Arthroscopy: The Journal of Arthroscopic & Related Surgery
Current conceptsArthroscopic Treatment of Femoroacetabular Impingement
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
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