Patient History
67-year-old female complaining of hip pain.
Findings
SKELETAL: No fracture or dislocations. No intramedullary lesions. No cortical breakthrough or periosteal reactions.
PELVIS: Labral-sacral junction, sacrum, sacroiliac joints, iliac blades, iliopectineal and ilioischial lines as well as the pubis are intact.
JOINTS: Coxa profunda.
Left hip acetabular over coverage with a lateral central edge angle (LCE)] of 55.5º (normal 25º-39º).
Normal head sphericity. Normal tapering at the head-neck junction. No dystrophic bumps or synovial pitting.
Moderate osteoarthrosis of the left hip with marginal spurs throughout the femoral head.
Diffuse chondral plate delamination with saucerized chondral flap tear (carpet lesion) anterosuperiorly.
Chondral delamination with mild subchondral stress osteoedema at the superior femoral head weight-bearing surface and anterosuperior acetabular column.
No avascular necrosis.
ACETABULUM/LABRUM: Focal, complex tear at the anterosuperior labrum without displacement.
Lobulated and internally septated adjacent anterosuperior paralabral cyst dissecting below the iliopsoas measuring 1cm x 2.3cm x 2.6cm (AP, transverse and CC diameters, respectively).
MUSCLES/TENDONS/LIGAMENTS: Nominal distention of the iliopsoas bursa.
Nominal insertional tendinosis of the gluteus medius on the lateral facet of the greater trochanter. No bursitis.
The rest of the abductor and adductor musculature is unremarkable.
OTHER/SOFT TISSUE: Normal neurovascular bundle.
Unremarkable pelvic basin contents.
Impressions
1. Left hip joint pincer-type femoroacetabular impingement (FAI) due to coxa profunda, and acetabular over coverage.
2. Findings result in moderate osteoarthritis of the left hip with marginal spurs throughout the femoral head. Diffuse chondral plate delamination with saucerized chondral flap tear anterosuperiorly.
3. Generalized chondral plate delamination with mild subchondral stress osteoedema at the superior femoral head weight-bearing surface and anterosuperior acetabular column.
4. Focal, complex anterosuperior labral tear associated with a 1cm x 2.3cm x 2.6cm anterosuperior paralabral cyst dissecting below the iliopsoas.
