Radiographic Markers of Hip Dysplasia and Femoroacetabular Impingement Are Associated with Deterioration in Acetabular and Femoral Cartilage Quality: Insights from T2 MRI Mapping

Femoroacetabular impingement (FAI) and hip dysplasia have been shown to increase the risk of hip osteoarthritis in affected individuals. MRI with T2 mapping provides an objective measure of femoral and acetabular articular cartilage tissue quality. This study aims to evaluate the relationship between hip morphology measurements collected from three-dimensional (3D) reconstructed computed tomography (CT) scans and the T2 mapping values of hip articular cartilage assessed by three independent, blinded reviewers on the optimal sagittal cut. Hip morphology measures including lateral center edge angle (LCEA), acetabular version, Tönnis angle, acetabular coverage, alpha angle, femoral torsion, neck-shaft angle (FNSA), and combined version were recorded from preoperative CT scans. The relationship between T2 values and hip morphology was assessed using univariate linear mixed models with random effects for individual patients. Significant associations were observed between femoral and acetabular articular cartilage T2 values and all hip morphology measures except femoral torsion. Hip morphology measurements consistent with dysplastic anatomy including decreased LCEA, increased Tönnis angle, and decreased acetabular coverage were associated with increased cartilage damage (p < 0.001 for all). Articular cartilage T2 values were strongly associated with the radiographic markers of hip dysplasia, suggesting hip microinstability significantly contributes to cartilage damage. The relationships between hip morphology measurements and T2 values were similar for the femoral and acetabular sides, indicating that damage to both surfaces is comparable rather than preferentially affecting one side.