Description
Femoroacetabular impingement (FAI) has been described initially in the 1990%u2019s. FAI was extensively evaluated and demonstrated that it is caused by recurring compression of a morphologically abnormal proximal femur and/or acetabulum during terminal range-of-motion of the hip. Depending on the osseous abnormality, FAI results in typical damage to the labrum and acetabular cartilage. The osseous abnormality may be due to loss of the normal femoral head-neck offset resulting in cam impingement, or may be dueto loss of acetabular coverage resulting in pincer impingement. Third type is referred to as mixed or combined impingement.Most FAI patients are young, athletically active and usually present with unilateral symptoms. Anterior groin or hip pain most often accompany limitation of hip flexion and internal rotation. The pain may be described in the greater trochanter area, lateral thigh or may be referred to the knee. Plain x-rays are used to diagnose abnormalities with FAI and assess the hips to rule out osteoarthritis, avascular necrosis and other articular conditions. A true APpelvic view and a cross-table lateral view of the proximal femur and hip x-rayin 45° of hip flexion. MR imaging is essential in the assessment of the labrumand articular cartilage. Especially when performed with gadolinum injection. Femoral torsion can be estimated from axial computed tomography (CT) or axial MRI images performed through the proximal and distal femur.Conservative management provides limited relief. Conservative treatment includes activity modification, core muscle strengthening, antiinflammatory medication, and intraarticular local anesthetic and corticosteroid injections.FAI was initially addressed by open dislocation technique with varying success. Mini-open method with concomitant arthroscopic surgery was popularized to resolve the morbidities associated with the open technique. Arthroscopic management of the FAI has proven to be effective in eliminationof the symptoms. The technique addresses the impingement by removing the morphologic abnormalities involving the acetabulum and/or the femoral
head-neck junction. Tears of the labrum may either be repaired or debrided if there is extensive damage. Articular cartilage lesions on both sides may be addressed by debridement and microfracture. Earlier intervention before irreversible joint damage occurs results in optimum long term outcome. Complications of surgery for correction of FAI include minor ectopic calcification, nonunion of the greater trochanteric osteotomy, fracture, nerve damage, adhesions, avascular necrosis, and persisting pain.
