The Journal of Bone and Joint Surgery (American). 2009;91:1120-1129.
doi:10.2106/JBJS.G.00144
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Radiographic and Patient Factors Associated with Pre-Radiographic Osteoarthritis in Hip Dysplasia

Rebecca H. Jessel, BA1, David Zurakowski, PhD1, Christoph Zilkens, MD1, Deborah Burstein, PhD2, Martha L. Gray, PhD3 and Young-Jo Kim, MD, PhD1

1 Department of Orthopaedic Surgery, Children's Hospital Boston, Hunnewell 225, 300 Longwood Avenue, Boston, MA 02115. E-mail address for Y.-J. Kim: young-jo.kim{at}childrens.harvard.edu
2 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
3 Harvard-MIT Division of Health Sciences and Technology, MIT E25-519, 77 Massachusetts Avenue, Cambridge, MA 02139

Investigation performed at Children's Hospital, Boston, Massachusetts

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Orthopaedic Research and Education Foundation (OREF). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. The purpose of this study was to investigate the anatomic and demographic factors associated with the early onset of osteoarthritis in dysplastic hips by utilizing the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index as a marker of the disease.

Methods: Ninety-six symptomatic dysplastic hips in seventy-four patients were assessed with standard radiographs and a dGEMRIC scan. The lateral center-edge angle of Wiberg, the acetabular index of Tönnis, and the break in the Shenton line were measured on a standing anteroposterior radiograph. Anterior undercoverage was assessed by measuring the anterior center-edge angle on a Lequesne false-profile view. A labral tear was considered to be present when contrast agent was seen through the entire thickness of the labrum on magnetic resonance arthrography. Osteoarthritis was defined as a dGEMRIC value of <390 msec (two standard deviations below the dGEMRIC index in normal hips).

Results: The mean dGEMRIC index (and standard deviation) for this cohort (473 ± 104 msec) was significantly lower than that of a morphologically normal hip (570 ± 90 msec). The anterior center-edge angle, the joint space width, and the presence of a labral tear were all found to be associated with osteoarthritis in the univariate analysis. Multivariate analysis identified age, the anterior center-edge angle, and the presence of a labral tear as independent factors associated with osteoarthritis. A second model was fitted with omission of the anterior center-edge angle because the lateral and anterior center-edge angles were highly correlated and the lateral center-edge angle is a more common clinical measure. This model identified age, the lateral center-edge angle, and the presence of a labral tear as significant independent factors associated with osteoarthritis.

Conclusions: As has been demonstrated in previous studies of the hip, this investigation showed osteoarthritis to be associated with increasing age and the severity of dysplasia, as demonstrated both by the Wiberg lateral center-edge angle and the Lequesne anterior center-edge angle. Additionally, we identified a labral tear as being a risk factor for osteoarthritis.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.


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