Why are some patients with FAI morphology asymptomatic and never develop OA ( 21- 23)?Īccurately determining the amount of articular cartilage injury is important as it has a direct impact on the clinical decision-making between hip preservation surgery and total hip replacement ( 24).During disease progression, what is the exact discriminative point when cartilage damage becomes irreversible ( 20)?.What morphological factors, beside cam-type FAI and dysplasia contribute to hip OA ( 19)?.New biomechanical concepts were recognized such as the depiction of FAI as a major cause of secondary OA in non-dysplastic hips ( 14- 18).Ĭrucial questions still remain to be answered. Ganz developed a revolutionary technique that allowed for safe dislocation of the hip and direct visualization of the joint, which provided fundamental insights into the pathogenesis of early osteoarthritis (OA) ( 3, 13). The hip joint has gained particular attention in the last decade in parallel with significant advances in MSK imaging. In the mid-1990s MRA was the examination of choice for the evaluation of labral disruption, and remains the imaging gold-standard for patients with femoroacetabular impingement (FAI) ( 15). The development of MR arthrography (MRA) had a major impact on treatment decisions, particularly in the evaluation of cartilage and labral integrity ( 2). Thirty years ago, MRI examinations were technically difficult and resulted in low resolution images. MRI allows for a more comprehensive analysis of the articular cartilage, capsulolabral tissue, soft-tissue and osseous structures ( 14). Table 1 Timeline of major achievements in imaging and hip orthopedics Only with the establishment of multiplanar reconstructions based on 3D data sets was the use of CT in MSK imaging transformed ( 3), allowing for accurate and improved surgical planning ( Table 1). Initially, only low-quality axial two-dimensional images were available and examination times were even longer than current MRI acquisition times. The advent of computed tomography (CT), represented a transformation in clinical practice from XR to cross-sectional imaging. In the future, we will likely see all-in-one patient-centric examinations based on MRI, which can provide valuable information on joint morphology, biochemical function and dynamic “ in vivo” assessment.Ĭonventional radiography (XR) remains the cornerstone of hip imaging ( 2), and continues to have a role in screening, diagnosis and post-operative surveillance. However, MRI is still limited in its ability to provide static morphological diagnosis. Additionally, the development of state-of-the-art quantitative MRI techniques has allowed for the depiction of early stage cartilage lesions ( 1). With recent major developments of magnetic resonance imaging (MRI), attention has turned to the unique capability of defining bone morphology and soft tissue abnormalities. Advancements in orthopaedic surgery and arthroscopy have developed in unison with imaging techniques, which has led to improvements in clinical diagnosis, therapeutic interventions and patient prognostication. Musculoskeletal (MSK) imaging has undergone a major transformation over the past five decades. Received: 23 February 2018 Accepted: 20 April 2018 Published. Keywords: Hip imaging femoroacetabular impingement (FAI) magnetic resonance Finally, emerging trends that will shape the field of hip imaging in the years to come will be discussed. The current limitations as well as future directions of biochemical imaging will be outlined. The purpose of this article is to provide a historical perspective on the utility of various types of imaging techniques for the hip joint, including cutting-edge clinical applications and topics at the forefront of musculoskeletal research. Understanding the pathophysiology through the visualization of osseous structures and detailed depiction of soft tissue structures has become part of routine clinical imaging and has had a major impact on therapeutic decision-making. In just a few years, MRI findings that were in the past ascribed to degenerative change or normal variation must now be integrated in different entities, such as cam impingement or subspine impingement. Hip pathology in general and the concept of femoroacetabular impingement (FAI) has come to the forefront of imaging and orthopedics. Innovation has been the catalyst for the transformation of radiology, as the arrival of new imaging modalities and the introduction of magnetic resonance imaging, resulted in a paradigm shift from bone morphology analysis to integrated soft tissue, joint and cartilage assessment. Policy of Dealing with Allegations of Research MisconductĪbstract: The past fifty years have transformed diagnostic imaging of the hip joint.Policy of Screening for Plagiarism Process.
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