Hip Preservation
General

Foveal Loading

Fovea centralis is a naturally occurring defect in the femoral head where the Ligamentum teres attaches to the head. A branch of the obturator artery passes along the ligamentum to supply a small portion of the head around the fovea. The fovea usually faces the acetabular fossa and pulvinar fat and does not bear any weight and does not contact the acetabular articular cartilage.

Coxa valga and Caput valgum move the fovea up in contact with the acetabular dome. Weight bearing on the fovea can cause pain from the incongruity of the cartilage surfaces as well as from crushing of the ligamentum between the head and the acetabulum. Treatment is varus osteotomy to move the fovea medial to the sourcil.

High acetabular fossa / Medial dysplasia of the acetabulum and Downsloping sourcil / Reverse sourcil angle can load a normally placed fovea against the usually non weigh bearing acetabular fossa crushing the ligamentum teres and cause medial osteoarthritis of the hip. Treatment option is reverse pariacetabular osteotomy before arthritis sets in.

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