A 24-year-old woman presented to our hospital with complaint of intermittent left hip joint catching pain and snapping sensation for 3 years. Three years ago, she was admitted at our hospital with history of pedestrian traffic accident followed by fracture-dislocation of the left hip joint. After closed reduction, CT scans showed the fracture in anterior wall of the acetabulum. She underwent internal fixation for acetabular fracture using the fully threaded cannulated screw and was lost to follow-up after surgery. The plain anterior-posterior radiography showed asymmetry of the joint space and CT scans showed an intra-articular bony fragment on the left hip joints. She underwent hip arthroscopy for bony fragment removal. In arthroscopic findings, acetabular osseo-labral fragment was widely detached from the superior to posterior acetabular rim and incarcerated in the joint space. We made standard three portals (anterior, anterolateral, posterolateral) and additional distal anterolateral portal (1-2 cm distal to anterolateral portal). We performed reduction of inverted labral tear and refixation using two 2.7 mm absorbable suture anchor (Bioraptor; Smith & Nephew, Andover, MA, USA), and the bony fragment was removed. In addition, there were evidence of chronic cam type femoroacetabular impingement and osteochondral defect on femoral head. We performed femoral osteoplasty across the head-neck junction to protect secondary injury and micro-fracture in femoral head. After operation, concentric reduction and complete removal of bony fragment were confirmed using CT scans (Fig. 1). The visual analogue score (VAS) for pain improved from 7 preoperatively to 3 postoperatively and 1 at 3 months follow-up. At 2 year follow-up, modified Harris hip score (mHHS) was improved from 52 preoperatively to 92 postoperatively and hip outcome score of activity of daily living (HOS ADL) and sport related activity (HOS sport) were improved from 58 and 56 preoperatively to 93 and 91 postoperatively, respectively.

A 17-year-old man was referred to our hospital with a one year history of left hip joint pain, sometimes severe catching pain, and worsened with activity. Physical examination revealed a hip pain when moving leg and slightly limited range of motion was observed due to pain. A year ago, the patient felt groin pain following hip fracture-dislocation cause to passenger traffic accident. In medical history, he was treated only the closed reduction of hip joint and rest in a private clinic. The plain anterior-posterior radiography showed asymmetry of the medial joint space and CT scans showed an intra-articular bony fragment on the hip joint. The patient underwent hip arthroscopy for bony fragment removal. In arthroscopic findings, acetabular osseo-labral fragment was widely detached from the superior to posterior acetabular rim and incarcerated in the joint space. We performed reposition of inverted labral tear and refixation using two 2.7 mm absorbable suture anchor (Bioraptor) using standard 3 portals and additional distal anterolateral portal, and the bony fragment was removed. After operation, concentric reduction and complete removal of bony fragment were confirmed using CT scans (Fig. 2). At 2 year follow up, the symptoms of the patient were disappeared. mHHS was improved from 55 preoperatively to 93 postoperatively and HOS ADL and HOS sport were improved from 59 and 62 preoperatively to 92 and 93 postoperatively, respectively.

A 54-year-old woman presented to our hospital with complaints of right hip pain and limited range of motion. She was complaint that the pain type was different from before: she felt catching pain when moving the leg. Two months ago, she was involved in traffic accident and sustained posterior dislocation of the right hip associated with a fracture of the inferior femoral-head. The hip was reduced spontaneously while the patient was being positioned for plain radiographs in local hospital. Post-reduction plain radiographs showed that the femoral-head fragment was aligned satisfactorily however bony fragment and asymmetry joint space were found. In medical history, she was recommended bed rest in a local hospital because of femoral-head fracture. The patient underwent hip arthroscopy for bony fragments removal. In arthroscopic findings, acetabular osseo-labral fragment was widely detached from the superior to posterior acetabular rim and incarcerated in the joint space. We performed labral debridement and excision of bony fragments because of the labral tear was irreducible and bony fragments were small (bony deficit across the posterior acetabulum was less than 10%) (Fig. 3). At 2 year follow up, the symptoms of the patient were improved but mild pain (VAS 1) still remained. Her mHHS was improved from 47 preoperatively to 85 postoperatively, and HOS ADL and HOS sport were improved from 51 and 49 preoperatively to 85 and 87 postoperatively.