Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip.

OBJECTIVES: We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome. METHODS: Hip MRA performed at our institution (3/2012-1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed. RESULTS: N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen. CONCLUSIONS: GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.

Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases.

Aseptic loosening due to wear debris is the most frequent modality of failure in total hip arthroplasty. Bisphosphonates, a class of molecules which inhibit bone resorption showed an inhibitory effects on particles-induced osteolysis in vitro and in animal models. We report the clinical, radiographic and densitometric outcome of four postmenopausal women with total hip arthroplasty affected by peri-prosthetic osteolysis treated with neridronate due to their unwillingness to be operated. After neridronate treatment, there was general improvement in pain and function: VAS decrease 13 points (15%), the Harris Hip Score increase 9 points (15%). An average number of 3.3 x-ray per patients with an average follow-up of 23 months (range 12-34) were collected and evaluated. In all the patients except one, serial radiographs didn't show any progression of radioluciencies lines or periprosthetic osteolysis. Bone density was evaluated by Dual energy X-ray absorptiometry after an average follow-up of 21 months (range 6-46 mo): periprosthetic BMD around the whole stem and the cup increased respectively 2.4% and 7.1%. Treatment was well tolerated and no significant side effects were registered. This retrospective collection of a small group of patients suggest that bisphosphonates should be clinically useful in preventing periprosthetic wear debris mediated osteolysis and claim for dedicated clinical trials.

Femoro-acetabular impingement: can indirect MR arthrography be considered a valid method to detect endoarticular damage? A preliminary study.

To assess the effectiveness of indirect Magnetic Resonance arthrography (i-MRa) in the detection of chondral and labral lesions related to femoro-acetabular impingement (FAI) a series of 21 hip joints in 17 patients with a clinical diagnosis of FAI were examined either with standard MR imaging, i-MRa and direct-MR arthrography (d-MRa). Sensitivity and accuracy of i-MRa in detecting chondral, labral and tardive lesions were calculated and compared with standard MR. The agreement in detecting endoarticular damage between i-MRa and d-MRa and the interobserver agreement was assessed by K statistic (p<0.05). Finally the presence of trocanteric bursitis was evaluated. I-MRa showed higher values of both sensivity and accuracy than standard MR in detecting chondral damage, with an increase to 92% for the first item and 95% for the second. The same was noticed in labrum evaluation with an increase to 88% and 90% respectively. The level of agreement between i-MRa and d-MRa in detection of chondral lesions was excellent, substantial for the labral damage and absolute for early osteoarthritic changes. An excellent interobserver agreement resulted in detection of both chondral and labral damages with i-MRa. In 6 hips (28,5%) we also found the presence of peri-trochanteric soft tissue inflammation that indicated the possibility of extrarticular involvement in FAI. Indirect-MRa can be considered a valid method of assessing endoarticular damage related to FAI, in comparison to d-MRa. It should be performed instead of standard MR if d-MRa is not available.