Hip Impingement: Removal of Bony Lesion From the Femoral Neck

Hip Impingement: Removal of Bony Lesion From the Femoral Neck

The removal of a bony cam lesion happens toward the end of a hip surgery, after any type of labral repair is performed. Inside the joint, here is the top of the ball where the cam lesion is. The surgeon is looking at the size and location of the cam lesion, making sure they remove enough bone from the right spot. Typically, a layer of surface cartilage covers the cam lesion, so the surgeon looks for damage to this cartilage. This damage happens when the cam lesion bumps into the edge of the socket.

Once the surgeon decides where the bone needs to be removed, they use what is called a radiofrequency wand, or RF wand, that removes the damaged cartilage on the cam lesion, leaving a surface of bare bone. This also helps the surgeon see the border of where they should start removing bone. The surgeon will continue to use the RF wand until all the cartilage and other soft tissue is removed from the cam lesion.

Sometimes, tissue from the joint capsule is covering where the surgeon needs to work. If this is the case, they can put one or multiple sutures through that tissue, and then pull on the sutures outside of the joint, lifting the tissue off the bone so the bone can be shaved down. This also gets the tissue out of the way, so it is not damaged. The surgeon now uses a burr, which slowly shaves down the extra bone. There needs to be enough bone removed to prevent problems from coming back but not too much to make the bone weak.

The surgeon will take their time to make sure the correct amount of bone is removed and that the normal shape of the ball is restored. They will change the view of the camera many times, taking a look from different angles to make sure nothing is missed. Now that the surgeon has removed enough bone, the ball or femoral head, looks much more normal in shape. It is common for the surgeon to take x-rays during the surgery to make sure the shape is appropriate. Once finished, the capsule tissue is closed to keep the joint stable during the recovery process.