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playing golf. Any movement of the hip was painful, and his symptoms were only partially alleviated by using crutches. Radiographs revealed mild degenerative changes but fairly good joint space preservation (Figure 15.5A). A bone scan and serologic testing were performed to rule out occult fracture, neoplasia, or infection. All results were unremarkable. Evaluation of the lumbar spine was also carried out to rule out a source of referred symptoms. An MRI of the hip was also unremarkable. Because of his recalcitrant symptoms, a fluoroscopically guided intraarticular injection of bupivacaine and corticosteroid was performed, which provided pronounced alleviation of his symptoms, but only for a few days. Arthroscopy was subsequently recommended. He was found to have extensive tearing of the anterolateral labrum as well as associated grade IV articular fragmentation of the acetabulum, which was excised (see Figure 15.5B,C). Postoperatively, he experienced pronounced symptomatic improvement and was able to return to his normal sports activities for the following 6 years.

Case 6

A 69-year-old woman was referred with a 6-week history of spontaneous onset incapacitating sharp, stabbing right hip pain. Her history was remarkable in that she had undergone multiple screw fixation of a femoral neck fracture 9 years previously. However, she had been asymptomatic and unrestricted in her activities until her recent onset of symptoms. Radiographs revealed her fracture to be fully healed. Evidence suggested an intraarticular loose body, but also modest joint space narrowing (Figure 15.6 A). A CT scan further defined the extent of the intraarticular fragment (Figure 15.6B).

It was uncertain how much of her symptoms was simply due to the degenerative changes and how much might be attributable to the bone fragment. However, with her recent spontaneous onset of sharp stabbing pain and evidence of an intraarticu-lar fragment, it was thought that arthroscopy to retrieve the fragment was the next step in her management to remove this as a potential contributing source. At arthroscopy, the large loose body was identified and retrieved. However, there was also noted to be severe articular damage with grade IV changes of the acetabulum and grade III damage to the femoral head (see Figure 15.6C). Postopera-tively, the sharp stabbing symptoms were eliminated, but she continued to experience pain with daily activities. This was thought to be attributable to her underlying degenerative disease.

In this case, the patient experienced an acute episode of pain, mechanical symptoms, and clear evidence of an intraarticular loose body, all of which are normally good prognostic indicators of a potentially successful outcome of hip arthroscopy. However, radiographically, she had evidence of joint space loss reflecting underlying degenerative disease. In our experience, whenever there is radiographic evidence of degenerative disease, this is often the limiting factor in the response to ar-throscopy and should be considered an overriding poor prognostic indicator, even in the presence of more favorable clinical findings. Degenerative disease is also often a great imitator. It may present with gradually worsening activity-related symptoms, but also may present with the acute onset of pain in absence of any prodromal findings.


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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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