Bone-wax granuloma after femoral neck osteoplasty.

A 37-year-old woman presented with sharp pain in the right hip that had been present for 3 years; the pain was localized to the groin. She also had episodes of “catching” in the hip joint. Conservative treatment had been tried but without success. On examination, there was an antalgic limp, a positive impingement sign and a reduction in internal rotation. Radiographs did not show any hip joint disease, but magnetic resonance imaging demonstrated a torn anterior labrum with an abnormal osseous bump at the junction of the femoral head and neck, confirming the diagnosis of femoroacetabular impingement (Fig. 1). The hip joint was explored surgically through a digastric trochanteric flip approach. The lesion of the anterior labrum was confirmed, and contact between the anterolateral femoral neck and the labrum was observed on motion. The labrum was stable, but a partial horizontal detachment of the labrum at its junction with the anterior acetabular cartilage was debrided because refixation was not possible, and an anterior femoral neck osteoplasty was performed with an osteotome to give a normal neck contour. Cancellous bleeding from the anterior femoral neck was controlled by applying bone wax (Ethicon, Johnson and Johnson, Somerville, NJ). The bleeding area from cancellous bone of the anterior femoral neck measured about 3.5 cm2. One gram of bone wax was firmly pressed onto this area until bleeding stopped, and the excess (about 0.5 g) was removed. Six weeks after surgery, the patient had a pain-free hip with improved internal rotation. She returned to work 3 months postoperatively. Six months postoperatively, she presented because of the reappearance of pain and stiffness of the hip joint. The hip was irritable with minimal motion. Infection was ruled out: there was negative growth from culture of a hip joint aspirate, C-reactive protein level was 5.4 (normal, < 8) mg/L and erythrocyte sedimentation rate was 7 (normal < 20) mm/h. A new magnetic resonance image showed an abnormal signal in the anterior labrum, suggesting a new or persistent tear (Fig. 2). Hip injection with local anesthetic and steroid relieved the pain, but only for 4 weeks. The hip joint was reexplored and dislocated with open surgery through a digastric trochanteric flip approach instead of hip arthroscopy because labrum fixation was planned; however, the labrum was found to be healed to the