Pathology

Pathology

Conditions in and around the hip

Routine investigations for patients with suspected hip pathology include:
- AP pelvis x-ray and a true lateral view of the femoral neck
- High resolution 3-D reconstructed CT scan of the hip
- MRI of the hip with saggital, coronal and axial reconstructions
- MR arthrogram of the hip with saggital, coronal and axial reconstructions

FAI - X-Rays, CT Scans & MR Arthrogram
	Pelvis x-ray
	CT scan Femoroacetabular impingement (FAI) left hip with large impingement lesion Early osteoarthritis

Pelvis X-Ray
	Bilateral impingement lesions on pelvis x-ray Patient only symptomatic on right side!

CT & 3D CT Scans
	CT scan showing femoroacetabular impingement (FAI) 3-D reconstructed CT scan showing femoroacetabular impingement

3-D reconstructed CT scan of patient with symptoms of femoroacetabular impingement

Diagnosis = Os acetabulare – a loose fragment of bone at the rim of the hip socket

MR Arthrogram of left hip
	MR arthrogram of hip Labral tear
	Loss of sphericity of femoral head Impingement lesion

Acetabular labrum

The labrum is a ring of fibrocartilage ‘grisel’ around the rim of the socket. It is frequently torn by injury or as part of femoroacetabular impingement (FAI). It may also degenerate with wear and tear

X-rays of FAI
	Normal labrum seen at hip arthroscopy Degenerate labral tear prior to treatment

Ligamentum Teres

The ligamentum teres is a structure deep inside the hip joining the femoral head to the base of the socket
Acute injuries may cause ligamentum teres tears or they can gradually occur with wear and tear


	Ligamentum teres partial tear viewed at hip arthroscopy prior to debridement

Articular cartilage

Articular cartilage is the slippery surface of the joint. The smooth surfaces of the ball and socket which glide over one another as the joint moves.


	Cartilage damage is usually caused by trauma or wear and tear and varies in severity normal cartilage
	Delaminated cartilage (cartilage peeling away from bone)


	Degenerate flap tear (damaged cartilage)
	Completely worn out cartilage exposing subchondral bone

Acetabular Microfracture

One of the treatments for localised full thickness cartilage loss in an area is acetabular microfracture
This causes bleeding into the defect which stimulates a healing response. A fibrocartilage scar forms over the area


	See at Hip Arthroscopy

Osteoarthritis

While short term relief of mechanical symptoms can often be gained, hip arthroscopy is not a long-term solution to arthritis


	Widespread cartilage loss on the ball and socket
	Degenerate tears of labrum and ligamentum teres


	Rim and central osteophytes
	Loose bodies

Synovitis


	The lining of the hip joint becomes irritated and inflamed often by various conditions in the joint It is associated with other conditions, but may be the main cause of pain It is frequently debrided at hip arthroscopy See at Hip Arthroscopy

Femoroacetabular impingement lesions

These ‘bumps’ on the femoral neck impact on the rim of the socket causing pain, labral tears and cartilage damage
They are painless, but cause symptoms by the damage they inflict
Excision of the impingement lesion is part of the treatment of femoroacetabular impingement, along with treatment of the damaged labrum and cartilage
These are some impingement lesions at the head/neck junction viewed at hip arthroscopy prior to removal

Loose bodies

Loose bodies frequently cause painful mechanical symptoms inside the hip
They may arise from a loose piece of bone after an injury, or as part of an underlying condition such as arthritis or synovial chondromatosis
Loose bodies viewed at hip arthroscopy and removal