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Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition.

ABSTRACT: Femoroacetabular impingement syndrome (FAIS) consists of abnormal hip joint morphology and pain during activities of daily living. Abnormal gait mechanics and potentially abnormal muscle forces within FAI patients leads to articular cartilage damage. Therefore, there is a necessity to understand the effects of FAI on hip joint muscle forces during gait and the link between muscle forces, patient reported outcomes (PRO) and articular cartilage health. The purposes of this study were to assess: (1) hip muscle forces between FAI patients and healthy controls and (2) the associations between hip muscle forces with PRO and cartilage composition (T1?/T2 mapping) within FAI patients. Musculoskeletal simulations were used to estimate peak muscle forces during the stance phase of gait in 24 FAI patients and 24 healthy controls. Compared to controls, FAI patients ambulated with lower vasti (30% body-weight, p?=?0.01) and higher sartorius (4.0% body-weight, p?

SUBMITTER: Samaan MA

PROVIDER: S-EPMC6428078 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition.

Samaan Michael A MA Zhang Alan L AL Popovic Tijana T Pedoia Valentina V Majumdar Sharmila S Souza Richard B RB

Journal of biomechanics 20181223

Femoroacetabular impingement syndrome (FAIS) consists of abnormal hip joint morphology and pain during activities of daily living. Abnormal gait mechanics and potentially abnormal muscle forces within FAI patients leads to articular cartilage damage. Therefore, there is a necessity to understand the effects of FAI on hip joint muscle forces during gait and the link between muscle forces, patient reported outcomes (PRO) and articular cartilage health. The purposes of this study were to assess: (1 ...[more]

PMID: 30600097

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Project description:Femoroacetabular impingement (FAI) has a strong clinical association with the development of hip osteoarthritis (OA); however, the pathobiological mechanisms underlying the transition from focal impingement to global joint degeneration remain poorly understood. The purpose of this study is to use whole-genome RNA sequencing to identify and subsequently validate differentially expressed genes (DEGs) in femoral head articular cartilage samples from patients with FAI and hip OA secondary to FAI. Thirty-seven patients were included in the study with whole-genome RNA sequencing performed on 10 gender-matched patients in the FAI and OA cohorts and the remaining specimens were used for validation analyses. We identified a total of 3531 DEGs between the FAI and OA cohorts with multiple targets for genes implicated in canonical OA pathways. Quantitative reverse transcription-polymerase chain reaction validation confirmed increased expression of FGF18 and WNT16 in the FAI samples, while there was increased expression of MMP13 and ADAMTS4 in the OA samples. Expression levels of FGF18 and WNT16 were also higher in FAI samples with mild cartilage damage compared to FAI samples with severe cartilage damage or OA cartilage. Our study further expands the knowledge regarding distinct genetic reprogramming in the cartilage between FAI and hip OA patients. We independently validated the results of the sequencing analysis and found increased expression of anabolic markers in patients with FAI and minimal histologic cartilage damage, suggesting that anabolic signaling may be increased in early FAI with a transition to catabolic and inflammatory gene expression as FAI progresses towards more severe hip OA. Clinical significance:Cam-type FAI has a strong clinical association with hip OA; however, the cellular pathophysiology of disease progression remains poorly understood. Several previous studies have demonstrated increased expression of inflammatory markers in FAI cartilage samples, suggesting the involvement of these inflammatory pathways in the disease progression. Our study further expands the knowledge regarding distinct genetic reprogramming in the cartilage between FAI and hip OA patients. In addition to differences in inflammatory gene expression, we also identified differential expression in multiple pathways involved in hip OA progression.

Project description:BackgroundAlthough the association between femoroacetabular impingement (FAI) syndrome and hip osteoarthritis (OA) is well established, not all hips exhibiting cam or pincer morphologies (i.e. imaging findings of FAI syndrome) are symptomatic or arthritic. It is difficult to detect which subgroup will wear out, or how does the arthritic process start radiographically. Therefore, we measured in a retrospective study based on computed tomography (CT) analysis, the joint space width (JSW) according to a standard protocol and we investigated its variation according to the presence of a cam and/or pincer morphology. We hypothesized that the radiological presence of a cam and/or pincer hip morphologies, even in asymptomatic subjects, would affect JSW.MethodsTwo hundred pelvic CT scans performed for non-orthopedic etiologies in asymptomatic patients were analyzed using a 3D software. After excluding patients with hip OA or previous hip surgery, 194 pelvic CT scans (388 hips) were retained. We measured for each hip the presence of FAI syndrome imaging findings (cam and pincer morphologies) using the classical parameters of coxometry. In addition, we performed a measurement of articular joint space width according to a standard protocol. We then calculated the mean thickness of 3 defined regions along the femoroacetabular joint: anterior-superior, posterior-inferior, and posterior-superior. Lastly, we compared the JSW across 4 groups: hips with (1) no cam or pincer, (2) pincer, (3) cam, and (4) cam and pincer morphologies using a multivariate analysis. Additionally, a topographic heatmap of JSW was plotted allowing quantitative representation of JSW along the joint.ResultsIncreased JSW with peak difference of 0.9 mm (25.7%) was found in hips with cam and pincer morphologies when compared to normal ones (p = 0.002) and to hips with pincer or cam morphologies only.ConclusionPositive variations in JSW were associated to the presence of cam and pincer morphologies. This significant increase in JSW could be one of the earliest measurable changes preceding later classical alterations.

Project description:BackgroundThe cam deformity causes the anterosuperior femoral head to obstruct with the acetabulum, resulting in femoroacetabular impingement (FAI) and elevated risks of early osteoarthritis. Several finite element models have simulated adverse loading conditions due to cam FAI, to better understand the relationship between mechanical stresses and cartilage degeneration. Our purpose was to conduct a systematic review and examine the previous finite element models and simulations that examined hip joint stresses due to cam FAI.MethodsThe systematic review was conducted to identify those finite element studies of cam-type FAI. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and studies that reported hip joint contact pressures or stresses were included in the quantitative synthesis.ResultsNine articles studied FAI morphologies using finite element methods and were included in the qualitative synthesis. Four articles specifically examined contact pressures and stresses due to cam FAI and were included in the quantitative synthesis. The studies demonstrated that cam FAI resulted in substantially elevated contact pressures (median = 10.4 MPa, range = 8.5-12.2 MPa) and von Mises stresses (median 15.5 MPa, range = 15.0-16.0 MPa) at the acetabular cartilage; and elevated maximum-shear stress on the bone (median = 15.2 MPa, range = 14.3-16.0 MPa), in comparison with control hips, during large amplitudes of hip motions. Many studies implemented or adapted idealized, ball-and-cup, parametric models to predict stresses, along with homogeneous bone material properties and in vivo instrumented prostheses loading data.ConclusionThe formulation of a robust subject-specific FE model, to delineate the pathomechanisms of FAI, remains an ongoing challenge. The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early joint degeneration.

Dataset Information

Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition.

Publications

Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition.

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