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Femoral Head Arthritis

FIGURE 2.19. A 52-year-old woman with a 2-year history of bilat- changes. (B) Arthroscopic view of the right hip reveals a prolifera-

eral hip pain following high-dose cutaneous exposure to organophos- tive reactive synovitic process obliterating the acetabular fossa (ar-

phate insecticides. (A) AP radiograph of the right hip is unremark- rows), which is being debrided. able with well-maintained joint space and no evidence of bony

FIGURE 2.19. A 52-year-old woman with a 2-year history of bilat- changes. (B) Arthroscopic view of the right hip reveals a prolifera-

eral hip pain following high-dose cutaneous exposure to organophos- tive reactive synovitic process obliterating the acetabular fossa (ar-

phate insecticides. (A) AP radiograph of the right hip is unremark- rows), which is being debrided. able with well-maintained joint space and no evidence of bony

Osteophytes are commonly encountered in association with osteoarthritis but rarely benefit from excision. The osteophytes evident radiographically are rarely the sole cause of pain but are simply a radiographic indicator of the degenerative process. Although debridement in the presence of degenerative disease is sometimes appropriate, osteophyte excision alone is rarely a productive undertaking.

The concept of femoroacetabular impingement as a consequence of hip joint morphology is beginning to be understood.67,68 Traditional arthrotomy has been proposed in the management with bony resection. It is likely that most of these can be addressed arthro-scopically with equal success. However, an apprecia tion for the pathomechanics of these specific lesions is just beginning to unfold. Many overlap with associated osteoarthritis, in which case excision of the impinging lesion may be of limited benefit.

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