History 25 year old man with right hip and groin pain.
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Findings In the first patient there is productive bone formation at the anterior femoral head neck junction and associated subchondral cystic change. The second patient demonstates productive bone formation about the anterosuperior acetabulum with degeneration and fissuring of the anterior superior labrum. Cartilage loss is seen along the posterioinferior aspect of the joint. Cartilage wear has yielded a joint effusion containing reactive synovitis.
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Diagnosis FAI relates to a mismatch at the hip joint either along the femoral side or the acetabular side. Patients typically present with pain exacerbated by certain motions, particularly those related to flexion and internal rotation. Cam lesions involve the femoral side and relate to a loss of the anterior femoral head neck offset. Bone and subchondral cysts form at this location causing subsequent degeneration of the anterorsuperior labrum and early cartilage loss. The pincer lesions relate to ossification along the acetabular side leading to overcoverage of the femoral head. Although anterosuperior labral degeneration is seen, cartilage wear is often found at a contre-coup location of the posterior inferior acetabulum. Pincer pathology is also implicated in the setting of coxa profunda and focal retroversion of the acetabulum. In order to help prevent early degeneration of the hip joint, progression of degeneration, and alleviate patient’s pain surgeons, using new arthroscopic techniques, are able to debride the bone and labrum and restore normal architecture to the hip joint.
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Resources
• High resolution noncontrast MRI of the hip. Potter HG, Schachar J. J Magn Reson Imaging. 2010 Feb;31(2):268-78. Review.
• The concept of femoroacetabular impingement: current status and future perspectives.Leunig M, Beaulé PE, Ganz R. Clin Orthop Relat Res. 2009 Mar;467(3):616-22. Epub 2008 Dec 10. Review.
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What’s the Diagnosis - Case 32
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