Pathomechanics Underlying Femoroacetabular Impingement Syndrome: Theoretical Framework to Inform Clinical Practice

Abstract

Over the last decade, there has been a marked increase in attention to, and interest in, femoroacetabular impingement syndrome (FAIS). Despite continued efforts by researchers and clinicians, the development, progression, and appropriate treatment of FAIS remains unclear. While research across various disciplines has provided informative work in various areas related to FAIS, the underlying pathomechanics, time history, and interaction between known risk factors and symptoms remain poorly understood. The purpose of this perspective is to propose a theoretical framework that describes a potential pathway for the development and progression of FAIS. This paper aims to integrate relevant knowledge and understanding from the growing literature related to FAIS to provide a perspective that can inform future research and intervention efforts.

The Effect of a Formal Nonoperative Management Program Combining a Hip Injection With Structured Adjunctive Exercise Rehabilitation in Patients With Symptomatic Femoroacetabular Impingement Syndrome

“…As such, the exercises and progressions were refined per published evidence and rehabilitation recommendations available at the time of study onset, 6,9,14,24,38,40 with the hip strength deficits and altered kinematic differences that had been reported in patients with FAIS. [2][3][4]8,20,21,23,31 It is important to note that the current study investigated patient outcome following a combined nonoperative intervention (injection and exercise), in part attributed to a hypothesis that a ''best option first'' approach is likely to achieve optimum outcomes. This may be because of patients experiencing excessive pain preventing them from exercising effectively, and they also often lacked motivation to pursue nonoperative management after previously failed and possibly suboptimal attempts at rehabilitation.…”

“…Rather, it was designed cognizant of the hip strength deficits 31 and altered kinematic differences commonly reported in patients with FAIS, such as reduced squat depth and increased anterior pelvic tilt, as well as increased hip adduction and internal rotation with contralateral pelvic drop, especially in unilateral weightbearing activities. 2-4,8,20,21,23…”

“…Rather, it was designed cognizant of the hip strength deficits 31 and altered kinematic differences commonly reported in patients with FAIS, such as reduced squat depth and increased anterior pelvic tilt, as well as increased hip adduction and internal rotation with contralateral pelvic drop, especially in unilateral weightbearing activities. [2][3][4]8,20,21,23 The program was initiated at 4 to 7 days after injection, consisting of a therapist-supervised component spanning 12 weeks. This included 2 to 4 supervised therapist sessions (mean, 2.8) over an initial 6-week period, followed by supervised sessions as needed (mean, 2.6; range, 2-4) to progress activity up to 3 months after injection.…”

Caring for adults with hip pain

“…FAI results from abnormal hip joint morphology where there is impingement between the proximal femur and the acetabulum within a functional ROM. 9 Repetitive contact may accelerate degenerative changes resulting in OA. 9,10 The acetabular labrum increases the surface area of the hip socket and is vital to the stability of the hip joint.…”

“…9 Repetitive contact may accelerate degenerative changes resulting in OA. 9,10 The acetabular labrum increases the surface area of the hip socket and is vital to the stability of the hip joint. It also protects the underlying articular cartilage.…”