Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK)
TL;DR: Individuals with both severe cam-type deformity and reduced internal rotation are strongly predisposed to fast progression to end-stage osteoarthritis.
Abstract: Objective To determine the association between cam impingement, which is hip incongruity by a non-spherical femoral head and development of osteoarthritis. Methods A nationwide prospective cohort study of 1002 early symptomatic osteoarthritis patients (CHECK), of which standardised anteroposterior pelvic radiographs were obtained at baseline and at 2 and 5 years follow-up. Asphericity of the femoral head was measured by the α angle. Clinically, decreased internal hip rotation (≤20°) is suggestive of cam impingement. The strength of association between those parameters at baseline and development of incident osteoarthritis (K&L grade 2) or end-stage osteoarthritis (K&L grades 3, 4, or total hip replacement) within 5 years was expressed in OR using generalised estimating equations. Results At baseline, 76% of the included hips had no radiographic signs of osteoarthritis and 24% doubtful osteoarthritis. Within 5 years, 2.76% developed end-stage osteoarthritis. A moderate (α angle >60°) and severe (α angle >83°) cam-type deformity resulted in adjusted OR of 3.67 (95% CI 1.68 to 8.01) and 9.66 (95% CI 4.72 to 19.78), respectively, for end-stage osteoarthritis. The combination of severe cam-type deformity and decreased internal rotation at baseline resulted in an even more pronounced adjusted OR, and in a positive predictive value of 52.6% for end-stage osteoarthritis. For incident osteoarthritis, only a moderate cam-type deformity was predictive OR=2.42 (95% CI 1.15 to 5.06). Conclusions Individuals with both severe cam-type deformity and reduced internal rotation are strongly predisposed to fast progression to end-stage osteoarthritis. As cam impingement might be a modifiable risk factor, early recognition of this condition is important.
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University of Warwick1, Coventry Health Care2, Erasmus University Rotterdam3, University of Michigan4, Washington University in St. Louis5, Qatar Airways6, University College Cork7, University of Melbourne8, Copenhagen University Hospital9, Baylor University Medical Center10, RMIT University11, Duke University12
TL;DR: The 2016 Warwick Agreement on femoroacetabular impingement syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome.
Abstract: The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016 , an open meeting held in the UK on 27–29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0–10. Substantial agreement (range 9.5–10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term ‘femoroacetabular impingement syndrome’ was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.
The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell’A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
644 citations
TL;DR: SMSC-140-Exos enhanced the proliferation and migration of ACs without damaging ECM secretion in vitro, while in vivo, SMSC- 140- exos successfully prevented OA in a rat model.
Abstract: OBJECTIVES: Osteoarthritis (OA) is the most common joint disease throughout the world. Exosomes derived from miR-140-5p-overexpressing synovial mesenchymal stem cells (SMSC-140s) may be effective in treating OA. We hypothesized that exosomes derived from SMSC-140 (SMSC-140-Exos) would enhance the proliferation and migration abilities of articular chondrocytes (ACs) without harming extracellular matrix (ECM) secretion.
METHODS: SMSCs were transfected with or without miR-140-5p. Exosomes derived from SMSCs or SMSC-140s (SMSC-Exos or SMSC-140-Exos) were isolated and identified. Proliferation, migration and ECM secretion were measured in vitro and compared between groups. The mechanism involving alternative Wnt signalling and activation of Yes-associated protein (YAP) was investigated using lentivirus, oligonucleotides or chemical drugs. The preventative effect of exosomes in vivo was measured using Safranin-O and Fast green staining and immunohistochemical staining.
RESULTS: Wnt5a and Wnt5b carried by exosomes activated YAP via the alternative Wnt signalling pathway and enhanced proliferation and migration of chondrocytes with the side-effect of significantly decreasing ECM secretion. Highly-expressed miR-140-5p blocked this side-effect via RalA. SMSC-140-Exos enhanced the proliferation and migration of ACs without damaging ECM secretion in vitro, while in vivo, SMSC-140-Exos successfully prevented OA in a rat model.
CONCLUSIONS: These findings highlight the promising potential of SMSC-140-Exos in preventing OA. We first found a potential source of exosomes and studied their merits and shortcomings. Based on our understanding of the molecular mechanism, we overcame the shortcomings by modifying the exosomes. Such exosomes derived from modified cells hold potential as future therapeutic strategies.
434 citations
Cites background from "Cam impingement causes osteoarthrit..."
...Anatomical factors are strongly associated with OA, such as hip dysplasia [4, 5], femoroacetabular impingement morphology [6, 7], varus (or valgus) knee alignment [8, 9], and leg length inequality [10]....
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TL;DR: Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome, and both led to a greater improvement than did personalising hip therapy.
373 citations
TL;DR: In youth soccer players, cam deformities gradually develop during skeletal maturation and are probably stable from the time of growth plate closure, which will have a major effect on the prevalence of hip osteoarthritis.
Abstract: Background:A cam deformity is a major risk factor for hip osteoarthritis, and its formation is thought to be influenced by high-impact sporting activities during growth.Purpose:To (1) prospectively study whether a cam deformity can evolve over time in adolescents and whether its formation only occurs during skeletal maturation and (2) examine whether clinical or radiographic features can predict the formation of a cam deformity.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:Preprofessional soccer players (N = 63; mean age, 14.43 years; range, 12-19 years) participated both at baseline and follow-up (mean follow-up, 2.4 ± 0.06 years). At both time points, standardized anteroposterior and frog-leg lateral radiographs were obtained. For each hip, the α angle was measured, and the anterosuperior head-neck junction was classified by a 3-point visual system as normal, flattened, or having a prominence. Differences between baseline and follow-up values for the α angle and the prevalence of e...
250 citations
Cites background from "Cam impingement causes osteoarthrit..."
...45 years that did not show an increase in the prevalence of cam deformities at a follow-up of 5 and 19 years, which favor the theory that a cam deformity is a growth-related acquired phenomenon.(2,25) The correlation coefficient between the amount of internal rotation and the a angle in the frog-leg view of the 30 hips with a closed growth plate at baseline (r = –0....
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...Keywords: adaptation; cause; football (soccer); hip; femoroacetabular impingement; osteoarthritis; pediatric sports medicine Osteoarthritis (OA) of the hip is a highly prevalent and disabling disease, especially among former athletes.6,35 The role of femoral morphological characteristics, in particular a cam deformity, has become increasingly recognized in the pathophysiology of OA.2-4,29,36 A cam deformity is a nonspherical extension of the femoral head anterosuperiorly that may lead to intra-articular damage by motion- dependent inclusion of the cam deformity into the acetabulum, known as cam impingement.11,29 It consistently shows an association with hip pain, limited internal rotation, labral tears, chondral lesions, and ultimately hip OA.2,8,10,25,37 The cause of a cam deformity is largely unknown, although several reports suggest that participating in high-impact sports during growth plays an important role.1,24,32 Two recent studies reported a markedly higher prevalence of cam deformities in asymptomatic adolescents participating in soccer and basketball, respectively, as compared with their nonathlete controls.1,32 These findings are supported by other studies that reported a high The American Journal of Sports Medicine, Vol. 42, No. 4 DOI: 10.1177/0363546514524364 2014 The Author(s) 798 prevalence of cam deformities in both symptomatic and asymptomatic athletic adults.12,16,17,27 It was shown in a cross-sectional study that a cam deformity is radiographically visible from the age of 13 years and may evolve over time.1 However, to the best of our knowledge, no prospective data are available on how a cam deformity evolves during skeletal maturation and whether it can evolve after skeletal maturation....
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...It consistently shows an association with hip pain, limited internal rotation, labral tears, chondral lesions, and ultimately hip OA.(2,8,10,25,37) The cause of a cam deformity is largely unknown, although several reports suggest that participating in high-impact sports during growth plays an important role....
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...A better understanding of the time frame in which a cam deformity develops may lead to the development of preventive measures, which might have a potential effect on the prevalence of OA....
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...A cam deformity has been recognized as a cause of hip pain and limited function in young adults and is a major risk factor for the development of hip OA.2,5,21,37 Recent studies reported a high prevalence of cam deformities in young adults participating in high-impact sporting activities.1,12,17,27,32 This is the first prospective study on the development of a cam deformity in which we showed that a cam deformity is gradually acquired and probably only during skeletal maturation....
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TL;DR: The current understanding of FAI is discussed, focusing on cam abnormalities and their association with OA, and preventative treatments aiming to reduce the incidence ofcam abnormalities and subsequent OA could be developed.
Abstract: Femoroacetabular impingement (FAI) is characterized by abnormal contact between the proximal femur and the acetabulum. Two subtypes have been described: pincer impingement, caused by an overcovered acetabulum; and cam impingement, which occurs as a result of an aspherical femoral head (cam abnormality). A strong correlation exists between cam impingement and the subsequent development of hip osteoarthritis (OA). Major cam abnormalities confer a high risk of OA. However, the association between cam abnormalities and the pathology of OA has been difficult to compare between studies, as different methods have been used to define the abnormality. Cam abnormalities are acquired during skeletal growth and could be influenced by high impact sporting activities. Preventative treatments aiming to reduce the incidence of cam abnormalities and subsequent OA could, therefore, be developed. In this Perspective, we discuss the current understanding of FAI, focusing on cam abnormalities and their association with OA.
157 citations
References
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TL;DR: It was concluded that, to ensure maximum uniformity in grading x rays in field surveys and therapeutic trials, all readings should be made by the same observer, preferably at a single session.
Abstract: In a previous study (Kellgren and Bier, 1956), three sets of x rays of the hands were used to assess interand intra-observer differences in interpreting changes of rheumatoid arthritis. Wide disagreement between observers was found, and it was concluded that, to ensure maximum uniformity in grading x rays in field surveys and therapeutic trials, all readings should be made by the same observer, preferably at a single session. The advisability of having a set of standard reference films was also considered.
10,028 citations
"Cam impingement causes osteoarthrit..." refers methods in this paper
...19 At baseline, and at 2 and 5 years follow-up, all anteroposterior pelvic radiographs were scored for osteoarthritis according to the K&L classification (grade 0–4).(20) In addition, superior and inferior joint space was determined on faux profil radiographs (grade 0–3)....
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Journal Article•
TL;DR: WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials and fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency.
Abstract: Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
7,147 citations
"Cam impingement causes osteoarthrit..." refers methods in this paper
...Furthermore, the presence and severity of hip pain were assessed using validated self-report questionnaires, including the Western Ontario and McMaster University osteoarthritis index (WOMAC, pain subscale) and the visual analogue scale.(22) 23...
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TL;DR: The burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain, which affects nearly everyone at some point in time and about 4-33% of the population at any given point is described.
Abstract: Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.
3,361 citations
TL;DR: It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.
Abstract: A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.
3,075 citations
University of Miami1, University of Alabama at Birmingham2, Stanford University3, George Washington University4, Indiana University5, Rush University Medical Center6, Queen's University7, SUNY Downstate Medical Center8, North Shore-LIJ Health System9, Johns Hopkins University10, University of Michigan11, The Queen's Medical Center12, University of Pittsburgh13, Washington University in St. Louis14, Northeast Ohio Medical University15, University of Kansas16
TL;DR: Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis of the hands were developed from data collected in a multicenter study and required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand.
Abstract: Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.
2,447 citations