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Femoroacetabular Impingement Negates the Acetabular Labral Seal During Pivoting Maneuvers but Not Gait

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function.

Questions/purposes

Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal?

Methods

Using 10 fresh cadaveric specimens (mean age 50 years, ± 8), we measured the capacity of the central compartment of the hip (the iliofemoral joint) to maintain a seal during fluid infusion, which may help elucidate the function of the labrum during weightbearing. Specimens with and without abnormal femoral morphology (six normal-appearing specimens and four whose geometry suggested cam-type FAI) were tested in postures observed during functional activities, including simulations of normal gait, stooping, and pivoting. Each specimen with FAI morphology exhibited secondary damage of the labrum and the adjacent chondral surface, whereas specimens of normal morphology were undamaged.

Results

Average peak central compartment pressure was reduced during pivoting for specimens with the presence of labral damage secondary to FAI. When placed in pivoting positions, hips with FAI maintained lower fluid pressures within the central compartment compared with intact specimens (15 ± 3 versus 42 ± 8 kPa, respectively; effect size: 1.08 [−0.36 to 2.31]; p = 0.007). No differences in peak pressure were observed between groups (FAI versus normal) for postures simulating either gait (21 ± 6 versus 22 ± 4 kPa; p = 0.902) or stooping (9 ± 2 versus 8 ± 3 kPa; p = 0.775) with the numbers available.

Conclusions

The acetabular seal, quantified by the maximum intraarticular pressure, was reduced during pivoting; however, the seal was maintained during simulated gait and stooping.

Clinical Relevance

Because degeneration is progressive with repetitive impingement, loss of the labral seal starts to be seen during pivoting and may progress from there, but in this small-sample cadaver study that evaluated specimens in middle adulthood, the seal remains intact during simulated gait and stooping. Our study suggests that labral damage secondary to cam-type FAI may reduce the ability of the labral to provide an adequate seal of the central compartment of the hip during loading; however, the extent to which this is affected requires further investigation.

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Acknowledgments

We acknowledge Mr Michael Hogen, Mr Stephen Wallace, and Mr Andrew Moorman for their assistance with data collection and specimen dissection; Mr Jerry Alexander for his assistance in acquiring specimens; and Mr Sabir Ismaily for his assistance with capturing the motion analysis data.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA

    Maureen K. Dwyer PhD, ATC & Joseph C. McCarthy MD

  2. Kaplan Joint Center, Newton-Wellesley Hospital, 2000 Washington Street, Green Building, Suite 361, Newton, MA, 02462, USA

    Maureen K. Dwyer PhD, ATC & Joseph C. McCarthy MD

  3. The Institute of Orthopedic Research and Education, Houston, TX, USA

    Hugh L. Jones BS & Philip C. Noble PhD

  4. St Anthony’s Hospital, Surrey, UK

    Richard E. Field PhD, FRCS (Orth), FRCS

  5. Baylor College of Medicine, Houston, TX, USA

    Philip C. Noble PhD

Authors
  1. Maureen K. Dwyer PhD, ATC
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  2. Hugh L. Jones BS
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  3. Richard E. Field PhD, FRCS (Orth), FRCS
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  4. Joseph C. McCarthy MD
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  5. Philip C. Noble PhD
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Corresponding author

Correspondence to Maureen K. Dwyer PhD, ATC.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Institute of Orthopedic Research and Education, Houston, TX, USA.

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Dwyer, M.K., Jones, H.L., Field, R.E. et al. Femoroacetabular Impingement Negates the Acetabular Labral Seal During Pivoting Maneuvers but Not Gait. Clin Orthop Relat Res 473, 602–607 (2015). https://doi.org/10.1007/s11999-014-3760-1

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  • DOI: https://doi.org/10.1007/s11999-014-3760-1

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