FAI Repair Case Study

PROCEDURE IN DETAIL: The patient was brought into the operating room, after satisfactory anesthesia, was placed in the left lateral dicubitis position. The right hip was prepped and draped. A previous made incision was reopened over the greater trochanter and carried down to Illiotibial (IT) band. The IT band was opened in the direction of the skin incision. The anterior 1/3 of the gluteus medius/minimus group was reflected off the trochanter over to the anterior brim of the pelvis. The hip was dislocated. The femoral component was easily removed. It was loose in the cement. The polyethylene was loose and easily removed. There was a lot of cement in and around the acetabulum. We debridement most of this. There was a wired mesh plug that went medially into the pelvis that was left in place. There was also one in the ishium that was quite stable and it was left in place. There was a large defect in the medial wall of the acetabulum about the size of a silver dollar.

During the weeks of February 7 through February 17, I observed a total hip arthroplasty on a 56-year-old Caucasian female patient who suffered from a femoral neck fracture and damage to the acetabulum. The fracture was a result from a car accident where the patient's knees collided with the dashboard, forcing the femur into the hip and breaking the femur.

Dr. Justin Clayton at the Mercy Clinic Orthopedic Surgery evaluated the claimant on April 6, 2018. Dr. Clayton stated the claimant may have rheumatoid disease and prescribe him Meloxicam. In addition, he reported the claimant would be referred for further arthritis evaluation (Ex. 23F).

HPI: S.J. is a 67 y/o Caucasian male with a history of left hip pain for two years. He has difficulty walking due to left hip pain and utilizes a cane, can walk five blocks, climbs stairs leading with the right leg. He denies any surgeries on the left lower extremity. He sought physical therapy, but he does not feel that it is improving his pain but does believe it is improving his strength. He is scheduled for a left total hip arthroplasty due to the progression of severe osteoarthritis of the left hip as confirmed by a pelvic x-ray and MRI of the lower extremity without contrast. S.J. has taken various medications that are listed on the current medication section of this note.

Musculoskeletal System: Patient denies having history of arthritis or gout. She also denies the presence of pain, stiffness, swelling, deformity, limitation of motion,

Per the AME report dated 07/08/15, the patient was deemed P & S with regard to her right knee and lumbar spine as of this date. Future medical care includes ongoing exercise program, occasional orthopedic visits, brief periods of PT, anti-inflammatory medications for flares, prescription medications and periodic injections.

Patient continues to manage pain with medications which brings the pain intensity from 7/10 on an average down to 3-4/10 and allows her to continue activities of daily living (ADLs) with less pain and stiffness. Patient states that without medications, she will not be able to function or move due to increase pain

The patient tells me she has been doing reasonably well over the summer. She is still feeling better off of the simvastatin than she was on the simvastatin, which was causing a lot of muscle aching. She feels now that she just has her typical fibromyalgia type of pain, as well as her arthritis pain. She has known osteoarthritis in her right knee, underwent a total knee replacement back in 2011, still struggles with pain in that area. She has been to see Dr. Sastry in the last couple of months, though I do not have a report from that visit. He did some x-rays, which reportedly showed everything was okay and she was recommended to go to physical therapy, which she thinks actually helps quite a bit. When she does the exercises, her knee feels better. The patient also has a history of lumbar spinal stenosis, has been seeing Interventional Spine, has received injections in her back, which she feels are helpful, somewhat. She thinks the physical therapy, which she also had used for her back, helps as well. She has started back with a chiropractor, which she thinks is also very helpful. These pains somewhat limit her exercise, though she tries to walk

The patient’s pain has clearly lasted beyond the anticipated time of healing. Previous methods of treating chronic pain have been unsuccessful and there is an absence of other significant options likely to result in significant clinical improvement. She has had conservative care including pain medication, braces/casts, physical therapy, transcutaneous electrical nerve stimulation unit (TENS), massage, exercise program, acupuncture, and chiropractic therapy. She is currently not a surgical

The problems that are identified in 56-year-old Jonathon are painful, swollen, erythematous of the knee with periarticular involvement, high blood pressure of 191/112, high cholesterol of 300 mg/dl, and obesity. The differential diagnoses for Jonathon are osteoarthritis, acute monoarthritis, and Gout. I believe that Jonathan’s primary diagnosis is osteoarthritis. Osteoarthritis is a degenerative joint disease that affects cartilage between bones, which may restrict movement and leads to pain, stiffness, swelling, and inflammation (Thakur, Mande, & Mitra (2014). According to Kullich, Overbeck, & Spiegel (20130, osteoarthritis is associated with pain with weight bearing, but it can be experienced during rest as the disease become more advanced. Being that Jonathan is a retired mechanic, his knee problem could have stemmed from his previous occupation and his knee possibly developed normal wear and tear due to frequent required bending from his last job. Jonathan weighs 310 lbs, his problem could have

If no further damage found, patient treated with aforementioned immobilization. Further damage underwent arthroscopic or open surgery

According to the orthopedic QME on 7/9/13, future medical care includes inflammation medicine, occasional pain medication, muscle relaxants, occasional injections, left shoulder surgery, physical therapy and occasional orthopedic doctor visit. Additional physical therapy has been included in the patient’s future medical care on 11/6/14 evaluation.

Cam impingement is more common in young men, presenting at an average age of 32 years. Athletes that are involved in high-impact sports, such as soccer, basketball and ice hockey, during adolescence have a higher prevalence of cam-type FAI as compared to non-athletes [13, 14]. This may be due to increased stresses on the femoral head while the physis of the femoral head is still developing. Another theory is that it may be due to new bone formation at the anterosuperior head-neck junction. Paediatric hip diseases such as Slipped Capital Femoral Epiphysis [7] and Calve-Perthes [8] have been associated with an increased incidence of FAI. Other factors which may influence impingement includes an abnormal femoral head neck offset, pistol grip deformity,

However, our study revealed that all patients who dislocated their hemiarthroplasty were from ASA grade III compared to 62.9 % patients with ASA grade III in non-dislocation group. This 100% representation of ASA Grade III in dislocation group in our study is much higher than our usual patient group as well as ASA grades in fracture neck of femur patients published in literature.

The patient is a 70-year-old gentleman that presented to the ED complaining of inability to walk because of right hip pain. The patient was seen in the emergency room on 11/20/16, was given Tylenol 3 discharged with pain meds after hip x-rays reported as being negative. The patient continued to be in great pain and could not bear the pain any longer and in fact had an appointment with his pain management physician and could not get there it was increased with any movement and not relieved by Percocet. His comorbid conditions are asthma, congestive heart failure, hypertension, morbid obesity, dyslipidemias and obstructive sleep apnea. He has also a right inguinal hernia repair, back surgery a number of years ago. Upon admission it is noted that he has intractable right hip