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Cited by 1,620Hip disorders and treatmentsOsteoarthritis Treatment and MechanismsBone and Joint Diseases

The Etiology of Osteoarthritis of the Hip: An Integrated Mechanical Concept

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Ganz, Reinhold, Leunig, Michael, Leunig-Ganz, Katharina, Harris, William H.·2008·Clinical Orthopaedics & Related Research
DOI 10.1007/s11999-007-0060-zPMC PMC2505145
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Abstract

UNLABELLED: The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present. LEVEL OF EVIDENCE: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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  • Transitioning to more narrow/medium stance squats will promote greater tibial inclination and a quadriceps bias.

    “During the sub-acute or recovery phase, transitioning to more narrow/medium stance squats will promote greater tibial inclination47 and a quadriceps bias.”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [47]

    The Introduction and Recent Evidence in Support of the Theory discuss hip osteoarthritis and femoroacetabular impingement, not squat mechanics. Searches for narrow-stance squats, tibial inclination, and quadriceps bias found no passage addressing the attributed claim. Page numbers were not available in our copy. (LLM, conf=0.78)

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  • A wider stance will reduce ankle dorsiflexion, which will facilitate a more favorable trunk-tibia relationship to produce a hip bias.

    “To obtain a hip bias squat with limited forward trunk lean, a wider stance width can be used. A wider stance will reduce ankle dorsiflexion,47 which will facilitate a more favorable trunk-tibia relationship to produce a hip bias.”

    From A Biomechanical Review of the Squat Exercise: Implications for Clinical Practice. (2024) · cites this paper as [47]

    The paper’s Recent Evidence in Support of the Theory section discusses hip impingement and motion, not squat stance width or ankle mechanics. Searches for wider stance, ankle dorsiflexion, and trunk–tibia positioning found no passage addressing the claimed relationship. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 10

  1. Leunig M, Beck M, Dora C, Ganz R. Femoroacetabular impingement: etiology and surgical concept. Oper Tech Orthop. 2005;15:247-255.
  2. Leunig M, Beck M, Dora C, Ganz R. Femoroacetabula ¨res Impingement als Auslo ¨ser der Koxarthrose. Orthopade. 2006;35: 77-84.
  3. Leunig M, Fraitzl CR, Ganz R. Early damage to the acetabular cartilage in slipped capital femoral epiphysis: therapeutic con- sequences [in German]. Orthopade. 2002;31:894-899.
  4. Leunig M, Ganz R. Femoroacetabula ¨res Impingement: Ha ¨ufige Ursache von zur Arthrose fu ¨hrenden Hu ¨ftbeschwerden. Unfall- chirurg. 2005;108:9-10, 12-17.
  5. Solomon L. Geographical and anatomical patterns of osteoar- thritis. Br J Rheumatol. 1984;23:177-180.
  6. Solomon L, Beighton P. Osteoarthrosis of the hip and its rela- tionship to pre-existing in an African population. J Bone Joint Surg Br. 1973;55:216-217.
  7. Strehl A, Ganz R. Anterior femoroacetabular impingement after healed femoral neck fractures [in German]. Unfallchirurg. 2005;108:263-273.
  8. Stulberg SD. Acetabular dysplasia, development of osteoarthritis of the hip. In: Harris WH, ed. The Hip: Proceedings of the Second Open Scientific Session of the Hip Society. St Louis, MO: CV Mosby; 1974:82-93.
  9. Werlen S, Leunig M, Ganz R. Magnetic resonance arthrography of the hip in femoroacetabular impingement: technique and findings. Oper Tech Orthop. 2005;15:191-203.
  10. Wettstein M, Dienst M. Hip arthroscopy for femoroacetabular impingement [in German]. Orthopade. 2006;35:85-93.

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Authors
Ganz, R., Leunig, M., Leunig-Ganz, K., & Harris, W. H.
Affiliations
  • University of Bern (CH)
  • Triemli Hospital (CH)
  • Harvard University (US)
ORCID
Venue
Clinical Orthopaedics & Related Research
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2008-02
Volume
466
Issue
2
Pages
264-272
ISSN
0009-921X (ISSN-L)
DOI
10.1007/s11999-007-0060-z
PMC
PMC2505145
OpenAlex
W2080003986
Cited by
1,620
References
64
Citations by year
2026: 40 · 2025: 54 · 2024: 36 · 2023: 49 · 2022: 62 · 2021: 93 · 2020: 71 · 2019: 96 · 2018: 81 · 2017: 81 · 2016: 119 · 2015: 117 · 2014: 128 · 2013: 113 · 2012: 102
FWCI
89.92
Type
journal article
Language
en
Open access
Locations
  • Clinical Orthopaedics and Related Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
  • reroDoc Digital Library (submittedVersion)
  • Open Access CRIS of the University of Bern
Topics
  • Health Sciences › Medicine › Surgery › Hip disorders and treatments
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone and Joint Diseases
Keywords
hip osteoarthritis, etiology, femoroacetabular impingement, cam-type impingement, pincer-type impingement, articular cartilage, hip internal rotation, acetabular retroversion, coxa profunda, total hip arthroplasty
MeSH terms
Biomechanical Phenomena, Hip Joint, Humans, Osteoarthritis, Hip

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