The Differences in Imaging Findings Between Painless and Painful Osteoarthritis of the Hip.

IF 1.9 Q2 ORTHOPEDICS Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders Pub Date : 2020-08-04 eCollection Date: 2020-01-01 DOI:10.1177/1179544120946747
Hiroaki Kijima, Shin Yamada, Natsuo Konishi, Hitoshi Kubota, Hiroshi Tazawa, Takayuki Tani, Norio Suzuki, Keiji Kamo, Yoshihiko Okudera, Masashi Fujii, Ken Sasaki, Tetsuya Kawano, Yosuke Iwamoto, Itsuki Nagahata, Takanori Miura, Naohisa Miyakoshi, Yoichi Shimada
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引用次数: 11

Abstract

Purpose: In osteoarthritis of the hip, the pain may be strong even if the deformity is mild, but the pain may be mild even if the deformity is severe. If the factors related to the pain can be identified on imaging, reducing such factors can alleviate the pain, and effective measures can be taken for cases where surgery cannot be performed. In addition, imaging findings related to the pain are also important information for determining the procedures and the timing of surgery. Thus, the purpose of this study was to identify the differences in features of osteoarthritis seen on imaging between painless and painful osteoarthritis of the hip.

Methods: The subjects were the patients with hip osteoarthritis who visited our department in 2015 and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI), a total of 29 patients (54 hip joints; mean age 63 years; 8 males and 21 females). The degree of osteoarthritis was determined using the Tönnis grade from the x-ray image. The cartilage morphology, intensity changes of bone marrow on MRI (subchondral bone marrow lesions [BMLs]), osteophytes, joint effusions, and paralabral cysts were scored based on the Hip Osteoarthritis MRI Scoring System (HOAMS). The cross-sectional area of the psoas major muscle at the level of the iliac crest was measured on CT, and the psoas index (PI; the cross-sectional area ratio of the psoas major muscle to the lumbar 4/5 intervertebral disc) was calculated to correct for the difference in physique. Then, the relationships between these and visual analog scale (VAS) scores of pains were evaluated.

Results: The average VAS was 55.4 ± 39 mm. The PI and all items of HOAMS correlated with the VAS. The average VAS of Tönnis grade 3 osteoarthritis was 75.8 ± 26 mm. When investigating only Tönnis grade 3 osteoarthritis, the differences between cases with less than average pain and those with above average pain were the BML score in the central-inferior femoral head (P = .0213), the osteophyte score of the inferomedial femoral head (P = .0325), and the PI (P = .0292).

Conclusion: Investigation of the differences between painless and painful osteoarthritis of the hip showed that the cases with more pain have BMLs of the femoral head on MRI that extend not only to the loading area, but also to the central-inferior area. Even with the same x-ray findings, the pain was stronger in patients with severe psoas atrophy. Thus, the instability due to muscle atrophy may also play a role in the pain of hip osteoarthritis.

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无痛性和疼痛性髋关节骨关节炎影像学表现的差异。
目的:髋关节骨关节炎,即使畸形轻微,疼痛也可能很强烈,但即使畸形严重,疼痛也可能很轻微。如果能在影像学上识别出与疼痛相关的因素,减少这些因素可以减轻疼痛,对于不能手术的病例,可以采取有效的措施。此外,与疼痛相关的影像学表现也是确定手术程序和手术时机的重要信息。因此,本研究的目的是确定髋关节无痛性骨关节炎和疼痛性骨关节炎在影像学上的特征差异。方法:研究对象为2015年来我科就诊并行x线、CT、MRI检查的髋关节骨性关节炎患者,共29例(54个髋关节;平均年龄63岁;男性8人,女性21人)。骨性关节炎的程度通过x线图像的Tönnis分级来确定。根据髋关节骨关节炎MRI评分系统(HOAMS)对软骨形态、MRI上骨髓强度变化(软骨下骨髓病变[BMLs])、骨赘、关节积液和肱旁囊肿进行评分。在CT上测量髂嵴水平腰肌横截面积,腰大肌指数(PI;计算腰大肌与腰椎间盘(4/5)的横截面积比,以纠正体格上的差异。然后,评估这些与视觉模拟评分(VAS)之间的关系。结果:VAS平均为55.4±39 mm。PI和HOAMS各项目均与VAS相关。Tönnis 3级骨关节炎VAS平均值为75.8±26 mm。当仅调查Tönnis 3级骨关节炎时,疼痛低于平均水平的患者与疼痛高于平均水平的患者之间的差异是股骨头中下段BML评分(P = 0.0213),股骨头内侧段骨癣评分(P = 0.0325)和PI (P = 0.0292)。结论:通过对无痛性和疼痛性髋关节骨性关节炎差异的研究发现,疼痛较多的患者MRI上股骨头的脑损伤不仅延伸到负荷区,而且延伸到中下区。即使x线检查结果相同,严重腰肌萎缩患者的疼痛也更强烈。因此,肌肉萎缩引起的不稳定也可能在髋关节骨关节炎的疼痛中起作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
14
审稿时长
8 weeks
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