HIP INJURY -- WRESTLING

Abstract

HISTORY: A 21-year-old college wrestler presented with progressive, persistent pain in his right hip after undergoing arthroscopy at an outside institution. Despite multiple attempts at non-operative management, including activity modification, rest, physical therapy, and use of nonsteroidal anti-inflammatory drugs, pain and stiffness limited his sport-specific function. PHYSICAL EXAMINATION: Markedly limited active range of motion, particularly with hip flexion beyond 90 degrees; pain with range of motion DIFFERENTIAL DIAGNOSIS: 1. Chondral injury to femoral head 2. Injury (recurrence of tear) to acetabular labrum 3. Persistent cam type impingement of right hip 4. Chondromalacia of right acetabulum TEST AND RESULTS: Plain radiographs of pelvis and both hips MRI of right hip MR-arthrogram of right hip Results of all imaging studies were consistent with early progression of osteoarthritis, with changes considered advanced for a patient of his age. FINAL/WORKING DIAGNOSIS: Chondral injury and heterotopic ossification (HO) secondary to chronic cam type femoroacetabular impingement TREATMENT AND OUTCOMES: 1. Right hip revision arthroscopy with labral resection and labral reconstruction with allograft tissue 2. Right hip revision arthroscopic cheilectomy/femoroplasty 3. Right hip arthroscopic excision of HO fragment measuring 3 cm x 2 cm in anterior lateral joint capsule 4. Right hip arthroscopic chondroplasty of acetabulum with microfracture/bone marrow stimulation procedure 5. Immediate post-operative physical therapy (day of surgery) 6. Single dose of external beam radiation on post-operative day 1 to minimize risk of recurrence of HO 7. 20 pounds flat foot weightbearing restriction for six weeks 8. Naproxen 375 mg bid x 6 weeks to minimize risk or recurrence of HO 9. Continuous passive motion in immediate post-operative period