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Unravelling the hip pistol grip/cam deformity: Origins to joint degeneration
Author(s) -
Beaulé Paul E.,
Grammatopoulos George,
Speirs Andrew,
Geoffrey Ng K. C.,
Carsen Sasha,
Frei Hanspeter,
Melkus Gerd,
Rakhra Kawan,
Lamontagne Mario
Publication year - 2018
Publication title -
journal of orthopaedic research®
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.24137
Subject(s) - femoroacetabular impingement , osteoarthritis , degeneration (medical) , medicine , knee joint , deformity , physical medicine and rehabilitation , physical therapy , pathology , surgery , alternative medicine
This article reviews a body of work performed by the investigators over 9 years that has addressed the significance of cam morphology in the development of hip osteoarthritis (OA). Early hip joint degeneration is a common clinical presentation and preexisting abnormal joint morphology is a risk factor for its development. Interrogating Hill's criteria, we tested whether cam‐type femoroacetabular impingement leads to hip OA. Strength of associatio n was identified between cam morphology, reduced range‐of‐movement, hip pain, and cartilage degeneration. By studying a pediatric population, we were able to characterize the temporality between cam morphology (occurring 1st) and joint degeneration. Using in silico (finite element) and in vivo (imaging biomarkers) studies, we demonstrated the biological plausibility of how a cam deformity can lead to joint degeneration. Furthermore, we were able to show a biological gradient between degree of cam deformity and extent of articular damage. However, not all patients develop joint degeneration and we were able to characterize which factors contribute to this ( specificity ). Lastly, we were able to show that by removing the cam morphology, one could positively influence the degenerative process ( experiment ). The findings of this body of work show consistency and coherence with the literature. Furthermore, they illustrate how cam morphology can lead to early joint degeneration analogous to SCFE, dysplasia, and joint mal‐reduction post‐injury. The findings of this study open new avenues on the association between cam morphology and OA including recommendations for the study, screening, follow‐up, and assessment (patient‐specific) of individuals with cam morphology in order to prevent early joint degeneration. Statement of significance: By satisfying Hill's criteria , one can deduct that in some individuals, cam morphology is a cause of OA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3125–3135, 2018.