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      Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients

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          Abstract

          Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions—such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip—intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions.

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          Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip.

          Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement caused by excessive acetabular cover. We hypothesised that both mechanisms result in different patterns of articular damage. Of 302 analysed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Both cam and pincer impingement lead to osteoarthritis of the hip. Labral damage indicates ongoing impingement and rarely occurs alone.
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            The etiology of osteoarthritis of the hip: an integrated mechanical concept.

            The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present. Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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              The association of bone marrow lesions with pain in knee osteoarthritis.

              The cause of pain in osteoarthritis is unknown. Bone has pain fibers, and marrow lesions, which are thought to represent edema, have been noted in osteoarthritis. To determine whether bone marrow lesions on magnetic resonance imaging (MRI) are associated with pain in knee osteoarthritis. Cross-sectional observational study. Veterans Affairs Medical Center. 401 persons (mean age, 66.8 years) with knee osteoarthritis on radiography who were drawn from clinics in the Veterans Administration health care system and from the community. Of these persons, 351 had knee pain and 50 had no knee pain. Knee radiography and MRI of one knee were performed in all participants. Those with knee pain quantified the severity of their pain. On MRI, coronal T(2)-weighted fat-saturated images were used to score the size of bone marrow lesions, and each knee was characterized as having any lesion or any large lesion. The prevalence of lesions and large lesions in persons with and without knee pain was compared; in participants with knee pain, the presence of lesions was correlated with severity of pain. Bone marrow lesions were found in 272 of 351 (77.5%) persons with painful knees compared with 15 of 50 (30%) persons with no knee pain (P < 0.001). Large lesions were present almost exclusively in persons with knee pain (35.9% vs. 2%; P < 0.001). After adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. Among persons with knee pain, bone marrow lesions were not associated with pain severity. Bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.
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                Author and article information

                Contributors
                +33-381-668244 , +33-381-668495 , radio.aubry@free.fr
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1869-4101
                8 June 2010
                8 June 2010
                May 2010
                : 1
                : 2
                : 72-82
                Affiliations
                [1 ]Service de Radiologie A., CHU Jean Minjoz, Boulevard Flemming, 25000 Besançon Cedex, France
                [2 ]Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
                [3 ]Département d’Orthopédie, Hôpital Maisonneuve Rosemont, Montréal, QC Canada
                Article
                23
                10.1007/s13244-010-0023-x
                3259340
                22347907
                3ecfa07a-14c5-4323-8cd6-0cf01c0187dd
                © European Society of Radiology 2010
                History
                : 18 February 2010
                : 26 April 2010
                : 28 April 2010
                Categories
                Pictorial Review
                Custom metadata
                © European Society of Radiology 2010

                Radiology & Imaging
                magnetic resonance arthography,hip,mri
                Radiology & Imaging
                magnetic resonance arthography, hip, mri

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