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Prediction of intra-articular pathology and arthroscopic outcomes for femoroacetabular impingement and labral tear based on the response to preoperative anaesthetic hip joint injections

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

This study investigated whether the preoperative response to intra-articular injections is associated with intra-articular pathological findings and arthroscopy outcomes.

Methods

This study included 49 patients who underwent arthroscopic hip surgery for femoroacetabular impingement and labral tear after receiving preoperative hip joint injections. The response to anaesthetic injections was categorized as poor (0–50%) or good (51–100%). With respect to anatomical indices, we evaluated the lateral centre–edge angle (LCEA), acetabular roof obliquity (ARO), vertical-centre-anterior angle (VCA), and the alpha angle (on a lateral view). We evaluated the association between these indices (including the types of hip labral tears and cartilage damage) and the effectiveness of intra-articular injections.

Results

The study included 22 men and 27 women, and the mean age of patients was 36.4 years. No statistically significant association was observed between the response to preoperative anaesthetic hip joint injections and patient demographics (age, sex) and anatomical indices (LCEA, ARO, VCA, and alpha angle) (p > 0.05). All patients showed labral damage; however, labral tear classification or cartilage damage was not significantly associated with the effectiveness of joint injections. At the 1-year post-operative follow-up, patients with a good response to anaesthetic hip joint injections showed a significantly better outcome than patients with a poor response to these injections (p < 0.01).

Conclusion

The response to preoperative anaesthetic hip joint injections may indicate the presence of intra-articular pathology. Furthermore, this association may have predictive value in determining post-operative outcomes following hip arthroscopy.

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References

  1. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br 91(1):16–23. https://doi.org/10.1302/0301-620X.91B1.21329

    Article  PubMed  CAS  Google Scholar 

  2. Woodward RM, Philippon MJ (2018) Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: a review of imaging findings. J Med Imaging Radiat Oncol. https://doi.org/10.1111/1754-9485.12822

    Article  PubMed  Google Scholar 

  3. Kester BS, Capogna B, Mahure SA, Ryan MK, Mollon B, Youm T (2018) Independent Risk factors for revision surgery or conversion to total hip arthroplasty after hip arthroscopy: a review of a large statewide database from 2011 to 2012. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 34(2):464–470. https://doi.org/10.1016/j.arthro.2017.08.297

    Article  Google Scholar 

  4. Krych AJ, Sousa PL, King AH, Engasser WM, Levy BA (2016) Intra-articular diagnostic injection exhibits poor predictive value for outcome after hip arthroscopy. Arthrosc J Arthrosc Rel Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 32(8):1592–1600. https://doi.org/10.1016/j.arthro.2016.02.005

    Article  Google Scholar 

  5. Odoom JE, Allen GM, Wilson DJ (1999) Response to local anaesthetic injection as a predictor of successful hip surgery. Clin Radiol 54(7):430–433

    Article  CAS  PubMed  Google Scholar 

  6. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteo-arthritis. Acta Chir Scand 83(Suppl 58):53–68

    Google Scholar 

  7. Massie WK, Howorth MB (1950) Congenital dislocation of the hip. Part I. Method of grading results. J Bone Joint Surg Am 32-A(3):519–531

    Article  CAS  PubMed  Google Scholar 

  8. Lequesne M (1961) False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies. Revue du rhumatisme et des maladies osteo-articulaires 28:643–652

    PubMed  CAS  Google Scholar 

  9. Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560

    Article  CAS  PubMed  Google Scholar 

  10. Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC (2005) Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res 441:327–333

    Article  PubMed  Google Scholar 

  11. Lage LA, Patel JV, Villar RN (1996) The acetabular labral tear: an arthroscopic classification. Arthrosc J Arthrosc Rel Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 12(3):269–272

    Article  CAS  Google Scholar 

  12. Kemp JL, Collins NJ, Makdissi M, Schache AG, Machotka Z, Crossley K (2012) Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. Br J Sports Med 46(9):632–643. https://doi.org/10.1136/bjsports-2011-090428

    Article  PubMed  Google Scholar 

  13. Tonnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81(12):1747–1770

    Article  CAS  PubMed  Google Scholar 

  14. Byrd JW, Jones KS (2004) Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 32(7):1668–1674. https://doi.org/10.1177/0363546504266480

    Article  PubMed  Google Scholar 

  15. Yoong P, Guirguis R, Darrah R, Wijeratna M, Porteous MJ (2012) Evaluation of ultrasound-guided diagnostic local anaesthetic hip joint injection for osteoarthritis. Skelet Radiol 41(8):981–985. https://doi.org/10.1007/s00256-011-1290-4

    Article  Google Scholar 

  16. Cunningham DJ, Paranjape CS, Harris JD, Nho SJ, Olson SA, Mather RC 3rd (2017) Advanced imaging adds little value in the diagnosis of femoroacetabular impingement syndrome. J Bone Joint Surg Am 99(24):e133. https://doi.org/10.2106/JBJS.16.00963

    Article  PubMed  Google Scholar 

  17. Martin RL, Irrgang JJ, Sekiya JK (2008) The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthrosc J Arthrosc Rel Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 24(9):1013–1018. https://doi.org/10.1016/j.arthro.2008.04.075

    Article  Google Scholar 

  18. Ladd LM, Keene JS, Del Rio AM, Rosas HG (2016) Correlation between hip arthroscopy outcomes and preoperative anesthetic hip joint injections, MR arthrogram imaging findings, and patient demographic characteristics. AJR Am J Roentgenol 207(5):1062–1069. https://doi.org/10.2214/AJR.16.16383

    Article  PubMed  Google Scholar 

  19. Tresch F, Dietrich TJ, Pfirrmann CWA, Sutter R (2017) Hip MRI: prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. J Magn Reson Imaging 46(2):440–451. https://doi.org/10.1002/jmri.25565

    Article  PubMed  Google Scholar 

  20. Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR (1992) Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J rheumatol 19(12):1943–1949

    PubMed  CAS  Google Scholar 

  21. Saied AM, Redant C, El-Batouty M, El-Lakkany MR, El-Adl WA, Anthonissen J, Verdonk R, Audenaert EA (2017) Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement: systematic review and meta-analysis. BMC Musculoskelet Disord 18(1):83. https://doi.org/10.1186/s12891-017-1443-2

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Sankar WN, Beaule PE, Clohisy JC, Kim YJ, Millis MB, Peters CL, Podeszwa DA, Schoenecker PL, Sierra RJ, Sink EL, Sucato DJ, Zaltz I (2015) Labral morphologic characteristics in patients with symptomatic acetabular dysplasia. Am J Sports Med 43(9):2152–2156. https://doi.org/10.1177/0363546515591262

    Article  PubMed  Google Scholar 

  23. Ross JR, Clohisy JC, Baca G, Sink E, Investigators A (2014) Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia. J Arthroplasty 29(9 Suppl):160–163. https://doi.org/10.1016/j.arth.2014.03.054

    Article  PubMed  Google Scholar 

  24. Nakano N, Yip G, Khanduja V (2017) Current concepts in the diagnosis and management of extra-articular hip impingement syndromes. Int Orthop 41(7):1321–1328. https://doi.org/10.1007/s00264-017-3431-4

    Article  PubMed  Google Scholar 

  25. Martin HD, Reddy M, Gomez-Hoyos J (2015) Deep gluteal syndrome. J Hip Preserv Surg 2(2):99–107. https://doi.org/10.1093/jhps/hnv029

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kaya M (2018) Impact of extra-articular pathologies on groin pain: an arthroscopic evaluation. PLoS ONE 13(1):e0191091. https://doi.org/10.1371/journal.pone.0191091

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Kaya M, Fujii M, Iwamoto Y, Nagahata I (2018) Extra-articular debridement of hip joint for management of anterior hip pain. Arthrosc Techn 7(6):e651–e655. https://doi.org/10.1016/j.eats.2018.02.012

    Article  Google Scholar 

  28. Lai WC, Arshi A, Wang D, Seeger LL, Motamedi K, Levine BD, Hame SL (2018) Efficacy of intraarticular corticosteroid hip injections for osteoarthritis and subsequent surgery. Skelet Radiol 47(12):1635–1640. https://doi.org/10.1007/s00256-018-3052-z

    Article  Google Scholar 

  29. Brander V, Skrepnik N, Petrella RJ, Jiang GL, Accomando B, Vardanyan A (2019) Evaluating the use of intra-articular injections as a treatment for painful hip osteoarthritis: a randomized, double-blind, multicenter, parallel-group study comparing a single 6-mL injection of hylan G-F 20 with saline. Osteoarthr Cartil 27(1):59–70. https://doi.org/10.1016/j.joca.2018.08.018

    Article  CAS  Google Scholar 

  30. Abhishek A, Doherty M (2013) Mechanisms of the placebo response in pain in osteoarthritis. Osteoarthr Cartil 21(9):1229–1235. https://doi.org/10.1016/j.joca.2013.04.018

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank Editage (www.editage.jp) for the English language review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Nobuaki Chinzei and Shingo Hashimoto have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Nobuaki Chinzei, Shingo Hashimoto, Shinya Hayashi, Koji Takayama, Tomoyuki Matsumoto & Ryosuke Kuroda

  2. Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan

    Nobuaki Chinzei

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  1. Nobuaki Chinzei
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  2. Shingo Hashimoto
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Correspondence to Shingo Hashimoto.

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Chinzei, N., Hashimoto, S., Hayashi, S. et al. Prediction of intra-articular pathology and arthroscopic outcomes for femoroacetabular impingement and labral tear based on the response to preoperative anaesthetic hip joint injections. Eur J Orthop Surg Traumatol 30, 737–742 (2020). https://doi.org/10.1007/s00590-020-02627-0

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  • DOI: https://doi.org/10.1007/s00590-020-02627-0

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