Case 10

Question 1

59 yo recreational active female with recalcitant right hip pain. moderate to severe.

short-incomplete response to intra-articular cortisone

NSAIDs, PT, activity modification for 6 months

recommend hip arthroplasty consultation

Laid Crepe with high risk scope

wanted to remain active with running

Answer 1

Patient is a 59yo active runner who presented with 6 months of mechanical hip pain with running. Moderate to severe radiating into joint. sharp stabbing. moderate to severe in intensity.

I saw the patient nearly monthly for counseling on hip arthroscopy and conservative management.

Patient had an insufficient response to an intraarticular cortisone injection.

surgical goal was for a chance to continue to run/be active

Question 2

no frog leg

Answer 2

Physical exam notable for well-appearing fit female

Pain with flexion, internal rotation C/w impingement

negative log roll

TTP over anterior hip

NVI

Question 3

MR-arthrogram

Answer 3

Superior Cam Lesion

Retroversion with large pincer

Tonnis grade 1 (no cysts)

greater than 2mm joint space

adequate Pelvis tilt

moderate osteoarthriis

Question 4

I

Answer 4

The labrum demonstrates some anterosuperior degenerative blunting but otherwise maintains its normal triangular morphology. There is moderately advanced anterosuperior joint space narrowing and cartilage loss consistent with osteoarthritis.

The morphology of the femoral head and neck are unremarkable and there are no findings to suggest femoroacetabular impingement.

Question 5

Question 6

Answer 6

Ordered for further characterization of OA/FAI measurements, intra-op tools

Findings are compatible with right hip osteoarthritis, concordant with MR arthrogram of right hip on 8/23/2019.

Question 7

Answer 7

radiology read of arthritis on radiographic interpretation

HIP at risk

with radiographic measurements of FAI

no absolute contraindication to hip arthroscopy with imaging

Question 8

Answer 8

1. Failure of conservative measures for over 6 Months
2. Medically healthy
3. desire to run/not accepting arthroplasty limitations
4. accepting of a high failure rate to THA
5. Radigraphic FAI
6. “The surgical alterternative is the arthroscopy complication/failure”

Question 9

Answer 9

1. Combined severe FAI
2. Hip osteoarthritis
3. Unstable labral tear
4. Hip synovitis
5. Hip loose body

Question 10

a

Question 11

Question 12

Answer 12

Question 13

Answer 13

collar osteophyte removed

less overcoverage/retroversion

progressive sclerosis

joint space narrowing

post-op 2 weeks, then 4 Months

COVID restrictions

6 months functional assessment

Question 14

HPI

Answer 14

underwent hip arthroplasty within a year