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Early Arthritis & Hip Degeneration

There are multiple etiologies that can lead to end stage degenerative joint disease of the hip in young patients. Dysplasia, osteonecrosis, Perthes, post-traumatic deformity, and inflammatory arthropathies are among the common causes, however, there are a large number of young patients that appear to have a primary arthritic process.

Femoroacetabular impingement (FAI) has been proposed as a significant cause of this premature hip degeneration in the young patient. Advancements in the diagnosis and understanding of femoroacetabular impingement have led to the development of new treatment algorithms and modalities. This is clearly seen in the exponential increase of arthroscopic hip procedures that are performed in contemporary orthopaedics. However, the question still remains as to what is the cause, effect, and relationship of femoroacetabular impingement to early degeneration of the hip.

Clohisy et al recently reported that 33% of patients under the age of 50 that underwent a total hip arthroplasty had radiographic evidence of femoroacetabular impingement. The authors also found a 73% rate of arthroplasty or advancement in osteoarthritis grade in the contralateral hip with bilateral findings of FAI. These results suggest a distinct relationship between impingement and end stage hip degeneration. However, Laborie et al found a 35% rate of CAM deformities and a 34% rate of pincer lesions in males in a prospective study of asymptomatic volunteers. This calls into question the pathologic relationship by demonstrating a high rate of impingement findings in patients with no hip disease. Ganz et al has also repeatedly proposed that structural abnormalities associated with CAM and pincer impingement can lead to advanced arthrosis. Nonetheless, a direct relationship between FAI and end-stage hip degeneration has not been established and represents the crux of current hip research in the young patient.

The purpose of the current study was to compare the prevalence of femoroacetabular impingement findings between a patient population under the age of 50 and over the age of 50 that underwent total hip arthroplasty. More specifically, radiographic indices for FAI were calculated and compared for each study population. We hypothesized that femoroacetabular impingement would be significantly more common in a patient population that required hip arthroplasty under the age of 50 years than an older patient subset.

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