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Femoroacetabular Impingement: Case Example

By Justin Saliman, MD

JW is a 48-year-old male who presented complaining of chronic hip pain that had been progressive over the past 20 years. He localized his pain specifically to the anterolateral groin region and had a positive C-sign. He had increased symptoms after sitting for long periods, as well as with exercise and prolonged walking. Physical examination demonstrated a positive labral stress test, with severe discomfort on ranging the forward flexed and internally rotated leg. His exam also demonstrated decreased motion to hip flexion, abduction and external rotation.

Weight-bearing radiographs demonstrated femoroacetabular impingement and maintenance of the joint space. He was sent for an MR arthrogram, which demonstrated a large acetabular labral tear at the anterior superior rim and adjacent chondromalacia. Lidocaine was injected at the time of the arthrogram, and the patient noted temporary relief of symptoms. He was referred for six weeks of physical therapy. However, he was only able to complete four weeks due to a worsening of symptoms.

He was ultimately brought to the operating room where a large acetabular labral tear was identified. The adjacent acetabular cartilage demonstrated grade Ill chondromalacia and a positive wave sign (Fig. 1 below).The acetabular overhang was debrided to decrease impingement and to obtain a healthier anterolateral acetabular chondral margin. The labrum was repaired back to the new acetabular rim using Fiberwire® and three Arthrex PEEK Pushlock™ anchors (Fig. 2). When the traction was released, a good suction cup effect of the labrum on the femoral head was noted. The peripheral compartment demonstrated a large region of impinging camtype osteophytic change on the femoral neck, which was debrided by femoroplasty with an arthroscopic burr (Fig. 3a-b).

The patient reported significant pain relief at his one-week follow-up appointment and 95 percent symptom improvement by his three-month follow-up appointment. He felt improvement in range of motion and he was able ito return to symptom-free exercising.

Justin Saliman, MD, is a surgeon with the Cedars-Sinai Orthopaedic Center. This article was originally published in Advances in Orthopaedics.

Figure 1: Acetabular labral tear and adjacent chondromalacia

Figure 2: After acetabuloplasty and labral repair

Figure 3: Before femoroptasty (A) and after femoroplasty (B) with traction released

Figure 4: X-ray before femoroplasty (A) and after femoroplasty (B)