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Hip impingement: The femoral acetabular story

Femoral acetabular impingement (FAI) results from repetitive hip movement with an underlying anatomical variation of the femoral head, acetabulum or both. Three types of FAI are described in the literature. These are cam, pincer and mixed FAI which involves a combination of cam and pincer FAI. Cam impingements originate from the femoral neck whereas pincer impingements involve the acetabulum.

Femoral acetabular impingement is increasingly being recognised as a cause of hip and groin pain in athletes. In susceptible individuals, repetitive sporting activity can lead to injury or irritation of the labrum and articular cartilage. It is possible that these injuries may lead to osteoarthritis. Early detection and appropriate management of FAI may slow the onset or progression of osteoarthritis.

The new edition of the Clinical Sports Medicine textbook outlines the clinical presentation of FAI and discusses factors that may contribute to the development of hip related pain. The chapter includes an example of a clinical assessment of the hip, common features of radiographic investigations and possible management options.

When conservative management fails, surgical options such as arthroscopy may be considered. Arthroscopy techniques for FAI continue to advance with each passing year. Arthroscopic femoral osteoplasty is one technique used to address underlying anatomical variants. Co-author Joanne Kemp and colleagues have published a recent paper titled: Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. Their review found that hip arthroscopy has the potential to significantly reduce pain and improve function in patients with intra-articular hip pathology. More research is required into the long term effects of hip arthroscopy surgery especially in relation to the development of osteoarthritis.

 

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