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It's a Nobel prize winning innovation..
And within our lifetimes..

Precision MRI has unlocked our understanding of hip osteoarthritis
And deleted the term 'primary hip osteoarthritis’ from the medical dictionary.


How does MRI work?

The human body is slid into the narrow Magnet tube.

The human body is mainly made of cells and water, H­₂0.

2x Hydrogen atoms bound to 1x Oxygen in a life-giving bond.
(I went deep on Life-giving Water here)


A powerful magnet field Resonates back and forth across the tube
..and human body.

Each H or hydrogen atom is given an energetic push
..like a toddler on a swing.

Those excited toddlers release back that energy as radio waves
Intensity depends the number of toddlers, H-atoms or H­₂0 in each tissue..

• Water or inflammation => BRIGHT white.
• Fat, muscle and bone => Shades of GREY.

Radio detectors pick up the signal..
Powerful computers build a 3-D Image*
A picture of water H20 density in different human tissues emerges.

*Computers from 2nd half of last century. Sufficient computer power end of last century. No wonder MRI is recent 


How does that help?

Using magnets to detect differences in water content..??
..sounds like the images would be a blurry mess

BUT the level of detail is exquisite

We see detail down to the individual millimetre size blood vessel.

In Newsletter #029 MRI picked up 3x 'trapped' nerve roots..

MRI measures + combines multiple fine slices to form a 3-D picture..
(3-D makes the difference)

MRI shows up previously invisible deformities.
(Invisible on a 2-D plain x-ray film)

Deformities that inflame + damage the hip labrum.

The labrum is the ring of tissue that deepens the hip socket 
And it's key to sealing and lubricating the hip.

So, labral damage leads to:

⬆ Forces
⬇ Lubrication
⬆ Cartilage damage. 
 
A hip might look fairly normal on a single image.
A front to back plain x-ray film.

BUT that shot in one or two planes..
..hides most of the shape and detail of what is going on.

We can now pick up 1 of 2 deformities..


1. A Cam deformity

A loss of femoral head roundness
An off-centre lollipop on a stick or cam deformity.

There's a subtle flattening at the front of the hip.
And it's a subtle change..

That flat area bumps into the hip labrum.
Especially with the hip in deep flexion.

Repetitive bumping => Inflammation of the labrum
Inflammation => hip pain.

That knowledge has profoundly improved my own hip pain.
(see Newslettter #05)


2. A Deep socket

The other common deformity is a deep hip socket.
If the socket is deep the ball hits the edge earlier in hip flexion..
..and more often.
 
The outcome is the same..
Again, especially with the hip in deep flexion.

Repetitive bumping => Inflammation of the labrum
Inflammation => hip pain.

(again jump to Newslettter #05 for what to do about it).
 
 
We missed the Cam and Deep socket for the duration of modern medicine.
Until 3-dimensional MRI came along.
 
 
Better MRI (and CT) scans have added information and knowledge.
About subtle and not so subtle deformities of the ball and socket.

 
A Final thought

We now appreciate that 'primary' hip osteoarthritis does NOT exist.

Perhaps ‘deformity’ is also the wrong term?
What we're describing is variation in hip shapes, right?

We may be hitting on evolutionary and physiological explanations of these subtle differences in hip shape.

I’ll explain more next week..

So, next week is T. Rex and academy footballers.

Is it possible to link the two? I'll give it go..

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