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Pincer type femoroacetabular impingement

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis almost certain

Presentation

History from referring physician "degenerative changes in right hip?"

Patient Data

Age: 40 years
Gender: Female

Abnormal morphology of the acetabuli with over-coverage of both femoral heads. There is also bilateral coxa profunda as evident with the acetabular fossa (Figure B and C: dotted blue lines) medial to the ilioischial line (Figure B and C: yellow line). Overall imaging appearance is consistent with pincer type femoroacetabular impingement (AFI). 

Two areas of impingement are present at the anterosuperior and inferomedial corners of the hip joints ( Figure B and C: asterisks and blue arrows) and more pronounced at inferomedial aspect of the hip joints. 

Lateral projection of the right hip showed normal cutback at the femoral head-neck junction. (Figure C: dotted blue line and blue arrow).

Case Discussion

This is a classic case of pincer type FAI. The demographics are also typical with 40 being the average age of presentation.

Pincer type FAI is characterized by one or more of the following abnormality including acetabular retroversion, coxa profunda and protrusio acetabuli. These changes lead to over-coverage of the femoral head by the overhanging acetabulum and resulting in impingement at the extreme of joint motion.

Typically pincer type FAI has a smaller anterosuperior coup lesion and a more pronounced contrecoup lesion posteriorly as demonstrated in this case. Pincer type FAI can co-exist with Cam-type FAI thus assessment of the femoral head-neck junction is paramount to exclude co-existing pathology. 

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