Open and arthroscopic management of femoroacetabular impingement: a review of current concepts

Abstract

Femoroacetabular impingement (FAI) is a common femoral and/or acetabular abnormality that can cause progressive damage to the hip and osteoarthritis. FAI can be the result of femoral head/neck overgrowth, acetabular overgrowth or both femoral and acetabular abnormalities, resulting in a loss of native hip biomechanics and pain upon hip flexion and rotation. Radiographic evidence can include loss of sphericity of the femoral neck (cam impingement) and/or acetabular retroversion with focal or global overcoverage (pincer impingement). Operative intervention is indicated in symptomatic patients after failed conservative management with radiographic evidence of impingement and minimal arthritic changes of the hip, with the goal of restoring normal hip biomechanics and reducing pain. This is done by correcting the femoral head–neck relationship to the acetabulum through femoral and/or acetabular osteoplasty and treatment of concomitant hip pathology. In pincer impingement cases with small lunate surfaces, reverse periacetabular osteotomy is indicated as acetabular osteoplasty can decrease an already small articular surface. While surgical dislocation is regarded as the traditional gold standard, hip arthroscopy has become widely utilized in recent years. Studies comparing both open surgery and arthroscopy have shown comparable long-term pain reduction and improvements in clinical measures of hip function, as well as similar conversion rates to total hip arthroplasty. However, arthroscopy has trended toward earlier improvement, quicker recovery and faster return to sports. The purpose of this study was to review the recent literature on open and arthroscopic management of FAI.

Luxación controlada de cadera en el tratamiento de la condromatosis sinovial asociada a una lesión tipo cam

“…8 La artroscopia de cadera se convirtió en el procedimiento de referencia para el manejo quirúrgico de la lesión tipo cam, y la luxación controlada quedó relegada para casos con tipo cam en la región posterior o tipo cam circunferenciales. 21 Sin embargo, mediante la artroscopia es difícil ingresar en la región posteroinferior, y el manejo de la CS es complejo cuando hay gran cantidad de cuerpos libres y un compromiso sinovial extenso de difícil acceso. Además, no está exenta de complicaciones, como lesión condrolabral iatrogénica, lesión neurovascular y neuropraxia por tracción.…”

Hip Arthroscopy Followed by 6-Month Rehabilitation Leads to Improved Periarticular Muscle Strength, Except for Abductors and External Rotators

“… 6 , 7 , 8 , 9 , 10 Compared to open procedures, this surgical approach might also have the advantage of requiring a shorter rehabilitation period, thereby offering a fast return to daily activities in satisfying conditions. 11 , 12 …”

Long-Term Outcomes of Arthroscopic Labral Treatment of Femoroacetabular Impingement in Adolescents

“…Hip arthroscopy has slowly become the gold standard for the treatment of FAI because of its minimally invasive nature and low morbidity rate 7 . Hip arthroscopy has shown not only comparable outcomes to open surgical dislocation but also higher functional scores and faster return to sport as well as accelerated recovery as a result of the muscle-sparing technique 8,9 . Improved understanding of the development of FAI has created a need for early diagnosis and effective treatment in the adolescent population, especially given the high levels of physical activity needed to achieve musculoskeletal maturity and the irreparable damage that FAI can cause in a very young hip joint.…”