I had arthroscopy 6 months ago to address a labral tear and FAI impingement. Has been extremey bothersome but tolerable from 3mos on, but tecently presented with increasing severe hip pain and inability to bear weight. After fluoroscopy and MRA this week, the findings were as follows:
1. Post surgical change involves the right hip joint capsule and right proximal femur.
2. Innumerable small loose bodies are present within the joint, as discussed (*See below)
3. Moderate- sized areas of high- grade cartilage loss involving the right superior hip.
4. Superolateral acetabulum is detached. Anterior labrum is enlarged and appears degenerated.
5. Moderate patchy marrow edema. throughout the femoral head, nonspecific, possibly related to overlying cartilage loss.
Haven't been contacted by my orthopedic surgeons yet, and guessing that this will require all sorts of additional surgery to fix and minimize pain, but any opinions/advice on what these findings are from those in the Orthopedic world are welcome! Cartilage loss and the patchy edema are especially baffling, as well as the foreign bodies.
Also of huge concern is the fluid that spontaneously came out of my hip joint capsule, but that's another story and pathology hasn't come back from that sample yet so i'm unsure if it's fluid from infection. I'll include those notes below also (**)
(*Within the joint anteriorly, innumerable small low signal bodies are present. A few small bodies are present in the joint
superolaterally, in the region of the capsular defect. The largest bodies measure 6 x 2mm, 5 x 1.5 mm, 4 mm, and 6 x 2 mm. Some of these small foci of intra-articular low Tl signal may be related to synovitis. Moderate amount of contrast is seen in the iliopsoas bursa. Right hip joint is extremely capacious.
Deficiency of the joint capsule anteriorly and laterally Large amount of injected
contrast extends into the soft tissues anteriorly and laterally. This capsular deficiency is presumably related to prior surgery.
Patchy marrow edema is present in the femoral head. Moderate sized area of cartilage loss involves the right superior
femoral head Cartilage loss also involves the superior acetabulum
**An appropriate skin entry site over the right femoral neck was selected. The skin and subcutaneous soft tissues were then anesthetized with lidocaine. Subsequently, a 22-gauge spinal needle was advanced to the cortical surface of the right femoral neck There is spontaneous drainage of a small quantity of a yellow serous fluidat the time of the needle placement. This was not obtained with aspiration but spontaneously drained. A total volume of 12 cc consisting of 5 cc of marcaine and 7 cc of a standard dilute gadolinium, 1% lidocaine, and iodinated contrast was injected into the right hip joint. Intraarticular
localization was confirmed with fluoroscopy.
1. Post surgical change involves the right hip joint capsule and right proximal femur.
2. Innumerable small loose bodies are present within the joint, as discussed (*See below)
3. Moderate- sized areas of high- grade cartilage loss involving the right superior hip.
4. Superolateral acetabulum is detached. Anterior labrum is enlarged and appears degenerated.
5. Moderate patchy marrow edema. throughout the femoral head, nonspecific, possibly related to overlying cartilage loss.
Haven't been contacted by my orthopedic surgeons yet, and guessing that this will require all sorts of additional surgery to fix and minimize pain, but any opinions/advice on what these findings are from those in the Orthopedic world are welcome! Cartilage loss and the patchy edema are especially baffling, as well as the foreign bodies.
Also of huge concern is the fluid that spontaneously came out of my hip joint capsule, but that's another story and pathology hasn't come back from that sample yet so i'm unsure if it's fluid from infection. I'll include those notes below also (**)
(*Within the joint anteriorly, innumerable small low signal bodies are present. A few small bodies are present in the joint
superolaterally, in the region of the capsular defect. The largest bodies measure 6 x 2mm, 5 x 1.5 mm, 4 mm, and 6 x 2 mm. Some of these small foci of intra-articular low Tl signal may be related to synovitis. Moderate amount of contrast is seen in the iliopsoas bursa. Right hip joint is extremely capacious.
Deficiency of the joint capsule anteriorly and laterally Large amount of injected
contrast extends into the soft tissues anteriorly and laterally. This capsular deficiency is presumably related to prior surgery.
Patchy marrow edema is present in the femoral head. Moderate sized area of cartilage loss involves the right superior
femoral head Cartilage loss also involves the superior acetabulum
**An appropriate skin entry site over the right femoral neck was selected. The skin and subcutaneous soft tissues were then anesthetized with lidocaine. Subsequently, a 22-gauge spinal needle was advanced to the cortical surface of the right femoral neck There is spontaneous drainage of a small quantity of a yellow serous fluidat the time of the needle placement. This was not obtained with aspiration but spontaneously drained. A total volume of 12 cc consisting of 5 cc of marcaine and 7 cc of a standard dilute gadolinium, 1% lidocaine, and iodinated contrast was injected into the right hip joint. Intraarticular
localization was confirmed with fluoroscopy.
