Fig. 3—

36-year-old man with gradually increasing bilateral groin pain over 2 years. Case shows value of MRI in surgical decision-making for patients with early signs of osteoarthritis on radiographs.

A, Anteroposterior radiograph of pelvis shows advanced arthritis with moderate joint space narrowing on left. On right side, beginning joint space narrowing and mixed-type femoroacetabular impingement (FAI) with cam deformity (arrow) and prominent posterior wall (dashed line) indicating focal posterior overcoverage are evident.

B, Sagittal proton density–weighted image from direct MR arthrogram obtained with application of leg traction of right hip to assess extent of intraarticular damage shows intrasubstance tearing of anterosuperior labrum (arrowheads). Excessive cartilage delamination and full-thickness cartilage loss (arrows) and subchondral cyst (asterisk) at acetabular rim are evident. These MRI findings are strong predictors of poor outcome after FAI surgery. Consequently, joint-preserving procedure on hip was not considered reasonable. Patient was scheduled for total hip arthroplasty of left hip and symptomatic treatment, including activity modification and physical therapy for right hip.