Current concepts in the diagnosis and management of femoroacetabular impingement

Abstract

Femoroacetabular impingement is becoming increasingly recognised as a cause of hip pain in the young adult. It is thought that the condition may lead to acetabular labral tears, chondro-labral separation, chondral delamination and eventually predispose to osteoarthritis of the hip. Efforts have thus been directed to diagnosing and treating the underlying pathology and subsequent sequelae. This article presents the relevant literature with regards to the aetiology of femoroacetabular impingement, its clinical features, investigations and options of management. Finally outcomes relating to both open and arthroscopic approaches to treatment are discussed.

The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

“…This reduces the free arc of hip motion [7] and causes articular or soft tissue damage around the acetabular rim [8,9] which may eventually result in irreversible labral and chondral damage [8,10], thereby ultimately progressing on to osteoarthritis (OA) [11][12][13]. Based on the morphological bony anomalies contributing to the impingement process, two distinct types of FAI have been described [6]. The pincer type is caused by bony anomalies associated with the acetabulum such as excessively retroverted acetabulum or an acetabular protrusion, whilst the cam type is caused by mis-shaped head-neck junction of the femur causing a prominence at the femoral head-neck junction leading to impingement.…”

“…This leads to a pathological abutment and a point or regional loading of the femoral neck or head-neck junction against the acetabulum [4][5][6]. This reduces the free arc of hip motion [7] and causes articular or soft tissue damage around the acetabular rim [8,9] which may eventually result in irreversible labral and chondral damage [8,10], thereby ultimately progressing on to osteoarthritis (OA) [11][12][13].…”

Outcomes of cartilage repair techniques for chondral injury in the hip—a systematic review

“…Common causes of cartilage damage in the hip include femoroacetabular impingement (FAI), developmental dysplasia, osteonecrosis, osteochondritis dissecans, loose bodies, slipped capital femoral epiphysis, and trauma [1][2][3][4][5]. Amongst them, FAI has increasingly gained recognition as a major cause of chondral injury and subsequent development of arthritis in the hip joint [6][7][8][9][10]. In CAM FAI, the abnormal contact between the aspherical femoral head-neck junction and the acetabular rim results in a large amount of shear stress being transmitted to the labro-chondral junction.…”

Timing in hip arthroscopy: does surgical timing change clinical results?

“…For their management, open or arthroscopic labrum repair, impinging bone excision or microfracture have been advocated [6]. There is a trend towards less invasive procedures, with high rates of success when these pathologies are treated arthroscopically [9][10][11]. The best timing for arthroscopic knee surgery reported for anterior cruciate ligament lesions is within the first year of injury [12], but there is no study describing the best timing for hip arthroscopy.…”