Case Study: Hip Dennis A. Cardone, DO Disclosure Chief Medical - - PowerPoint PPT Presentation

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Nov 15, 2023 37 likes •241 views

Department of Orthopedic Surgery Case Study: Hip Dennis A. Cardone, DO Disclosure Chief Medical Officer, New York City Public High School Athletics (PSAL) Division of Sports Medicine 2 Department of Orthopedic Surgery Case Study 19

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Case Study: Hip

Dennis A. Cardone, DO

Department of Orthopedic Surgery

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Department of Orthopedic Surgery

Disclosure

Chief Medical Officer, New York City Public High School Athletics (PSAL)

2 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

19 yo female D1 lacrosse player presented in training room with acute onset left anterior

hip pain after a sprint/cut during an intercollegiate match. Pain localized to anterior hip. Symptoms aggravated with walking and running.

PMH: None
PSH: None
PE: Gait non-antalgic. ER 70. IR 15. F 130. Abd 45. Add 20. Pain with forced flexion and

internal rotation. Pain with resisted hip flexion. No tenderness to palpation. (+)FADIR. (-)SLR.

3 Division of Sports Medicine

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Department of Orthopedic Surgery 4 Division of Sports Medicine

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Department of Orthopedic Surgery 5 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

Plan: Rehab program in the training room.
Three week follow-up:
Complaints of worsening left hip pain. Pain in groin with radiation to buttock.

Symptoms aggravated with walking and prolonged sitting.

PE: Pain at end range of flexion. (+)FADIR. (+)SLR.
Plan: MRI left hip

6 Division of Sports Medicine

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Department of Orthopedic Surgery 7 Division of Sports Medicine

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Department of Orthopedic Surgery 8 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

4 weeks:

Worsening pain. Using crutches.
Consult orthopedic sports medicine specialist
Possible hip labral tear with impingement
Ultrasound guided left hip injection
MRI lumbar spine

9 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

MRI:

Small central disc protrusion L5-S1
Mild multilevel facet arthrosis, most pronounced L5-S1

10 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

8 weeks

PREOPERATIVE DIAGNOSIS: LEFT HIP FEMOROACETABULAR IMPINGEMENT WITH A CAM AND PINCER. POSTOPERATIVE DIAGNOSES:

1. FEMOROACETABULAR IMPINGEMENT, SMALL CAM AND PINCER FROM 12 O'CLOCK

TO 1:30 WITH A CROSSOVER SIGN.

2. SMALL LABRAL TEAR 1 O'CLOCK.

OPERATIONS:

1. LABRAL REPAIR.
2. ACETABULOPLASTY.
3. FEMOROPLASTY.

11 Division of Sports Medicine

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Department of Orthopedic Surgery 12 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

Three months post-op
3 weeks worsening left hip pain
DX: synovitis
IA corticosteroid injection
Four months post-op
Continued pain (similar to pre-op)
Pain relief (short-term) after injection
Consult other hip surgeon

13 Division of Sports Medicine

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Department of Orthopedic Surgery 14 Division of Sports Medicine

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Department of Orthopedic Surgery 15 Division of Sports Medicine

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Department of Orthopedic Surgery 16 Division of Sports Medicine

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Department of Orthopedic Surgery

Case Study

….one week later

CAM deformity of the femur and AIIS impingement

…six weeks later

PREOPERATIVE DIAGNOSES: Left hip femoroacetabular impingement, cam lesion, pincer lesion, acetabular labral tear. POSTOPERATIVE DIAGNOSES: Left hip femoroacetabular impingement, pincer lesion with acetabular labral tear. OPERATIONS: Open Surgical dislocation left hip with trochanteric osteotomy, femoroplasty

17 Division of Sports Medicine

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Department of Orthopedic Surgery 18 Division of Sports Medicine

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Department of Orthopedic Surgery 19 Division of Sports Medicine

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Department of Orthopedic Surgery

Thank you

Division of Sports Medicine 20