Chondral Lesions of the Acetabulum or Femoral Head

Chondral lesions are among the most elusive sources of hip joint pain. Because of the more constrained anatomy of the hip compared to the shoulder, until recently these lesions were not believed to exist. Furthering the consternation of both patient and clinician, no currently available radiographic test reliably diagnoses the presence or extent of these lesions.1 Even gadolinium-enhanced arthro MRI scanning has limitations in elucidating chondral injuries. This lack of sensitivity may be...

Correlations

The most striking trend observed in both the arthroscopic and cadaveric data is the overwhelming preponderance of lesions involving the anterior labral-cartilage junction. The most common location for labral tears was unequivocally the anterior articular margin. There are several hypothetical explanations for this phenomenon. These include This region of the labrum may possess inferior intrinsic mechanical properties compared to other portions of the labrum this region may be subjected to...

Initial Assessment

When setting treatment goals it is important to have a clear understanding of the nature of the hip pathology. Knowing if the hip pathology was related more to an inflammatory process than to mechanical forces such as load, friction, or blunt trauma is useful information in planning treatment interventions to restore mobility and strength.4 Learning of the presence and extent of articular cartilage involvement is essential for exercise progression and for setting realistic functional outcomes....

References

Hip arthroscopy Applications and technique. J Am Acad Orth Surg 1995 3(3) 115-122. 2. Vervest AM, Maurer CA, Schambergen TG, Debie RA, Bulsta SK. Effectiveness of physiotherapy after menisectomy. Knee Surg Sports Traumatol Arthrosc 1999 7(6) 360-364. 3. St. Pierre DM. Rehabilitation following arthroscopic menisectomy. Sports Med 1995 20(5) 338-347. 4. Hall CM, The Hip. In CM Hall, L Thein Brody (Eds.) Therapeutic Exercise Moving Toward Function. Philadelphia...

Stability

Building upon baseline strength through a variety of resistive devices helps return the muscles to more normal power. Muscles also need to be trained in the range of movement where they will be used. Resistive weight training can include using machines such as the rotary hip, leg press, and calf raise. Leg pulleys or resistive band exercises are more high level, as there is less stability inherent in the position. With unilateral leg pulley or resistive band exercise, performing an isotonic...

Rehabilitation After Hip Arthroscopy

McCarthy, Brian D. Busconi, Bruce Dick, and Kevin Flaherty The primary goals for many patients undergoing hip arthroscopy are relief of pain and a return to their premorbid level of activity. Oftentimes these patients have a history of pain, muscle inhibition, altered gait, and impaired function for varying lengths of time. As the hip is an integral part of the lumbo-pelvic-hip complex, dysfunction or derangement of the hip can also lead to compensatory lumbar...

Calcium Pyrophosphate Deposition Disease CPPD Chondrocalcinosis

Calcium pyrophosphate deposition disease is the crystalline arthropathy most likely to affect the hip joint.65 The cause of the disease is unknown, but pathologically it results from increased calcium or inorganic phosphate concentrations in hyaline or fibrocartilage that precipitate to form crystals. Chon-drocalcinosis is the descriptive term used to denote the presence of calcium pyrophosphate crystals in cartilage, and although it occurs in the hip it is radiographically difficult to...

Synovial Abnormalities

The synovium can be the genesis of deep-seated and unremitting hip joint pain. A diverse number of etiologies may initiate synovial irritation. These conditions may be of inflammatory, hematologic, crystalline, collagen disease, mechanical, viral, or tumorous origin. Specific treatment is based upon whether the condition is focal or diffuse, and self-limiting or unremitting in nature. Crystalline diseases such as gout or pseudogout can produce extreme hip joint pain. A joint effusion, best seen...

Infection Septic Arthritis

Hip joint infection and septic arthritis, although most common in growing children, is becoming more prevalent in the adult population due to the growing number of elderly, disabled, and immunosuppressed patients, and those with chronic systemic illnesses. The ramifications of sepsis in this major weightbearing joint can result in lifelong disability for a child, and can be responsible for the loss of independence and or demise of an adult if not recognized and treated early. Evrard has...

Acetabular Labral Lesions Cadaveric Research

Flat Acetabulum

The labrum acts as a stabilizer of the hip joint. But in the dys-plastic hip, it becomes part of the weightbearing surface of the acetabulum. It is postulated that this causes overload of the superior and or anterior labrum in tension and shear, leading to labral injury.19 Some studies do not support the theory that the labrum plays a crucial role in hip stability, although it has been demonstrated that the presence of the labrum per se has no significant influence on the weightbearing function...

Types of Loose Bodies

Symptoms Capsular Contracture

Loose bodies may be ossified and non-ossified and classified as osteocartilaginous, cartilaginous, fibrous, or foreign. By far, the most commonly identified and reported loose bodies associated with the hip are ossified, mainly because they are evident on plain radiographs. As our diagnostic acumen and understanding of early hip pathology improve, the presence and significant of cartilaginous and fibrous processes within the joint will undoubtedly expand. Osteocartilaginous loose bodies are...

Acetabular and Labral Pathology

McCarthy, Philip Noble, Michael Schuck, Frank V. Aluisio, John Wright, and Jo-ann Lee The diagnosis of acetabular labral tear as a cause for hip pain has received little attention in the orthopedic literature, until recently. Many reasons contributed to making this diagnosis difficult. Radiographs readily visualize the bony architecture of the hip and pelvis, but not the chondral surfaces. Bone scans can demonstrate areas of increased uptake, but not the relatively avascular labrum....

Hemophilia and Hemosiderotic Synovitis

Hemosiderotic synovitis is a condition that results from chronic, repetitive intra-articular hemorrhage. Hemophilia is the bleeding disorder most commonly associated with intra-articular bleeding, but recurrent hemorrhage can also occur secondary to pigmented villonodular synovitis, synovial hemangioma, and repetitive trauma. The consequences of chronic hemarthrosis are direct damage to the articular cartilage and persistent hemosiderotic synovitis that leads to synovial hypertrophy and...

Synovial and Intra Articular Pathology

The hip joint, a diarthrodial or synovial joint, under normal conditions can function under very high loads and stresses for seven to eight decades. The thick, fibrous joint capsule encloses the metabolically active synovial connective tissue in an environment that nourishes and protects the articular cartilage. A highly permeable vascular capillary system invests the synovium and functions to produce synovial fluid, a plasma ultrafiltrate that sustains and lubricates the avascular cartilage....

Inflammatory Synovitis Rheumatoid Arthritis

Rheumatoid arthritis is the most common inflammatory arthritis, affecting 1-2 of the population. Onset of the disease is typically in the fourth and fifth decades of life. With current medical management, overall prognosis has improved, but unfortunately after 10-12 years with the disease, more than 80 of patients have evidence of some joint deformity. Juvenile rheumatoid arthritis JRA , although not as common, involves the hip in approximately one third of children and adolescents, leading to...

Pathology and Management

Contour Irregularity Femoral Head

The pathologies affecting the femoral head are Chondromalacia Chondrolysis Chondral defects Osteochondral defects Osteochondritis dissecans Degenerative joint disease Tumors Global softening of the articular cartilage, chondromalacia coxae, similar to that in the knee, has been reported.6 It does Avascular necrosis Ligamentum teres lesions Inflammatory disease Deformity Arthrofibrosis Fractures appear to be a definite clinical entity and is sometimes the cause of hip pain. The characteristic...

Synovial Chondromatosis Osteochondromatosis

Intra Articular Loose Body

Synovial chondromatosis osteochondromatosis is considered a benign disease that results in a monoarticular arthropathy. The hip is the third most common site of involvement, surpassed by the elbow and the knee.12-15 Synovial chondromatosis was first described by Jaffe as intrasynovial cartilaginous metaplasia, a histologic diagnosis, which can result in formation of multiple intra- and extracapsular loose bodies.15 Surgical findings reveal thickened synovium and loose bodies of varying size and...

Pigmented Villonodular Synovitis

Pigmented villonodular synovitis PVNS is a nonneoplastic proliferative disorder that can affect any synovial-lined structure, including bursae, tendons, and joints. PVNS is most commonly reported in the knee, but also occurs in the hip joint. The process occurs most frequently in the third or fourth decades of life, with no sex predilection,68 and should be considered in the differential diagnosis for all young patients presenting with uncharacteristic clinical and or radiographic features...

Labral Injuries Clinical Correlations Etiology and Classification

Acetabular Trauma

As noted above, the acetabular labrum is a fibrocartilaginous structure attached to the rim of the acetabulum that provides additional surface area for the articulation with the femoral head. The labrum exists at the anterior, superior lateral , and posterior margins of the acetabulum and is absent inferiorly in the cotyloid fossa, at which point it attaches to the transverse acetabular ligament. Pathology of the labrum including tears, hypertrophy, and instability is perhaps the most common...

Imaging of a Painful

Septic Arthritis Hip Imaging

Newman The imaging workup of the patient with hip pain should begin with plain or routine radiographs of the pelvis and hips. Certainly, by obtaining an anteroposterior view of the pelvis, as well as a lateral radiograph true lateral, frog lateral, or Lowenstein view one can readily compare the right and left hips, and therefore a built-in comparison is available for the radiologist and orthopedist. The diagnosis in many cases is obvious if the patient has had...

Cumulative Findings

Acetabular Cartilage Lesion

Of the 436 patients who underwent hip arthroscopy 250 54.8 were noted to have labral tears. There were 130 females and 110 males. The average age of this patient group was 37.3 years range, 14-72 . There was minimal difference 1.7 years between the average age of the male and female patients. All labral tears were located at the articular, and not at the capsular margin of the labrum. Almost all of these lesions 234, or 93.6 were located in the anterior quadrant of the acetabulum. Posterior...

Differential Diagnosis of the Painful

Anterior Soft Tissues Neck

Hip and pelvis injuries encompass a wide spectrum of pathology resulting from repetitive microtraumatic stresses or acute traumatic forces. Fortunately, the majority of these injuries heal without permanent sequelae however, accurate recognition and prompt appropriate treatment are required to minimize complications. Approximately 2.5 of all sports-related injuries are located in the hip and pelvic area. Epidemiolog-ical surveys suggest that injuries to the hip and pelvis account for...