Current concepts
Arthroscopic Treatment of Femoroacetabular Impingement

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Abstract

The etiology of degenerative joint disease of the hip remains unsolved. A precursor for some patients, especially younger ones, may be hip impingement. Repetitive microtrauma at maximal flexion can cause chronic pain from the abutment at the femoral head-neck junction caused by an abnormal offset. Chronic impingement from an aspherical head can lead to degenerative labral tears and acetabular chondral degeneration, which may contribute to the degenerative cascade. Arthroscopic treatment of hip impingement caused by an abnormal head-neck offset improves symptoms, restores hip morphology, and ultimately may halt the progression toward degenerative joint disease in certain patients. Early results show that if debridement of the impinging lesion and injured labrum is performed in the setting of normal femoral and acetabular articular surfaces, the results are promising.

Section snippets

Background

A nonspherical femoral head has been associated with early development of osteoarthritis of the hip.8, 9 The effect of asphericity on the acetabular labrum and the consequent degeneration that ensues has received attention in the literature because labral degeneration may lead to early osteoarthritis.1, 3, 10 McCarthy et al.3 showed that the relative risk of significant chondral erosion approximately doubles in the presence of labral lesions.

Whereas the asphericity seen in dysplastic heads can

History

Although degenerative arthritis is the most common diagnosis for hip pain of intra-articular origin, FAI should be considered, especially in younger individuals. The typical patient is a middle-aged, athletic individual complaining of groin pain with activity. This often occurs during activities requiring hip flexion. Simple activities such as walking may aggravate symptoms in some, and sports may aggravate them in others. Symptoms range from mild to severe and are often intermittent. The groin

Nonsurgical

Conservative treatment modalities should be attempted for patients diagnosed with hip impingement. Anti-inflammatory medications and activity modification may improve or alleviate symptoms. Because hip impingement is a mechanical problem, conservative measures will not eliminate the source. Patients who fail conservative treatment are candidates for arthroscopic debridement of the femoral neck and the treatment of any significant labral lesions.

Surgical

A complete arthroscopic examination of the hip

Open Debridement

Initial reports on the treatment of FAI have involved the use of open surgical dislocation techniques. In the largest series to date,25 the open surgical dislocation approach was performed on 19 patients with a mean age of 36 years and an average follow-up of 4.7 years. The authors25 documented good results in 14 of 19 patients with no cases of osteonecrosis. They concluded that the surgical dislocation approach yielded good results in patients with early degenerative changes, but was not

Discussion

Hip impingement can be a difficult entity to diagnose and treat. The current literature suggests that FAI plays a role in the cascade of hip osteoarthritis in some patients—those with structural proximal femoral head-neck abnormalities.3, 4, 5, 6, 7 This entity usually appears in younger and more physically active adults and can be debilitating. Subsequent labral and chondral lesions have been linked to the repetitive microtrauma caused by the deformity of the femoral neck or acetabulum.14

References (27)

  • T.G. Sampson

    Hip morphology and its relationship to pathologyDysplasia to impingement

    Oper Tech Sports Med

    (2005)
  • M. Dienst et al.

    Hip arthroscopy without tractionIn vivo anatomy of the peripheral hip joint cavity

    Arthroscopy

    (2001)
  • E.L. Funke et al.

    Complications in hip arthroscopy

    Arthroscopy

    (1996)
  • M. Leunig et al.

    Acetabular rim degenerationA constant finding in the aged hip

    Clin Orthop

    (2003)
  • R. Seldeg et al.

    Anatomy, histologic features, and vascularity of the adult acetabular labrum

    Clin Orthop

    (2001)
  • J.C. McCarthy et al.

    The role of labral lesions to development of early hip disease

    Clin Orthop

    (2001)
  • R. Ganz et al.

    Femoroacetabular impingementA cause for early osteoarthritis of the hip

    Clin Orthop

    (2003)
  • M. Beck et al.

    Anterior femoroacetabular impingement: Part II: Midterm results of surgical treatment

    Clin Orthop

    (2004)
  • M. Lavigne et al.

    Anterior femoroacetabular impingement: Part I: Technique of joint preserving surgery

    Clin Orthop

    (2004)
  • K. Ito et al.

    Femoroacetabular impingement and the cam-effect

    J Bone Joint Surg Br

    (2001)
  • D.A. Goodman et al.

    Subclinical slipped capital femoral epiphysis

    J Bone Joint Surg Am

    (1997)
  • W.H. Harris

    Etiology of osteoarthritis of the hip

    Clin Orthop

    (1986)
  • N. Santori et al.

    Arthroscopic findings in the initial stages of hip osteoarthritis

    Orthopedics

    (1999)
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