Indications for Total Hip Arthroplasty in Young Adults – Idiopathic Osteoarthritis Seems To Be Overestimated

Abstract

Purpose: New aspects like acetabular overcoverage, acetabular retroversion and proximal femoral head-neck dysplasia have been detected as a main cause of osteoarthritis. The study addresses the detection of reasons for osteoarthritis requiring THA in young adults. We wanted to prove the hypothesis that idiopathic reasons play an overestimated role in osteoarthritis in young patients.

Materials and Methods: 228 total hip arthroplasties in patients aged ≤ 60 years were performed at our institution. After the detection of the primary reasons for osteoarthritis of the hip, the radiographic pictures of all other patients were analyzed for radiographic signs of hip dysplasia or femoroacetabular impingement. For interobserver quality testing, this was done by two different observers.

Results: 132 patients were initially classified as having idiopathic osteoarthritis of the hip. There was no pathological radiographic finding in only 5 patients. 80 patients presented a reduced head-neck offset as a sign of CAM impingement with a mean head ratio of 1.52 ± 0.35 and an alpha angle of 62.8 ± 9.28°. 21 patients presented a figure-8 sign as an indicator for acetabular retroversion. 68 patients presented at least one radiographic finding for “dysplasia” and 60 patients at least one radiographic finding for excessive “overcoverage”. The Bland-Altman Plot for testing interobserver reliability demonstrated good interobserver agreement.

Conclusion: Idiopathic OA in young adults is rare if you look hard enough for the underlying pathology. If treated, patients might benefit and THA could be postponed for several years.

Abstract

Ziel: Eine übermäßige Überdachung, acetabuläre Retroversion und Störungen im Übergangsbereich von Hüftkopf zum Schenkelhals werden als eine wesentliche Ursache für eine Hüftarthrose gesehen. Diese Arbeit setzt sich mit der Erkennung von Ursachen einer frühen Arthrose des Hüftgelenks auseinander. Es soll die Hypothese untersucht werden, dass idiopathische Ursachen eine untergeordnete Rolle spielen.

Material und Methoden: 228 Hüftgelenkstotalendoprothesen wurden in Patienten implantiert, die zum Operationszeitpunkt jünger als 60 Jahre waren. Nachdem primäre Ursachen für eine Hüftgelenksarthrose ausgeschlossen wurden, wurden die radiologischen Bilder der restlichen Patienten auf Zeichen von Dysplasie und femoroacetabulärem Impingement untersucht. Um die Übereinstimmung zu bestimmen, wurde dies von zwei Auswertern vorgenommen.

Ergebnisse: Bei 132 Patienten wurde initial die Diagnose einer idiopathischen Arthrose des Hüftgelenks gestellt. Nur in 5 Fällen waren die radiologischen Bilder unauffällig. 80 Patienten hatten ein vermindertes Head-Neck Offset als Zeichen für ein CAM-Impingement mit einer durchschnittlichen Head-Ratio von 1,52 ± 0,35 und einem Alpha-Winkel von 62,8 ± 9,28°. 21 Patienten zeigten ein Figure-8-Sign als Hinweis für eine acetabuläre Retroversion. 68 Patienten hatten zumindest ein radiologisches Zeichen als Hinweis auf „Hüftdysplasie“ und 60 Patienten zeigten Zeichen für eine übermäßige Überdachung des Hüftkopfs. Mithilfe des Bland-Altman-Plots konnte eine gute Übereinstimmung zwischen den beiden Auswertern nachgewiesen werden.

Schlussfolgerung: Idiopathische Arthrose spielt in jungen Erwachsenen nur eine untergeordnete Rolle, wenn man genau auf die zugrunde liegende Pathologie achtet. Falls diese Patienten behandelt werden, könnte die Implantation einer Hüftgelenkstotalendoprothese um Jahre hinausgezögert werden.

Key words

femur - head/neck - radiography

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