Ganokroj P, MD1, Liangcharoensit K, MD2
Affiliation : , Lertwanich P, MD1
1 Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Department of Orthopaedic Surgery, Bangbo Hospital, Samutprakarn, Thailand
Background : Total hip replacement (THR) is a common procedure that can relieve the pain and improve the functions of patients
with advanced osteoarthritis (OA) of the hip. Femoroacetabular impingement (FAI), with either a cam or pincer morphology,
produces chondral or labral damage that can develop into hip OA. This condition, which is commonly unrecognized, can be identified
in some patients undergoing a THR.
Objective : The present study aimed to determine the radiographic prevalence of cam morphology and the causes of THR during a
15-year period.
Materials and Methods : The authors retrospectively reviewed the medical records of all THR cases at a tertiary hospital in Thailand
between 2002 and 2017 to identify the causes of the THRs. For patients with primary hip OA, pre-operative radiographs were
reviewed by two orthopedic surgeons to detect cam and pincer morphologies. The patients were subsequently classified into three
groups: “abnormal morphology”, “no abnormal morphology”, and “indeterminate morphology”. The descriptive statistics for this
study were summarized.
Results : Of the 1,250 patients (providing 1,475 hips that underwent THR) in the study, 856 (68%) were female. The mean age of the
study cohort was 54.4+15.1 years. Idiopathic avascular necrosis (AVN) was the most common etiology (390 cases; 27%). The
most common disease among the very young age patients (<30 years) was AVN due to drugs (40 cases; 35%). Of the 167 patients
with primary hip OA, 37 hips (22%) had abnormal morphology (34 hips with cam morphology, 4 hips with pincer morphology, and
one patient with both morphologies).
Conclusion : Idiopathic AVN was the most common cause of the THRs. Cam morphology was found in at least one-fifth of the cases
with advanced primary hip OA.
Keywords : Cam morphology, Femoroacetabular impingement, Total hip replacement, Radiographic prevalence, Osteoarthritis
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