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Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK)
  1. Rintje Agricola1,
  2. Marinus P Heijboer1,
  3. Sita M A Bierma-Zeinstra1,2,
  4. Jan A N Verhaar1,
  5. Harrie Weinans1,3,
  6. Jan H Waarsing1
  1. 1Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  3. 3Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
  1. Correspondence to Dr Rintje Agricola, Department of Orthopaedics, Erasmus Medical Centre, Room Ee16-18, PO Box 2040, Rotterdam 3000 CA, The Netherlands; r.agricola{at}


Objective To determine the association between cam impingement, which is hip incongruity by a non-spherical femoral head and development of osteoarthritis.

Methods A nationwide prospective cohort study of 1002 early symptomatic osteoarthritis patients (CHECK), of which standardised anteroposterior pelvic radiographs were obtained at baseline and at 2 and 5 years follow-up. Asphericity of the femoral head was measured by the α angle. Clinically, decreased internal hip rotation (≤20°) is suggestive of cam impingement. The strength of association between those parameters at baseline and development of incident osteoarthritis (K&L grade  2) or end-stage osteoarthritis (K&L grades 3, 4, or total hip replacement) within 5 years was expressed in OR using generalised estimating equations.

Results At baseline, 76% of the included hips had no radiographic signs of osteoarthritis and 24% doubtful osteoarthritis. Within 5 years, 2.76% developed end-stage osteoarthritis. A moderate (α angle >60°) and severe (α angle >83°) cam-type deformity resulted in adjusted OR of 3.67 (95% CI 1.68 to 8.01) and 9.66 (95% CI 4.72 to 19.78), respectively, for end-stage osteoarthritis. The combination of severe cam-type deformity and decreased internal rotation at baseline resulted in an even more pronounced adjusted OR, and in a positive predictive value of 52.6% for end-stage osteoarthritis. For incident osteoarthritis, only a moderate cam-type deformity was predictive OR=2.42 (95% CI 1.15 to 5.06).

Conclusions Individuals with both severe cam-type deformity and reduced internal rotation are strongly predisposed to fast progression to end-stage osteoarthritis. As cam impingement might be a modifiable risk factor, early recognition of this condition is important.

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