0:01

Let's move to our second case and kind of tie it with the third and the

0:05

fourth case,

0:07

kind of talking about morphology of the hip and the things that can go

0:12

wrong when there's incongruity between the acetabulum and, uh,

0:17

femoral head.

0:19

So these cases are all respectively,

0:23

73 year old, a 31 year old, and a 67 year old,

0:27

all complaining of hip pain. So we'll pull up the, uh,

0:31

first case we see here in, in this case, that the, uh,

0:35

the femoral head is, uh, quite, uh,

0:38

or relatively enlarged relative to the acetabulum. And,

0:42

uh, some would argue that this is, may, may be a touch of Cox of mag, but I,

0:47

I'd like to see also a radiograph for this. But the more salient, uh,

0:51

the al the additional salient findings for this case is, uh,

0:55

I wanna point out that this, uh,

0:56

there's already some cartilage loss and some subc chondral cystic change

1:01

and, and osteophytic bone edema at the acetabular limbus sup

1:06

laterally. But also in this, uh, 73 year old, there's also some,

1:11

uh, tearing of the, uh, acid tabular labrum right here,

1:16

superiorly, as well as, uh, anterior superiorly,

1:20

anterior superiorly is probably the most common, uh, location of, uh,

1:24

acetabular, uh, these acetabular labeled tears.

1:27

And what I tell my trainees in, uh, here, uh,

1:30

when I'm reading out the hips with them, for the most part, you always, uh,

1:36

quite often, more often than not, you're, you're, you're gonna see these tears,

1:39

uh, anterior superiorly. The a anterior acet is typically gonna be,

1:44

uh, smaller than the posterior. And for whatever reasons it happens,

1:49

uh, most commonly here, I, I would say anterior superiorly. But, uh,

1:54

the, the important thing here is, um,

1:57

we can talk about the center edge angle, which, uh, uh,

2:03

from, depending on who you read or how, uh,

2:05

sensitive specific you want to be normal is gonna be about 20 to 25, uh,

2:10

degrees. And if you have under coverage and, uh,

2:14

an up sloping or vertically oriented acetabulum, you know,

2:19

something like this, let's say, then you're gonna worry about, uh,

2:22

DDH or developmental, uh, dysplasia of the hip.

2:25

Other things that you can see with that are gonna be cox magna.

2:28

But unfortunately in this, uh, patient that probably,

2:31

or possibly went underdiagnosed when they were younger,

2:34

they've gone on to develop osteoporosis here.

2:38

And if you try to address these lesions with perhaps, uh, uh,

2:42

Perce tablet or osteoplasty or, or other things, um,

2:46

unfortunately this person's already lost cartilage. Um, you know, what,

2:51

what we're trying to preserve and the whole point of a lot of the, uh,

2:55

sports imaging and MSK imaging that we do, and, uh, along with the, uh,

3:00

labral tear.