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What Does This MRI Report Of Right Hip Indicate?
Question: I had an MRA of my right hip done for severe pain with each step I take, what feels like almost constant dislocation with even the slightest move and when it dislocates, it locks and I can't get it back into place without almost screaming. I have had hip pain for 2 years but the severe pain and dislocation for about 4 months. Here is the impression from the MRI report:
MRI of the right hip demonstrates a frayed and degenerative labrum. No high grade tears or labral detachment. There is moderate thinning of the femoral and acetabular cartilage of the right hip with focal high grade fissure involving the superior anterior acetabulum with mild underlying subchondral cystic change. Similar change involving the posterior acetabulum.
Wilde field of view demonstrates similar findings in the left hip. Of note, there is a left superior femoral neck subcortical cyst, findings can be seen with impingement.
My question is since there is no tear or detachment, can this be fixed surgically? If so, will insurance approve surgery right away or only after wasting time on PT, etc. What does the focal high grade fissure mean and what does the cystic change mean? I am currently not having pain in my left hip, am I doomed to have the same problems in the left hip down the road? I have no quality of life and I'm miserable. Any help is appreciated.
MRI of the right hip demonstrates a frayed and degenerative labrum. No high grade tears or labral detachment. There is moderate thinning of the femoral and acetabular cartilage of the right hip with focal high grade fissure involving the superior anterior acetabulum with mild underlying subchondral cystic change. Similar change involving the posterior acetabulum.
Wilde field of view demonstrates similar findings in the left hip. Of note, there is a left superior femoral neck subcortical cyst, findings can be seen with impingement.
My question is since there is no tear or detachment, can this be fixed surgically? If so, will insurance approve surgery right away or only after wasting time on PT, etc. What does the focal high grade fissure mean and what does the cystic change mean? I am currently not having pain in my left hip, am I doomed to have the same problems in the left hip down the road? I have no quality of life and I'm miserable. Any help is appreciated.
Brief Answer:
Osteoarthritis both hips, Femoroacetabular impingement
Detailed Answer:
Hi there.
Welcome to Healthcare Magic.
Thanks for the query.
According to your history, physical symptoms and MRI scan report, you are suffering from arthritis of both your hips with concomitant Femoroacetabular impingement of the right hip.
In the right hip, there is a tear which is described as 'frayed and degenerative labrum'. This is a chronic low grade tear having occurred over few months to years. This cannot be fixed surgically but may need to be debrided or removed surgically. It can be done with a key hold arthroscopic procedure.
You also have subchondral cysts and thinning of the cartilage which indicates that arthritis of both the hips have set in. The high grade fissure in the acetabulum could be a part of impingement where the head of femur does not fit smoothly into the acetabular cup and as you move about, there is constant rubbing or irregular surfaces and damage to the cartilage and bone causing fissures.
Your left hip also shows changes of arthritis and impingement which could mean that the similar prognosis could be expected although a thorough physical examination is needed by your Orthopaedic surgeon to confirm the same.
The best treatment for this condition would be to replace the hip performing Total hip replacement surgery. Physiotherapy will not help in the long run.
I hope I have answered your query.
I will be available to answer your follow up queries.
Thanking you.
Regards,
Dr. Aashish Raghu
Kindly ask me further queries on my page at
http://www.healthcaremagic.com/doctors/dr-aashish-raghu/61955
Osteoarthritis both hips, Femoroacetabular impingement
Detailed Answer:
Hi there.
Welcome to Healthcare Magic.
Thanks for the query.
According to your history, physical symptoms and MRI scan report, you are suffering from arthritis of both your hips with concomitant Femoroacetabular impingement of the right hip.
In the right hip, there is a tear which is described as 'frayed and degenerative labrum'. This is a chronic low grade tear having occurred over few months to years. This cannot be fixed surgically but may need to be debrided or removed surgically. It can be done with a key hold arthroscopic procedure.
You also have subchondral cysts and thinning of the cartilage which indicates that arthritis of both the hips have set in. The high grade fissure in the acetabulum could be a part of impingement where the head of femur does not fit smoothly into the acetabular cup and as you move about, there is constant rubbing or irregular surfaces and damage to the cartilage and bone causing fissures.
Your left hip also shows changes of arthritis and impingement which could mean that the similar prognosis could be expected although a thorough physical examination is needed by your Orthopaedic surgeon to confirm the same.
The best treatment for this condition would be to replace the hip performing Total hip replacement surgery. Physiotherapy will not help in the long run.
I hope I have answered your query.
I will be available to answer your follow up queries.
Thanking you.
Regards,
Dr. Aashish Raghu
Kindly ask me further queries on my page at
http://www.healthcaremagic.com/doctors/dr-aashish-raghu/61955
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I am so pleased with your detailed answer. Thank you. I have attached a copy of the entire MRI report to include more than just the impression. It states in the report that no there is no evidence of femoral acetabular impingement in the right hip but your answer to me says that it's present. Can I have impingement based on my clinical symptoms even if the MRI says it's not present? My doctor said that I do have hip dysplasia and an extra calcium growth on the femoral head, like you mentioned. I guess I'm not sure exactly what impingement means. That means that the femoral head is not smooth and caused the damage to the cartilage with movement?
You also mention in your reply that the frayed labrum could be debrided surgically and you also mention towards the end of your reply that the best treatment would be a total hip replacement. Which surgery would I do first or are they done together or if I had the total hip replacement then I wouldn't need the debridement of the labrum? Did you mean a total hip replacement of my right hip now since it's the one giving me problems right now and then worry about the left hip later when symptoms present? Is my MRI of the right hip correlated with my physical symptoms bad enough right now to warrant surgery on the right hip now? I'm desperate for some kind of relief and really would like some type of surgical repair soon. If surgery in the near future is not warranted, do you recommend steroid injections into the hip for pain relief? I am sincerely thankful for your help and knowledge.
You also mention in your reply that the frayed labrum could be debrided surgically and you also mention towards the end of your reply that the best treatment would be a total hip replacement. Which surgery would I do first or are they done together or if I had the total hip replacement then I wouldn't need the debridement of the labrum? Did you mean a total hip replacement of my right hip now since it's the one giving me problems right now and then worry about the left hip later when symptoms present? Is my MRI of the right hip correlated with my physical symptoms bad enough right now to warrant surgery on the right hip now? I'm desperate for some kind of relief and really would like some type of surgical repair soon. If surgery in the near future is not warranted, do you recommend steroid injections into the hip for pain relief? I am sincerely thankful for your help and knowledge.
Brief Answer:
Need for surgery decided by the severity of the symptoms
Detailed Answer:
Hi there.
Thanks for the follow up query.
According to the MRI Report, there is a frayed and degenerated labrum. This occurs in degenerative joint disease and osteoarthritic conditions of the hip.
Impingement does not seem to be present in your Reports and needs to be clinically assessed by an Orthopaedic surgeon for confirmation. Impingement means non-smooth movement of the joint due to some obstruction coming from the head of the femur or the acetabulum which can cause restriction in full normal movement of the hip.
You have moderate arthritis changes according to the MRI but if you have severe disabling pain and difficulty in carrying out your daily activities, then a total hip replacement with debridement of the degenerated labrum can be done in the same sitting which will extinguish the pain and suffering, but will provide you limitations. The limitations are you not being allowed to sit cross legged, squat or kneel down because these activities can cause dislocation of the artificial hip and a risk of revision surgery.
The left hip can be catered to once more severe symptoms develop or you can get it operated in concert with the right, after discussing the pros and cons of such procedure after a thorough evaluation of your physical and functional status by your Orthopaedic surgeon.
I hope I have answered your query.
I will be available to answer your follow up queries.
Thanking you.
Regards,
Dr. Aashish Raghu
Need for surgery decided by the severity of the symptoms
Detailed Answer:
Hi there.
Thanks for the follow up query.
According to the MRI Report, there is a frayed and degenerated labrum. This occurs in degenerative joint disease and osteoarthritic conditions of the hip.
Impingement does not seem to be present in your Reports and needs to be clinically assessed by an Orthopaedic surgeon for confirmation. Impingement means non-smooth movement of the joint due to some obstruction coming from the head of the femur or the acetabulum which can cause restriction in full normal movement of the hip.
You have moderate arthritis changes according to the MRI but if you have severe disabling pain and difficulty in carrying out your daily activities, then a total hip replacement with debridement of the degenerated labrum can be done in the same sitting which will extinguish the pain and suffering, but will provide you limitations. The limitations are you not being allowed to sit cross legged, squat or kneel down because these activities can cause dislocation of the artificial hip and a risk of revision surgery.
The left hip can be catered to once more severe symptoms develop or you can get it operated in concert with the right, after discussing the pros and cons of such procedure after a thorough evaluation of your physical and functional status by your Orthopaedic surgeon.
I hope I have answered your query.
I will be available to answer your follow up queries.
Thanking you.
Regards,
Dr. Aashish Raghu
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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