0:00

And, uh, before we take questions,

0:02

they'll just slide right into the fourth case.

0:05

Hopefully tie everything together with all these sort of measurements with, uh,

0:09

femoral acetate, impingement, whatnot. So, rounding out with the other spectrum,

0:14

uh, of FAI, which is, uh,

0:17

we talked about the cam here we are gonna talk about the pincer type,

0:21

but basically you have, what happens here is you have an over coverage. Uh,

0:26

basically the, uh, femoral head is more normal size,

0:31

but now the ace tablum is basically like a, uh,

0:36

uh, uh, uh, uh, a crustaceans claw, if you will,

0:40

is over covering and really surrounding the, the, uh, the, uh,

0:45

spherical femoral head. And that can lead to an incongruent and,

0:49

and joint problems and, and mobility there so that you can measure by,

0:54

uh, uh, also the center edge angle. And again, uh,

0:57

normal is gonna be about 20 to 25 degrees over coverage,

1:01

depending on who you read is gonna be about, uh, 40 degrees. Um,

1:06

so if you kind of drop a, uh, an angle, uh,

1:11

from the center to,

1:16

uh, of the femoral head out to the acetabular limbus

1:21

region. So in this case, we kind of get about 60 degrees.

1:25

So that's certainly over coverage and some other things you can see here,

1:30

okay, obviously is the labral tear with associated paralabral cyst,

1:34

Anter superiorly. Okay. Uh, some other angles that you could, uh,

1:39

measure, uh, as provided in the literature. I believe it was by, uh,

1:44

Toni and, uh, perhaps, uh, ley. Uh,

1:48

but I would have to double check that. But you can measure the, uh, uh,

1:53

retroversion or as version or asked to have their version angle. And that, uh,

1:58

typically is gonna be, uh,

2:00

about 12 to 20 degrees, if I remember correctly.

2:04

But the way you measure that is you could drop down to the center, uh,

2:10

angle, okay? And, um, or the center of the femoral head,

2:15

and you basically, sorry, measure the, uh,

2:20

the anterior and posterior rims of the acetabulum. Okay?

2:25

And normally it's gonna be about 12 to 20 degrees, depending on who you read.

2:29

There are other authors that have also come along and also given

2:34

measurements are used, um, a similar concept, but they use,

2:39

uh, uh, a measure, they take a measurement,

2:41

typically higher up at about five millimeters or so below the

2:45

acetabular roof. And forgive me, but I, I forget the normals for that.

2:49

But again, as you can imagine, uh, you,

2:52

you can look for this acetabular over coverage or this pincer type, uh,

2:56

femoral acetate impingement. Now mind you,

2:58

You can have a global, uh, uh, pincer type where you have,

3:03

uh, over coverage, uh, uh,

3:05

pretty much over the entire femoral head as I understand it.

3:09

Or you can have focal areas, uh, of, uh, pincer type or,

3:13

or over coverage as well. And radiographically, that's, um,

3:18

you can pick that out or try to pick that out, uh, this diagnosis with the, uh,

3:23

figure of eight sign and, and things like that. But, uh, happily, uh,

3:27

share some of those, uh, you know, articles with y'all. Um, and, uh,

3:32

with that, I will pause for a moment and take any cases, uh, or, uh,

3:37

if anyone wants to discuss cases two through four, DDH,

3:41

and the various types of, um, uh,

3:44

hip impingement and obviously, sorry, these are also having to do with more,

3:50

uh, intraarticular, also extra-articular forms, you know, such as subs,

3:54

spine impingement, uh, you know, femoral acetabular impingement, uh, uh,

3:59

is issue femoral impingement, more distally and medially, things like that.

4:03

So there,

4:04

there are other forms of impingement of the hip and causes the hip pain.