EP9.14 Long-Term Capsular Adaptation Beneath Reconstructed Acetabula: Evidence of (Fibro)cartilaginous Metaplasia After Shelf Arthroplasty and Chiari Osteotomy

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ID: 331023
2026
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Abstract
Abstract Background Shelf arthroplasty and Chiari osteotomy are joint-preserving procedures for acetabular dysplasia that increase the load-bearing surface. It is hypothesized that the interposed capsule between the bone and femoral head undergoes fibrocartilaginous metaplasia under long-term mechanical loading; however, human histological evidence remains limited. This study aimed to investigate whether the hip capsule exhibits fibrocartilaginous or hyaline-like metaplasia after shelf arthroplasty or Chiari osteotomy. Methods In this prospective cross-sectional histological study, we analyzed hip capsule tissue retrieved during total hip arthroplasty (THA) in 10 patients with a history of shelf arthroplasty or Chiari osteotomy. The median interval between the index procedure and THA was 18 years (range 11–38 years). Histological and immunohistochemical staining (hematoxylin–eosin, Sirius Red, Alcian Blue/Periodic Acid–Schiff, and type II collagen) was used to assess fibrocartilage and hyaline-like cartilage formation. Two blinded pathologists assessed tissue type, relative proportions of fibrocartilage and hyaline-like cartilage, spatial distribution, and degenerative changes. Results Fibrocartilaginous metaplasia was present in all 10 specimens. In most samples, fibrocartilage was located on the bone-facing side and hyaline-like cartilage on the joint-facing side, with frequent transitional zones between both tissue types. Hyaline-like cartilage was present in variable proportions, ranging from 1–90%. Alcian Blue/Periodic Acid–Schiff staining showed a glycosaminoglycan-rich matrix in these regions, and type II collagen immunostaining demonstrated cytoplasmic positivity in cells within chondroid areas, supporting chondroid differentiation. Conclusions The interposed hip capsule after shelf arthroplasty or Chiari osteotomy does not remain a purely fibrous structure. Instead, it shows fibrocartilaginous metaplasia in all retrieved specimens, with variable additional differentiation toward hyaline-like cartilage. These findings provide histological support for extracapsular joint-preserving procedures in patients with hip dysplasia.
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Authors Drs Milou Hüsken, Koen Willemsen, V Busch, Peter Nikkels, de Steffie Gier, Ralph J. B. Sakkers, Marianna Tryfonidou, Björn Meij, Rintje Agricola, Harrie Weinans, Joris Bekkers, van der Bart Wal
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.494
URL
https://doi.org/10.1093/jhps/hnag043.494
Keywords Keywords not found

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