Management of hip pain in a 68 year-old woman

Total Hip replacement
Management of hip pain in a 68 year-old woman

The goals of this clinical case are to discuss the causes of a hip pain, to discuss the different therapeutic options, and to expose the posterior mini-invasive approach.​

Escaldes, ANDORRA
Hospital Nostra senyora de Meritxell
CHU Toulouse, FRANCE
Course Director

Professor Reina is Head of Hip and Trauma department, of the University Hospital in Toulouse, France. He holds a PhD in Anthropobiology. He completed a fellowship in Oxford, UK and worked in Mayo Clinic, Rochester for research.

His main focus is hip & pelvis surgery. His clinical practice comprises conservative surgery, primary and complex revision total hip arthroplasty as well as trauma for complex acetabular fractures.

Board member of French Hip Knee Surgery, he is also member of the European Hip Society and the International Board of the American Association of Hip Knee Surgeons. He published more than 150 peer reviewed publications and book chapters, and lectured in various international conferences. His research interests integrate big data in orthopedics, modern care in hip surgery such as minimally invasive techniques, and musculoskeletal system’s ability to adapt to its environment (biomechanics and anthropological variability).

Part one
Clinical presentation
  • 68 Y.O active female
  • BMI = 24
  • Her complaint is a disabling left hip pain evolving for 4 years
  • She walks without a cane but has a dodging limp
  • On physical examination, she presents a positive FADIR test and a positive FABER test. No signs of tendinosis are associated.
Pre-op X-rays
Pre-op X-rays
Pre-op X-rays
Pre-op X-rays

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In front of those disabling symptoms, a CT-scan is prescribed


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Part two
Final strategy decision : Total Hip Replacement

What pathology can be diagnosed?

  • Tonnis 1 Hip osteoarthritis ✔️
  • Coxa profunda ✔️
Tonnis 1 Hip osteoarthritis

What are the reasons of the patient’s condition?

  • Femoroacetabular impingement Pincer type ✔️
  • Anterior hip osteoarthritis ✔️

Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010 May;92(5):1162-9. doi: 10.2106/JBJS.H.01674. PMID: 20439662.

How would you manage this condition?

  • Total Hip Replacement ✔️

de Boer SF, Bouma HW, Pollard TC, Van Kampen PM, Carr AJ, Hogervorst T. Coxa recta, coxa profunda and abductor ratio: hip morphology variants compared in an arthroplasty and control population. Hip Int. 2013 May-Jun;23(3):287-92. doi: 10.5301/hipint.5000012. Epub 2013 Feb 14. PMID: 23417530.

Final strategy decision

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