip worthwhile? A prospective review of 328 adults investigated for hip pain. J Bone Joint Surg [Br] 1999;81:600–603. doi: 10.1302/0301-620X.81B4.8803. [DOI] [PubMed] [Google Scholar]
- 2.Brismar BH, Wredmark T, Movin T, Leandersson J, Svensson O. Observer reliability in the arthroscopic classification of osteoarthritis of the knee. J Bone Joint Surg [Br] 2002;84:42–47. doi: 10.1302/0301-620X.84B1.11660. [DOI] [PubMed] [Google Scholar]
- 3.Byrd JS, Jones KS. Osteoarthritis caused by an inverted acetabular labrum: radiographic diagnosis and arthroscopic treatment. Arthroscopy. 2002;18:741–747. doi: 10.1053/jars.2002.32837. [DOI] [PubMed] [Google Scholar]
- 4.Clohisy JC, Wright RW. Hip arthroscopy in the treatment of osteoarthritis. Oper Tech Sports Med. 2002;10:219–223. [Google Scholar]
- 5.Czerny C, Kramer J, Neuhold A, et al. Magnetic resonance imaging and magnetic resonance arthrography of the acetabular labrum: comparison with surgical findings. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb verfahr. 2001;173:702–707. doi: 10.1055/s-2001-16396. [DOI] [PubMed] [Google Scholar]
- 6.Dvorak M, Duncan CP, Day B. Arthroscopic anatomy of the hip. Arthroscopy. 1990;6:264–273. doi: 10.1016/0749-8063(90)90055-I. [DOI] [PubMed] [Google Scholar]
- 7.Edwards DJ, Lomas D, Villar RN. Diagnosis of the painful hip by magnetic resonance imaging and arthroscopy. J Bone Joint Surg [Br] 1995;77:374–376. [PubMed] [Google Scholar]
- 8.Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15:132–137. doi: 10.1053/ar.1999.v15.015013. [DOI] [PubMed] [Google Scholar]
- 9.Glick JM. Hip arthroscopy using the lateral approach. Instr Course Lect. 1988;37:223–231. [PubMed] [Google Scholar]
- 10.Holder J, Trudell D, Pathria MN, et al. Width of the articular cartilage of the hip: quantification by using fat-supression spin-echo MR imaging in cadavers. Am J Roentgenol. 1992;159:351–355. doi: 10.2214/ajr.159.2.1632354. [DOI] [PubMed] [Google Scholar]
- 11.Kallas KM, Guanche CA. Physical examination and imaging hip injuries. Oper Tech Sports Med. 2002;10:176–183. [Google Scholar]
- 12.Keene GS, Villar RN. Arthroscopic anatomy of the hip: an in vivo study. Arthroscopy. 1994;10:392–399. doi: 10.1016/s0749-8063(05)80189-6. [DOI] [PubMed] [Google Scholar]
- 13.Kelly BT, Williams RJ, III, Phillipon MJ. Hip arthroscopy: current indications, treatment options and management issues. Am J Sports Med. 2003;31:1020–1037. doi: 10.1177/03635465030310060701. [DOI] [PubMed] [Google Scholar]
- 14.McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The role of labral lesions in the development of early degenerative hip disease. Clin Orthop. 2001;393:25–37. doi: 10.1097/00003086-200112000-00004. [DOI] [PubMed] [Google Scholar]
- 15.O’leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy. 2001;17:181–188. doi: 10.1053/jars.2001.21481. [DOI] [PubMed] [Google Scholar]
- 16.Potter HG, Montgomery KD, Heise CW, Helfet DL. MR imaging of acetabular fractures: value in detecting femoral head injury, intraarticular fragments and sciatic nerve injury. Am J Roentgenol. 1994;163:881–886. doi: 10.2214/ajr.163.4.8092028. [DOI] [PubMed] [Google Scholar]
- 17.Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with the use of fast-spin-echo imaging. J Bone Joint Surg [Am] 1998;80:1276–1284. doi: 10.2106/00004623-199809000-00005. [DOI] [PubMed] [Google Scholar]
- 18.Scopp JM, Moorman CT., III The assessment of athletic hip injury. Clin Sports Med. 2001;20:647–659. doi: 10.1016/s0278-5919(05)70277-5. [DOI] [PubMed] [Google Scholar]