Repetitive high-impact physical activity (such as football) might increase the risk for hip osteoarthritis (OA). Once established, the radiological joint changes seen in OA are irreversible. Identifying early disease may be important, as this may represent a point in time where interventions aimed at slowing disease progression could be effective.
Little is known about hip OA features on MRI in younger people participating in high-impact physical activity who are free from radiographic OA, and who have or do not have hip and/or groin pain. Evaluating early OA features in younger active symptomatic individuals may aid in the understanding of early hip joint degeneration and assist in establishing the relationship between specific OA features and symptoms.
This study aimed to compare early hip OA features on MRI between people with and without hip and/or groin pain participating in high-impact physical activity (i.e., soccer or Australian football (AF)), to compare early hip OA features separately in men and women; and to evaluate the relationship between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS) symptom and pain subscales.
This case-control study used baseline data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). The FORCe study is an ongoing prospective study investigating changes to hip joint structures in symptomatic men and women participating in high-impact physical activity (soccer or AF).
A sample of 55 pain-free men and women without definite radiographic hip OA participating in high-impact physical activity were recruited to match the mean age (26 years) and sex distribution (25% women) of the 182symptomatic participants of the FORCe study (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and serve as a control group. Symptomatic and control participants were participating in the same league/competition level.
Each participant underwent a supine anteroposterior (AP) pelvis radiograph using a standardised protocol. Features of radiographic hip OA were evaluated using Kellgren and Lawrence (KL) classification (grade 0-4), with hip OA defined as a KL grade of 2 or greater.
Participants underwent unenhanced 3.0 T MRI scans that were evaluated by musculoskeletal radiologist, who was blinded to radiographic and clinical findings. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method was used to quantify and grade the severity of OA features. The SHOMRI scores (range 0-96) were calculated for each limb by evaluating and adding the scores for each of the eight OA features: articular cartilage (graded 0-2), bone marrow edema pattern (BMEP) (graded 0-3), subchondral cysts (graded 0-2), labrum (graded 0e5), paralabral cysts (present or absent), intraarticular bodies (present or absent), effusion-synovitis (present orabsent) and ligamentum teres (graded 0-3). The higher scores indicate more severe whole joint degenerative change.
Each participant completed the iHOT33 and the HAGOS, which are recommended patient reported outcomemeasures in young to middle-aged people with hip and/or groin conditions.
The prevalence of KL grade one was low in both symptomatic (4%) and control (5%) participants. Symptomatic participants had a median symptom duration of 24 months.
Higher total SHOMRI scores were observed in symptomatic hips than in control hips [mean difference (MD) =1.4 (95% CI: 0.7, 2.2)]. When stratified by sex, a similar finding was observed in men, with symptomatic hips having higher total SHOMRI scores [MD = 1.8 (95% CI: 1.0, 2.7)]. In contrast, symptomatic hips had similar total SHOMRI scores to control hips in women [MD = 0.1 (95% CI: -1.0, 1.2)].
For men, higher cartilage scores were found in symptomatic hips relative to control hips [adjusted incidence rate ratio (aIRR) = 1.60 (95% CI: 1.15, 2.22)]. In women, differences in cartilage score between symptom groups were inconclusive.
In all football players, labral scores were higher in symptomatic hips than in control hips [aIRR = 1.33 (95% CI: 1.08,1.64)]. A similar finding was observed in men, with higher labral scores in symptomatic hips whencompared to control hips [aIRR = 1.38 (95% CI: 1.08, 1.76)]. In women, results for differences in labral score between symptomatic and control hips were inconclusive.
In all football players, symptomatic hips had a lower prevalence of effusion-synovitis relative to control hips [aOR = 0.46 (95% CI: 0.26, 0.81)]. In men, a lower prevalence of effusion-synovits was also observed in symptomatic hips than in control hips [aOR = 0.49 (95% CI: 0.25, 0.96)]. For women, results for differences in effusion-synovitis prevalence between symptom groups were inconclusive.
The total SHOMRI and individual OA features scores were not associated with iHOT33 or HAGOS symptoms and pain subscale scores in all football players, or in men or women separately.
The authors concluded that football players frequently exhibited MRI-defined early hip OA features. The high prevalence of early hip OA features, irrespective of symptomatic status, suggests a complex and poorly understood relationship between pain and most OA features. Football players with longstanding hip and/or groin pain exhibited higher total SHOMRI, labral and cartilage scores. There was no relationship between OA feature scores (including total SHOMRI) and the iHOT33 or HAGOS.
Heerey JJ et al. (2021) Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthritis and Cartilage 29, 323–334.
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