gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Comparing dGEMRIC and clinical outcome 6 years after FAI surgery with versus without microfracturing: A prospective, controlled pilot study

Meeting Abstract

  • presenting/speaker Florian Schmaranzer - Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
  • Pascal Haefeli - Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
  • Markus Hanke - Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
  • Stefan Werlen - Sonnenhof, Abteilung für Radiologie, Bern, Switzerland
  • Klaus-Arno Siebenrock - Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
  • Moritz Tannast - Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und Traumatologie, Bern, Switzerland
  • Lorenz Büchler - Kantonsspital Biel, Department for Orthopedic Surgery, Biel, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN27-450

doi: 10.3205/17dkou061, urn:nbn:de:0183-17dkou0618

Veröffentlicht: 23. Oktober 2017

© 2017 Schmaranzer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Microfracturing is cost-effective and easy to perform in the setting of advanced cartilage degeneration due to femoroacetabular impingement with the goal to induce cartilage repair tissue. Currently only sparse literature is available on results after microfracturing of the hip. Furthermore it is unclear to which degree formation of cartilage repair tissue occurs in these patients. Delayed-gadolinium enhanced MRI of cartilage (dGEMRIC) is a novel, non-invasive, biochemical MRI technique that allows objective judgement of cartilage quality. Theoretically it enables cartilage monitoring based on the loss of cartilage glycosaminoglycan content, which ultimately leads to osteoarthritis. Currently the correlation between mid-term clinical outcome and dGEMRIC after FAI surgery is not established.

We aimed to compare:To compare (1) dGEMRIC indices, (2) clinical outcome in patients with a minimum 6-year follow up who had undergone FAI surgery with versus without microfracturing and (3) to correlate dGEMRIC with clinical outcome.

Methods: This prospective, controlled study was performed under IRB approval. The surgical hip database was reviewed for patients eligible for minimum 6-year follow up who underwent surgical hip dislocation with or without microfracturing for treatment of FAI and of extensive chondral flaps and defects. A total of 46 patients were identified, 17 in the 'microfracturing group' and 29 in the 'no microfracturing group". Groups were comparable for mean followup (mean 8 years; range 6-13 years) and age. All eligible patients underwent radiographs and dGMERIC at latest follow up. (1) dGEMRIC indices of acetabular cartilage were assessed on radially reformatted 3D T1 maps. Regions of interest were manually placed peripherally and centrally within the cartilage based on anatomical landmarks at the 12 'hour' positions of the clock-face. (2) Patient-reported outcome was evaluated at latest followup using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Harris Hip Score (HOOS). (3) Correlation between dGEMRIC and WOMAC and HOOS was performed using linear regression analysis. Unpaired Student's t-Tests and Man-Whitney U Tests were used (p<0.05).

Results and Conclusion:

1.
Overall and regional (superior, anterior and posterior) dGEMRIC indices did not signifantly (all > 0.05) differ between two groups.
2.
WOMAC (52 ± 65 versus 39 ± 46; p>0.05) and HHS (71 ± 27 versus 87 ± 12; p>0.05) did not differ between the 'microfracturing group' and 'no microfracturing group'.
3.
Overall and regional correlation between dGEMRIC indices and HHS was observed (up to R = 0.5; p = 0.001).

These results either indicate the absence of cartilage repair tissue formation after microfracturing or some degree of repair tissue formation following FAI correction without microfracturing.

Microfracturing did not improve clinical outcome hence future studies should compare microfracturing with more advanced cartilage repair techniques.