Patient History
73 yo male with right hip and groin pain.
Findings
SKELETAL: No fractures or dislocations. No intramedullary lesions. No cortical breakthrough or periosteal reactions.
PELVIS: Sacrum, sacroiliac joints, iliac blades, iliopectineal and ilioischial lines are intact. Posterior fixation at L4-L5.
JOINTS: Dysplastic appearance of bilateral femoral heads with an ellipsoid appearance and decreased epiphyseal height.
The alpha angle of the right hip is 65.8º.
The lateral center edge angle (LCEA) is of <20º.
The extrusion index measuring the percentage of the femoral head uncovered by the acetabulum is of 80º which is defined as dysplastic.
The delta angle measuring the position of the fovea capitis demonstrates a “fovea Alta” which is the abnormal position of the fovea capitis superiorly calculated by intersecting lines extending from the center of the femoral head to the medial edge of the dorsal and to the superior edge of the fovea capitis and measuring 9.4º.
ACETABULUM/LABRUM: Abnormally thickened labrum with carpet like degeneration extending from inside-out and focal tear anterosuperiorly at 10-12 o'clock positions with an intra labral and tiny paralabral cysts. Posterior column erosion with pseudocyst formation acetabular rim.
Advanced chondromalacia with nominal subchondral osteoedema at the superior acetabular column.
MUSCLES/TENDONS/LIGAMENTS: Saucerized and interstitial delamination of the ligamentum teres. The ischiofemoral, iliofemoral and transverse ligaments are intact.
Mild insertional tendinosis of the right gluteus minimus at the anterior facet of the greater trochanter.
OTHER/SOFT TISSUE: Remaining musculotendinous compartments and neurovascular bundles are intact.
Moderate prostatomegaly with dysplastic calcifications at the central gland or transitional zone.
Impressions
1. Dysplastic appearance of the bilateral femoral heads with associated advanced chondromalacia at the superior acetabular column.
2. Abnormally thickened right labrum with carpet like degeneration extending from inside-out resulting in a focal labral tear anterosuperiorly at 10-12 o'clock positions with an intra labral and tiny paralabral cysts.
3. Saucerized and interstitial HIGH GRADE delamination of the ligamentum teres.
4. Mild insertional tendinosis of the right gluteus minimus at the anterior facet of the greater trochanter.
