Ultrasound-Guided Pulse Lavage for Heterotopic Ossification After Prior Hip Arthroscopy: A Case Report.

Abstract

Femoroacetabular impingement (FAI) is an increasingly recognized form of hip pathology in young patients with hip pain1,2. FAI is most commonly caused by abnormal developmental morphology of the proximal aspect of the femur or the acetabulum. There are numerous other etiologies that produce abnormal contact between the femur and the acetabulum. These include prior femoral neck fracture, prior acetabular or femoral osteotomy, acetabular retroversion, and a slipped capital femoral epiphysis3. Ganz et al. provided three classifications of FAI: cam, pincer, or mixed type4. Cam impingement is characterized by a prominence of the femoral neck that impinges onto the acetabulum, resulting in damage to the labrum. The pincer type is characterized by acetabular overcoverage as the mechanism of impingement on a normal femoral head or neck. The mixed type includes aspects of both. All three types follow a common pathway of abnormal morphology, leading to abnormal contact and, as a result, labrum and cartilage damage. Hip arthroscopy has become a widely used tool to treat FAI5-7. An arthroscopic procedure is a minimally invasive way to treat the causative pathology in cam and pincer-type impingement; it also treats the symptomatic lesion, including labral tears and cartilage damage. Despite its clinical advantages compared with open treatment, hip arthroscopy is associated with complications, including traction nerve injury, extra-abdominal fluid extravasation, osteonecrosis, infection, femoral neck fracture, hip instability, and heterotopic ossification (HO)2,5,6,8-10. Incidence of HO has been reported to range from less than 1% to 6.3% in several series2,5,6,8-10. Strategies for limiting HO have included postoperative nonsteroidal anti-inflammatory drugs (NSAIDs) or …