Determination of pathognomonic set of symptoms in clinical and magnetic resonance examination of intraarticular soft tissue damages in posttraumatic coxarthrosis
Keywords:posttraumatic coxarthrosis, intraarticular soft tissue injuries, pathognomonic signs, frequency analysis
Background. Currently, about 60 % of intraarticular injuries of the hip joint (HJ) itself are diagnosed incorrectly due to the absence of changes on the radiographs in the early (preradiological) stages. It is believed that the diagnosis of injuries and diseases, leading to the HJ dysfunction, is relatively simple. However, one can only agree with this in cases of pronounced morphological changes in the subchondral bone, when the process of destruction of the articular cartilage has reached a significant degree and changes in bone tissue compensate for the load of articular surfaces. The aim of the study was to determine pathognomonic signs (combination of clinical and magnetic resonance imaging (MRI) signs) characterizing intraarticular soft tissue injuries in post-traumatic coxarthrosis (PT CA). Materials and methods. Thirty patients with posttraumatic hip osteoarthritis stage I–II were examined. The purpose of the examination was to investigate the informativity and specificity of clinical and radiological research methods in comparison with arthroscopy in the diagnosis of intraarticular soft tissue injuries in patients with early stages of PT CA. To assess the prevalence of intraarticular lesions of soft tissue elements of HJ in patients with hip dysplasia (patients with initial stages of PT CA) and their combination, a frequency analysis was performed. Results. Pathognomonic set of symptoms (combination of clinical and MRI signs) characterizing intraarticular injuries of soft tissue elements of the hip at the initial stages of the post-traumatic CA. These include the combination of signs with pincer femoroacetabular impingement (FAI): FABER (Patrick) + Stinchfield test + degenerative changes (rupture) of the articular lip + bone changes in the femoral neck, impingement test + FABER (Patrick) + Stinchfield test + degenerative changes (rupture) of the articular lip. Pathognomonic symptoms have been identified (a combination of clinical and MRI signs) that characterize the intraarticular lesions of soft tissue elements of the hip joint in the initial stages of PT CA. They include a combination of signs with cam-FAI: impingement test + Stinchfield test (lifting straight leg with resistance overcoming) and degenerative changes (rupture) of the articular lip + alpha angle greater than 55°, impingement test + FABER (Patrick) + Stinchfield test + degenerative changes (rupture) of the articular lip, impingement test + Log roll test + degenerative changes (rupture) of the articular lip + alpha angle greater than 55°. When determining the isolated posttraumatic damage of the articular lip and free joints of the HJ cavity in PT CA, the most informative one is the combination of 2 signs (clinical + MRI): for isolated lip damage — Stinchfield test + MRI-sign of articular lip injury, for the presence of free joints — Stinchfield test + MRI-sign of the presence of free joints. Sets of symptoms were found in 100 % of cases. Conclusions. Determination of the aforementioned pathognomonic symptoms will help improve the diagnosis of intraarticular hip joint lesions in their early detection, with subsequent surgical intervention, and reduce the progression of hip osteoarthritis.
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