Semin Musculoskelet Radiol 2020; 24(S 01): S1-S8
DOI: 10.1055/s-0040-1709557
Scientific Presentations and Posters
Georg Thieme Verlag KG Stuttgart · New York

Postoperative Traction MR Arthrography in Patients with Persisting Pain after Arthroscopic FAI Correction Reveals High Prevalence of Osseous Deformities and Intra-Articular Lesions

Florian Schmaranzer
1   Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
,
Till Lerch
2   Department of Orthopaedic Surgery, Inselspital, Bern, University of Bern, Bern, Switzerland
,
Klaus Siebenrock
2   Department of Orthopaedic Surgery, Inselspital, Bern, University of Bern, Bern, Switzerland
,
Ehrenfried Schmaranzer
3   Department of Radiology, BKH St. Johann in Tirol, St. Johann in Tirol, Austria
,
Moritz Tannast
2   Department of Orthopaedic Surgery, Inselspital, Bern, University of Bern, Bern, Switzerland
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Publikationsdatum:
25. März 2020 (online)

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Introduction Patient management after failed arthroscopic femoroacetabular impingement (FAI) surgery is challenging. We assessed the prevalence of new/residual osseous deformities, intra-articular lesions, and progression of osteoarthritis (OA) in symptomatic patients undergoing pre- and postoperative magnetic resonance (MR) imaging after hip arthroscopy.

Material and Methods We conducted a retrospective study approved by the institutional review board. Between 2010 and 2017, 17,806 patients underwent arthroscopic FAI correction. The database was reviewed for symptomatic patients with traction magnetic resonance arthrography (MRA) of the hip obtained before and after hip arthroscopy. A total of 49 patients was included (29 ± 10 years of age and 67% female). Traction was applied using a MR-compatible traction device. One reader assessed pre- and postoperative images for (1) acetabular coverage (lateral center edge < 25 degrees/> 39 degrees: dysplasia/pincer) and Tönnis OA grade on anteroposterior pelvic views; cam deformity (radial images α > 60 degrees); femoral torsion: low/high torsion: < 5 degrees/> 30 degrees; (2) residual tears and re-tears of the labrum and capsular adhesions/defects; and (3) OA progression on MRI.

Results Preoperatively, 42 (86%) hips showed deformities (some patients presented several different deformities; numbers do not add up): 2 (4%) dysplastic, 11 (22%) pincer, and 39 (80%) cam deformities. Postoperatively, 39 (80%) hips showed deformities: 9 (18%) dysplastic, 8 (16%) pincer, 20 (41%) cam deformity, 4 (8%) hips with torsion < 5 degrees, and 10 (20%) hips with torsion > 30 degrees. Postoperatively, 14 (29%) cases with residual and 12 (24%) cases with labrum re-tears were observed. Six (12%) hips had capsular adhesions; 22 (45%) had capsular defects. Radiographic OA progression was observed in 5 (10%) hips and in 14 (30%) hips on traction MRA.

Conclusion Prevalence of osseous deformities due to over- or undercorrection and intra-articular lesions is high after failed hip arthroscopy. Traction MRA was useful to detect OA progression.