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Management of Extra-articular Hip Conditions in Patients with Concurrent FAI

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Diagnosis and Management of Femoroacetabular Impingement

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Abstract

Groin pain is an increasingly common condition in athletes, particularly those involved in cutting sports or sports involving frequent acceleration and deceleration. The differential diagnosis for groin pain in athletes is vast and often poses a significant diagnostic challenge for physicians. Among athletes, femoroacetabular impingement (FAI) is a relatively common source of intra-articular groin pain. Hammoud et al. [22] suggested that the reduced functional range of motion in patients with FAI leads to high impaction loads at terminal ranges, which can ultimately result in a number of compensatory disorders. Furthermore, some case series have found associations between FAI and other extra-articular hip conditions including athletic pubalgia and osteitis pubis [21,40]. One study found that 33 % of athletes with chronic groin pain had two or more separate pathologies causing their symptoms [27]. Therefore, physicians must consider the possibility that there exist multiple and often concomitant pathologies in a patient presenting with groin pain. Otherwise, a substantial risk exists that the patient will continue to be symptomatic even after treatment. Although some patients presenting with groin pain may successfully recover with nonsurgical treatment, patients do frequently require surgical intervention. The surgical management of FAI generally involves either femoroplasty or acetabuloplasty done through either arthroscopic, open, or mini-open methods. However, failure to simultaneously address other underlying extra-articular pathologies such as athletic pubalgia through surgical treatment results in high rates of persistent symptoms and inability to return to sport [21,36,37,40]. This chapter looks to address the history, physical examination, investigations, and management of some common extra-articular hip conditions frequently associated with FAI including (1) athletic pubalgia, (2) osteitis pubis, and (3) internal snapping hip syndrome. Table 15.1 presents a brief summary of the pathology, recommended investigations, and management for each of these three conditions.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, Odense C, DK-5000, Denmark

    Uffe Jorgensen

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Nolan S. Horner, Darren de SA & Olufemi R. Ayeni

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  1. Nolan S. Horner
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  2. Uffe Jorgensen
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  3. Darren de SA
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  4. Olufemi R. Ayeni
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Correspondence to Uffe Jorgensen .

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Editors and Affiliations

  1. McMaster University, Hamilton, Ontario, Canada

    Olufemi R. Ayeni

  2. Hosp, Academy University of Gothenburg, Dept. of Orthopaedics, Sahlgrenska Univ Hosp, Academy University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Steadman Clinic, Ste 1000, Steadman Philippon Research Inst Steadman Clinic, Ste 1000, Vail, Colorado, USA

    Marc J Philippon

  4. Stanford University Dept of Orthopaedic Surg, M/C 6342, Redwood City, California, USA

    Marc R. Safran

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Horner, N.S., Jorgensen, U., de SA, D., Ayeni, O.R. (2017). Management of Extra-articular Hip Conditions in Patients with Concurrent FAI. In: Ayeni, O., Karlsson, J., Philippon, M., Safran, M. (eds) Diagnosis and Management of Femoroacetabular Impingement. Springer, Cham. https://doi.org/10.1007/978-3-319-32000-7_15

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  • DOI: https://doi.org/10.1007/978-3-319-32000-7_15

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