Hip Impingement Indianapolis, IN | Femoroplasty Mooresville, IN

This patient had experienced so much repetitive hip impingement that they had worn a

groove (blue arrows) into the femur side of the hip joint. Ouch! This was successfully

smoothed away with a femoroplasty (bottom image)

Hip arthroscopy example

Before: cam deformity on the femur causing

painful hip impingement. The femoral head

should be spherical. The cam ‘bump’ (the bone

outside of the circle) pinches against hip labrum

and acetabulum (socket) which can cause pain,

labrum tears, and cartilage damage!

After: arthroscopic reshaping of the femur. There

is now a smooth spherical shape. This eliminates

hip impingement and minimizes the risk of re-

injury to the hip labrum.

Hip arthroscopy example

Before: cam deformity on the femur causing

painful hip impingement. The femoral head

should be spherical. The cam ‘bump’ (the bone

outside of the circle) pinches against hip labrum

and acetabulum (socket) which can cause pain,

labrum tears, and cartilage damage!

After: arthroscopic reshaping of the femur. There

is now a smooth spherical shape. This eliminates

hip impingement and minimizes the risk of hip re

-injury.

The most common cause of failed hip arthroscopy is inadequate removal of bone that causing hip

impingement. This is an example of a revision hip arthroscopy I performed to remove a cam bump

that was still present after a hip arthroscopy done elsewhere. The patient recovered well and had

relief of their hip pain.

Before: cam deformity on the femur causing

painful hip impingement. The femoral head

should be spherical. The cam ‘bump’ (the bone

outside of the circle) pinches against hip labrum

and acetabulum (socket) which can cause pain,

labrum tears, and cartilage damage!

After: arthroscopic reshaping of the femur. There

is now a smooth spherical shape. This eliminates

hip impingement and minimizes the risk of hip re

-injury.

Revision hip arthroscopy example

Case example: arthroscopic labrum tear

Before: acetabular labrum tear. This patient also

had hip dysplasia (shallow hip socket) which

causes development of a large, easily torn

labrum.

After: successful arthroscopic labrum repair. The

patient also underwent a periacetabular

osteotomy (PAO) with my practice partner Dr.

Todd McKinley to treat the hip dysplasia. The

patient recovered well and is back to her preferred

physical activities.

Revision hip arthroscopy with labrum re-repair. The patient’s cam bump on the

femur (ball) side of the hip joint had not been removed during the first hip

arthroscopy performed elsewhere. This this led to a recurrent labrum tear.

Re-torn labrum (white structure at top of image) Re-repaired labrum with sutures

Cam bump on the femur. I reshape the femur with

A special arthroscopic burr (metal object in imag)

Femur after cam bump removal. The good

femoroplasty (femur reshaping) should have a

gentle slope like this.

Femur (ball) side of the hip joint

after arthroscopic reshaping by me.

A well-done fermoroplasty should

have smooth, gentle slope like this

to mimic the normal spherical

shape of a femur that is not prone

to hip impingement.

Hip arthroscopy is a difficult surgery and it is easy for surgeons

without enough experience with this procedure to make

technical errors! This is an example of a poorly performed

femur reshaping (femoroplasty) from a hip arthroscopy done

elsewhere. Too much bone was removed right next to the

cartilage (note what looks like a ‘cliff’ on the right side), and

not enough bone was removed away from the cartilage (note

the bone that the metal instrument is touching on the left

side). I performed revision hip arthroscopy and reshaped the

femur surface to give it a gentler slope that is more like the

natural shape of a hip that is not prone to hip impingement

Too much bone

removed

Not enough

bone removed

Patients can also have hip impingement and labrum tears from too much bone along the rim of the

acetabulum (hip socket). This is called ‘pincer’ impingment. In this example there is a torn, irritated

labrum and too much bone long the rim. I first moved the labrum out of the way to avoid damaging it.

Then I removed the excess bone along the rim of the socket (acetabulum). This is called an

acetabuloplasty. Finally, I repaired the labrum tear with sutures.

Labrum tear I peeled the torn labrum off of the rim of the socket to

avoid damaging it further when removing the excess

bone from the rim of the socket.

I removed the excess bone from the rim of

the hip socket (acetabulum) . Now there is a

smooth surface at the rim (blue arrow)

I repaired the labrum back to the rim of the acetabulum

Example of an arthroscopic labrum repair

performed by me

In some rare cases, chronic labrum inflammation and injury can cause the tissue to

turn into bone. Part of this patient’s labrum had turned into bone. This can’t be

repaired. I had to remove the abnormal labrum tissue and preform a labrum

reconstruction. This involves removing the irreparable labrum and replacing it with

tendon tissue. When performed for the right reasons, recent clinical studies have

shown that labrum reconstruction patients can do as well as patients that were able

to have a regular labrum repair!

Labrum turned into bone

Healthy labrum

Labrum turned

into bone

Removal of the

part of the

labrum that had

turned into bone

Reconstructed

labrum with

tendon tissue

Hip arthroscopy is a difficult surgery. It is easy for surgeons without enough experience with this procedure to

make technical errors! This is an example of a poorly performed hip socket reshaping (acetabuloplasty) from a hip

arthroscopy done elsewhere. The acetabuloplasty had not been finished all the way around the rim, resulting in a

shelf of bone and continued impingement (pincer impingement). I performed revision hip arthroscopy and

reshaped the rim of the acetabulum to give it a smooth contour and remove any remaining cause of hip

impingement. The labrum tissue was badly damaged from the pincer impingement and required a labrum

reconstruction. This involves replacing the irreparably damaged labrum tissue with tendon tissue. When

performed for the right reasons, recent clinical studies have shown that labrum reconstruction patients can do as

well as patients that were able to have a regular labrum repair!

Healthy joint surface (cartilage)

Severely damaged

labrum with sutures

from previous labrum

repair done elsewhere

The rim of the acetabulum had

not been reshaped properly and

there was shelf of bone where

the previous acetabuloplasty had

stopped

I revised the

acetabuloplasty to

make a smooth rim and

remove any remaining

cause of impingement

I reconstructed the labrum

with tendon tissue to replace

the severely damaged labrum