A 30-year-old woman with no medical history except left hip arthroscopy for femoroacetabular impingement 5 years ago, is suffering from groin pain. After checking the X-rays and CT scan, what is your diagnosis? Why has the hip scope failed and how would you manage this case?
- 30 yo female, physiotherapist
- No medical history except left hip arthroscopy for femoroacetabular impingement 5 years ago
- Groin pain in sitting and during sports activities, getting worse
- Had 3 hip injections of cortisone that provided relief but during a short time
- Physical exam: Flexion 100°, IR in flexion 5°, ER in flexion 40°
- FADIR +++ in the groin, FABER -, apprehension test and PART test –
Standard - X-rays
3D CT-scan
- Femoral version : +15°
- Tibial torsion: +30°
What is your diagnosis?
- ✔️ Femoro acetabular impingement Pincer type By TRUE acetabular retroversion (acetabular posterior dysplasia)
3 signs: cross-over sign, ischial spine sign, posterior wall sign
Retroversion index > 30%
Why has the hip scope failed?
- ✔️Wrong indication
Probably because true retroversion and femoroplasty are not enough in this case.
Acetabuloplasty is contra-indicated in this case because the surface of the acetabulum is good, it’s just the orientation that is not and needs to be addressed.
What is your surgical management?
✔️Anteverting Peri Acetabular Osteotomy
Anteverting/reverse PAO
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