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Radiographic Structural Abnormalities Associated with Premature, Natural Hip-Joint Failure
John C. Clohisy, MD1; Michael A. Dobson, MD1; Jason F. Robison, MD1; Lucian C. Warth, MD2; Jie Zheng, MS1; Steve S. Liu, MD2; Tameem M. Yehyawi, MD2; John J. Callaghan, MD2
1 Department of Orthopaedic Surgery (J.C.C., M.A.D., and J.F.R.) and Department of Biostatistics (J.Z.), Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110. E-mail address for J.C. Clohisy: jclohisy@wustl.edu
2 Department of Orthopaedic Surgery, University of Iowa School of Medicine, 200 Hawkins Drive, Iowa City, IA 52242
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Zimmer, Inc. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Zimmer, Inc., and DePuy).

Investigation performed at Washington University School of Medicine, St. Louis, Missouri, and University of Iowa School of Medicine, Iowa City, Iowa

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):3-9. doi: 10.2106/JBJS.J.01734
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Significant controversy exists regarding the causes of premature, natural hip-joint failure. Identification of these causes may guide future investigations targeting prevention of this disorder. The aims of this study were to: (1) determine and characterize structural abnormalities associated with premature, natural hip-joint failure, and (2) analyze disease progression in the contralateral hips of patients with femoroacetabular impingement deformities.


We analyzed 604 patients (710 hips) from three different medical centers who underwent primary total hip arthroplasty at or before fifty years of age (average age, forty years). Three hundred fourteen patients (52%) were male, and 290 patients (48%) were female.


The diagnoses associated with premature hip failure varied, but osteoarthritis and osteonecrosis were most common. Radiographic abnormalities associated with developmental hip dysplasia and femoroacetabular impingement were associated with the majority of osteoarthritic hips. Hips with femoroacetabular impingement deformities demonstrated distinct structural anatomy relative to asymptomatic hips, with a high prevalence of bilateral deformities. In a subgroup of seventy patients with femoroacetabular impingement deformities, contralateral radiographic disease progression or the need for total hip arthroplasty was observed in 73% of hips.


Osteoarthritis and osteonecrosis are the major causes of premature hip-joint failure in young patients. Femoroacetabular impingement abnormalities are usually bilateral and are commonly associated with progression of the disease to the contralateral hip.

Level of Evidence: 

Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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