Femoroacetabular impingement

Case contributed by Andrew Lawson
Diagnosis certain

Presentation

Longstanding pain in right hip.

Patient Data

Age: 60 years
Gender: Male
x-ray

Osteophyte formation and acetabular overcoverage.

mri

The femoral head contour is abnormal, with increased anterior alpha angle 77 degrees, and reduced femoral head neck offset (pistol grip deformity). There are small femoral head neck junction osteophytes superiorly and posteriorly. Prominent sublabral osteophyte formation at the superior and posterior acetabulum results in increased acetabular anteversion and over-coverage of the femoral head. 

Degenerative cystic change along the superior acetabulum. Anterosuperiorly there is labral degeneration associated with minor psoas bursal distension. No tendinosis is evident. There is patchy chondral loss at the superior aspect of the joint without subchondral signal change or eburnation. Ligamentum teres shows minimal change. Minor gluteal insertional tendinosis is noted. Normal marrow signal.

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