RESEARCH ARTICLE
Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head
Sebastian Serong,
Marcel Haversath,
Marcus Jäger,
Stefan Landgraeber,
Corresponding Author
Sebastian Serong
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
Correspondence
Sebastian Serong, Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany.
Email: [email protected]
Search for more papers by this authorMarcel Haversath
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Search for more papers by this authorMarcus Jäger
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Search for more papers by this authorStefan Landgraeber
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
Search for more papers by this authorSebastian Serong,
Marcel Haversath,
Marcus Jäger,
Stefan Landgraeber,
Corresponding Author
Sebastian Serong
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
Correspondence
Sebastian Serong, Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany.
Email: [email protected]
Search for more papers by this authorMarcel Haversath
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Search for more papers by this authorMarcus Jäger
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Search for more papers by this authorStefan Landgraeber
Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany
Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
Search for more papers by this authorAbstract
Osteonecrosis of the femoral head (ONFH) and CAM-type femoroacetabular impingement (FAI) present two different pathologies of the hip joint. The aim of this study is to describe the prevalence of CAM-FAI in a collective of ONFH hips and to evaluate its influence on ONFH therapy outcome. A cohort of 86 ONFH hips with a mean follow-up of 46.7 months (±20.5) after advanced core decompression (ACD) was evaluated regarding CAM deformity by measuring the alpha angle (α) and head–neck offset. The influence of CAM-type FAI was investigated using the Kaplan–Meier estimator and the Cox regression model. The mean α was 60.4° (±13.8) with 41 hips (47.7%) being ≥60°. The mean head–neck offset was 4.5 mm (±3.2), with 78 hips (90.7%) being ≤9 mm. Survival analysis indicated noticeably better ACD results for α < 60° versus α ≥ 60° (p = 0.07). Treatment failure within the first 2 years was statistically estimated as 27.7% for α < 60° versus 40.7% for α ≥ 60°: The hazard ratio for α ≥ 60° was 1.94. Head–neck offset-dependent survival showed better, though not significant, results for offset >9 mm (p = 0.38, hazard ratio 1.89 for offsets ≤9 mm). The prevalence of CAM-type deformity is greatly increased in patients with concomitant ONFH. There is a strong indication that CAM-type FAI has a negative influence on ONFH therapy outcome. The risk that ONFH treatment will fail seems to be twice as high for α ≥ 60° as for α < 60°. We recommend cotreatment of pathological head–neck offset in patients with ONFH.
CONFLICT OF INTEREST
The last author is a paid consultant at Wright Medical and Microport orthopaedics.
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