What is the diagnosis for corticated osseous fragments projecting adjacent to the superolateral rim of the right acetabulum, with increased size and similar positioning to previous imaging, suggestive of labral calcifications?

From the Guidelines

The patient's hip condition appears to be relatively stable with some progression of labral calcification, which may or may not be symptomatic, and further evaluation with MRI is recommended to assess the extent of the labral calcifications and potential associated conditions, such as femoroacetabular impingement (FAI) syndrome, as suggested by the 2020 study published in the British Journal of Sports Medicine 1. The imaging shows corticated osseous fragments near the right acetabulum's superolateral rim that have increased in size since December 5,2023. These fragments likely represent calcifications in the labrum rather than loose bodies. The hip joint spaces and alignment remain normal and unchanged from the previous study. There are mild degenerative changes in the sacroiliac joints, but the joint spaces are preserved and similar to the previous examination. This suggests stable mild osteoarthritis in the sacroiliac joints with no significant progression, while the labral calcifications have grown somewhat. Some key points to consider in the evaluation of hip-related pain include:

• The use of MRI to detect osseous and soft tissue abnormalities, as recommended by the 2017 study published in the Journal of the American College of Radiology 1
• The importance of considering the patient's symptoms, medical history, and physical examination findings in the diagnosis of hip-related pain, as emphasized by the 2020 study published in the British Journal of Sports Medicine 1
• The potential for labral calcifications to be associated with conditions such as FAI syndrome, which can cause hip pain and limited mobility, as discussed in the 2020 study published in the British Journal of Sports Medicine 1
• The need for a comprehensive evaluation, including imaging studies and physical examination, to determine the underlying cause of hip-related pain and to guide treatment, as recommended by the 2020 study published in the British Journal of Sports Medicine 1

From the Research

Corticated Osseous Fragments and Labrum Calcification

• The presence of corticated osseous fragments adjacent to the superolateral rim of the right acetabulum, with similar positioning and increased size, may indicate calcifications in the labrum 2, 3.
• Labral calcification is a common finding in patients with femoroacetabular impingement (FAI) and is associated with hip pain and symptoms 3, 4.
• The diagnosis of labral tears and calcification can be challenging, but magnetic resonance arthrography (MRA) is a reliable radiographic examination, with arthroscopy being the gold standard 2, 5.

Hip Joint Spaces and Alignment

• The hip joint spaces and alignment are within normal limits, which suggests that there is no significant joint degeneration or malalignment 2, 5.
• Mild degenerative changes at the sacroiliac joints with preserved joint spaces are also noted, which is consistent with the normal aging process 2, 5.

Treatment and Outcomes

• Treatment of labral calcification in the setting of FAI syndrome with arthroscopic calcification excision, labral repair, and osteoplasty can improve outcomes 6.
• Patients with labral calcification can achieve significant improvements in patient-reported outcomes and achievement of minimal clinically important differences at 2 years, similar to patients undergoing arthroscopic treatment for FAI without labral calcification 6.