Wk 2, Case 3 - Review

Patient History
57-yo male with right hip and groin pain for 6 months.

Findings
SKELETAL: No infiltrative or destructive bone lesion. No acute displaced macrofracture.

PELVIS: Prostate enlargement. Protrusion of the prostate into the bladder. Bladder wall thickening compatible with outlet obstruction. No free fluid. No hernia.

JOINTS: Severe right femoroacetabular joint space loss. Acetabular and femoral head-neck junction spurring and anterolateral labral tearing. Full-thickness cartilage loss of the weight bearing femoral head accompanied by cortical thinning. Subarticular microfracturing and developing osteonecrosis, without primary AVN, of the femoral head from 12 to 2 o’clock. Complex intermediate signal intensity joint fluid collection within the right hip with debris/bodies likely due to synovial thickening and/or cartilage fragmentation/delamination.

ACETABULUM/LABRUM: Acetabular spurring and anterolateral labral tearing. Marrow reaction within the anterior acetabular rim. No acetabular macrofracture.

MUSCLES/TENDONS/LIGAMENTS: Mild right gluteus medius and minimus peritendinitis, greater involving the gluteus minimus, no retracted tear. Normal right iliopsoas. Mild right hamstring tendinosis and ventral surface fraying without rupture. Swelling in the right adductor musculature may be related to reactive hyperemia from the adjacent joint pathology rather than impingement or strain.

OTHER/SOFT TISSUE: Left femoroacetabular arthropathy, incompletely characterized at the study periphery and on the axial data sets. No left AVN. No lymphadenopathy. Normal vasculature. Mild left hamstring and gluteal peritendinitis and tendinosis without macrotear.

Under coverage of the femoral head with large hypertrophic spurs suggests longstanding DDH as the cause of this patient’s advanced OA at age 57.

Conclusion
1. Severe right femoroacetabular arthropathy. 2.5 cm diameter osteochondral defect, with osseous edema and insufficiency microfracturing in the right femoral head; no underlying AVN or acute macrofracture. Right acetabular spurring and labral tearing. Complex joint fluid collection of the right hip, likely proteinaceous or hemorrhagic, containing debris/bodies.
2. Hamstring and gluteal tendinosis and peritendinitis without macrotear.