This 24-year-old professional player presents with progressive left hip pain and stiffness. This had been present for approximately six months. He has similar, but less significant, pain in his right hip. On examination, he was found to have pain with hip flexion beyond 90 degrees, reduced internal rotation (less than 10 degrees bilaterally) and pain with a quadrant test.
A CAM deformity and osteophytes are present on the femoral head and neck. MRI images show full-thickness cartilage loss involving the lateral 12 mm of the acetabular roof and anterior wall and also thinning of the articular cartilage on the anterosuperior aspect of the femoral head. There are ossicles in place of the superior and anterior labrum and small osteochondral bodies in the inferior aspect of the hip joint.
This player was reviewed by a number of medical and surgical specialists. He initially had a good response to physiotherapy, NSAID and a reduced training load and he was able to complete the season during which his symptoms developed. Unfortunately, his pain recurred during the subsequent pre-season and became worse. He then had transient relief from corticosteroid and PRP injections but was unable to return to normal training. He had several orthopaedic opinions and it was not felt that surgical treatment was indicated. He eventually had to retire 18 months after the onset of his pain.
Over the past decade, hip arthroscopies have been one of the fastest growing surgical procedures. In the United States alone, the number of procedures increased by more than 600% between the years 2006-2010. It is increasingly recognised that some patients do less well after this type of surgery and, as a result, the indications for surgical treatment are changing. A recent systematic review of outcomes following hip arthroscopy (for FAI) has shown a number of factors that may predict a good outcome following surgery. Younger patients, those who are male, have a lower BMI (<24.5 kg/m2), Tönnis grade 0 x-ray findings and who have pain relief from preoperative intra-articular hip injections are significantly more likely to achieve positive outcomes after hip arthroscopic surgery. There are also a number of factors that may predict a poor outcome post-arthroscopy. These include pre-operative evidence of OA (Tönnis Grade ≥ 2 or joint space <2 mm), increasing age, being female, the presence of chondral damage at the time of arthroscopy, a long duration of symptoms and a poor pre-operative non-arthritic hip score.
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