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

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 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. Division of Sports Medicine 3 Department of Orthopedic Surgery

Division of Sports Medicine 4 Department of Orthopedic Surgery

Division of Sports Medicine 5 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 Division of Sports Medicine 6 Department of Orthopedic Surgery

Division of Sports Medicine 7 Department of Orthopedic Surgery

Division of Sports Medicine 8 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 Division of Sports Medicine 9 Department of Orthopedic Surgery

Case Study MRI: • Small central disc protrusion L5-S1 • Mild multilevel facet arthrosis, most pronounced L5-S1 Division of Sports Medicine 10 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. Division of Sports Medicine 11 Department of Orthopedic Surgery

Division of Sports Medicine 12 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 Division of Sports Medicine 13 Department of Orthopedic Surgery

Division of Sports Medicine 14 Department of Orthopedic Surgery

Division of Sports Medicine 15 Department of Orthopedic Surgery

Division of Sports Medicine 16 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 Division of Sports Medicine 17 Department of Orthopedic Surgery

Division of Sports Medicine 18 Department of Orthopedic Surgery

Division of Sports Medicine 19 Department of Orthopedic Surgery

Thank you Division of Sports Medicine 20 Department of Orthopedic Surgery