Osteoarthritis edema hip

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Osteoarthritis is one of the most common disorders affecting joints. The joints most affected include the spine, hip, knee, shoulder, the great toe and the base of the thumb.

Degeneration of articular cartilage leading to osteoarthritis, can occur without predisposing factors or can be secondary to another condition, including trauma or sustained repetitive motion. Articular cartilage degeneration is a gradual process.

The diagnosis is reached through history and physical examination. X-rays can confirm the presence of relatively advanced OA. Magnetic resonance imaging (MRI) is needed to assess the presence of early disease.

MRI is very sensitive to bony and soft tissue changes. MRI can also demonstrate reactive bone edema or soft tissue swelling as well as small cartilage or bone fragments in the joint.Some centers use a specific cartilage pulse sequence to identify early evidence of cartilage damage.

In this abstract presented at a radiology meeting from Taljanovic, M.S. and colleagues from the University of Arizona, we see the value of MRI...

Musculoskeletal (Marrow Imaging)

Bone Marrow Edema in Hip Osteoarthritis: Quantitative Assessment with Magnetic Resonance Imaging and Correlation with Clinical Exam, Radiographic Findings, and Histopathology

To find correlation between the amounts of bone marrow edema calculated utilizing magnetic resonance imaging (MRI), clinical findings (pain, movement, and walking), histopathology, and radiographic findings, in patients with hip osteoarthritis.

Coronal MRI of the hips was acquired in 19 patients who underwent prosthetic hip replacement. A spin echo sequence with four echoes (TE= 25, 50, 75 and 100ms) was used. Image intensities were fit to the exponential decay curve I= I0exp (-TE/T2) to extract T2 values at each pixel. Separate T1-weigted SE images (TR 2000 ms, TE 16 ms) of fat (F) and water (W) were acquired with water and fat saturation, respectively. The ratio, W/(W+F) was calculated from two images’ signal intensities, on a per pixel basis. Calculations were made for the regions of interest. The calculated MRI values were correlated with the clinical, radiographic, and various histopathology findings.

Analyses of Variance (ANOVA) were done on the MRI data, for the W/(W + F) and for the T2 values (total and focal values for the symptomatic hip - study group and contralateral hip - control group). For both MRI data sets the values were significantly higher in the study group. Statistically significant correlation was found between pain and total W/(W + F) and pain and focal T2 using a Z-test. There was no statistically significant correlation between the clinical exam and pathology measures using a z-test. Statistically significant correlation was found between the number of micro-fractures and amount of bone marrow edema for the focal W/(W + F) in the proximal femur with ANOVA and z-test. The radiographic grading values were significantly higher for the study than control group using Kolmogorov-Smirnov test. There were significant correlations between the radiographic findings and MRI values for Total W/(W + F), Focal W/(W + F) and Focal T2, and between the radiographic findings, pain, and hip movement, using z-test.

The amount of bone marrow edema in the osteoarthritic hip, as measured by MRI, correlates with the severity of pain, radiographic grading, and with the number of micro-fractures.

Treatments include conservative therapy, e.g. physical therapy, alteration in precipitating event, oral medications, intraarticular steroid injections or surgical treatment e.g., osteotomies or joint replacement.

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