Femoroacetabular impingement impingement causes osteoarthritis of the hip by migration and micro-instability of the femoral head
Femoroacetabular impingement impingement causes osteoarthritis of the hip by migration and micro-instability of the femoral head
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DOI：
10.1016/j.mehy.2017.05.035
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发表时间：
2017-07-01
影响因子：
4.7
通讯作者：
Hogervorst, Tom
中科院分区：
文献类型：
--
作者：
Eijer, Henk;Hogervorst, Tom
股骨髋臼撞击是指股骨近端部分与髋臼边缘发生机械碰撞，导致相邻和对冲髋臼损伤的情况。越来越多的证据表明，至少对于凸轮撞击，而对于钳子撞击，与骨关节炎的发展有关。已经证明，撞击的手术可以改善功能并减少疼痛。直觉上，手术干预可以防止进一步的退化。然而，现有的文献迄今不能保证它。因此，撞击本身似乎并不是持续引起骨关节炎的充分原因。多年来，我们观察到一种现象，即在凸轮撞击患者中，股骨头在髋臼内向前和向上“迁移”。同样的，但不太恒定，可以观察到钳撞击，其中头部可能向后和内侧迁移。股骨头移位在文献中是已知的，被视为由髋关节骨关节炎引起或作为其一部分。我们认为移位是由撞击引起的，股骨头游走到撞击相关区域，并伴有软骨损伤。在凸轮撞击中，这可能是前外侧，在钳撞击中，这可能是后内侧。其效果必须是压缩力的巨大增加，特别是在凸轮冲击。移位甚至可能导致髋臼中股骨头的微不稳定，或成为微不稳定的迹象，这可能导致剪切力增加。因此，我们假设撞击可能通过移位和股骨头可能存在的微观不稳定性导致骨关节炎。检测和量化这些现象似乎是最重要的，并可能增加一个新的层面保守髋关节手术。(C)2017爱思唯尔有限公司版权所有
Femoroacetabular impingement is the condition whereby parts of the proximal femur mechanically collide with the acetabular rim leading to adjacent and contrecoup acetabular damage. Evidence is growing that at least for cam impingement, and perhaps less so for pincer impingement, there is a relation to the development of osteoarthritis.It has been demonstrated that surgery for impingement can improve function and decrease pain. Intuitively, it would then make sense that surgical intervention would prevent further degeneration. However, available literature to date cannot assure that it does. Therefore, the impingement itself seems not a sufficient cause to consistently cause osteoarthritis.For many years we have observed a phenomenon whereby the femoral head 'migrates' anteriorly and superiorly in the acetabulum in patients with cam impingement. The same, but less constant, can be observed in pincer impingement, where the head may migrate posteriorly and medially. Migration of the femoral head is known in the literature and seen as caused by, or as part of, osteoarthritis of the hip. We suggest that the migration is caused by the impingement, and that the femoral head wanders into the impingement-related area with cartilage damage. In cam impingement this may be anterolateral, in pincer impingement posteromedial. The effect must be a huge increase in compression forces, especially in cam impingement. The migration may even lead to, or be a sign of, micro-instability of the femoral head in the acetabulum, which may produce an increase in shear forces. We therefore hypothesise that impingement may lead to osteoarthritis by means of migration and the possible existence of micro-instability of the femoral head. Detecting and quantifying these phenomena seem of uttermost importance and may add a new dimension to conservative hip surgery. (C) 2017 Elsevier Ltd. All rights reserved.