Clinical Orthopaedics and Related Research

, Volume 467, Issue 3, pp 616–622 | Cite as

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment

Abstract

Femoroacetabular impingement (FAI) is a recently proposed mechanism causing abnormal contact stresses and potential joint damage around the hip. In the majority of cases, a bony deformity or spatial malorientation of the femoral head or head/neck junction, acetabulum, or both cause FAI. Supraphysiologic motion or high impact might cause FAI even with very mild bony alterations. FAI became of interest to the medical field when (1) evidence began to emerge suggesting that FAI may initiate osteoarthritis of the hip and when (2) adolescents and active adults with groin pain and imaging evidence of FAI were successfully treated addressing the causes of FAI. With an increased recognition and acceptance of FAI as a damage mechanism of the hip, defined standards of assessment and treatment need to be developed and established to provide high accuracy and precision in diagnosis. Early recognition of FAI followed by subsequent behavioral modification (profession, sports, etc) or even surgery may reduce the rate of OA due to FAI.

References

  1. 1.
    Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.PubMedCrossRefGoogle Scholar
  2. 2.
    Beaule PE, Zaragoza E, Copelan N. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination. A report of four cases. J Bone Joint Surg Am. 2004;86:2294–2298.PubMedGoogle Scholar
  3. 3.
    Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–1292.PubMedGoogle Scholar
  4. 4.
    Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  6. 6.
    Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–1457.PubMedCrossRefGoogle Scholar
  7. 7.
    Carlioz H, Pous JG, Rey JC. Upper femoral epiphysiolysis [in French]. Rev Chir Orthop Repar Appar Mot. 1968;54:387–491.Google Scholar
  8. 8.
    Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC. The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res. 2003;406:75–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.PubMedGoogle Scholar
  10. 10.
    Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88:1540–1548.PubMedCrossRefGoogle Scholar
  11. 11.
    Dora C, Mascard E, Mladenov K, Seringe R. Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B. 2002;11:34–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia. J Orthop Trauma. 2000;14:483–489.PubMedCrossRefGoogle Scholar
  13. 13.
    Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.PubMedCrossRefGoogle Scholar
  14. 14.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech Bristol, Avon. 2000;15:463–468.CrossRefGoogle Scholar
  15. 15.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–960.PubMedCrossRefGoogle Scholar
  16. 16.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRefGoogle Scholar
  17. 17.
    Ganz R, Bamert P, Hausner P, Isler B, Vrevc F. Cervico-acetabular impingement after femoral neck fracture [in German]. Unfallchirurg. 1991;94:172–175.PubMedGoogle Scholar
  18. 18.
    Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.PubMedCrossRefGoogle Scholar
  19. 19.
    Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRefGoogle Scholar
  20. 20.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMedGoogle Scholar
  21. 21.
    Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:263–269.PubMedGoogle Scholar
  22. 22.
    Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.PubMedGoogle Scholar
  23. 23.
    Harris WH, Krushell RJ, Galante JO. Results of cementless revisions of total hip arthroplasties using the Harris-Galante prosthesis. Clin Orthop Relat Res. 1988;235:120–126.PubMedGoogle Scholar
  24. 24.
    Herndon CH, Heymann CH, Bell DM. Treatment of slipped capital femoral epiphysis by epiphysiodesis and osteoplasty of the femoral neck. J Bone Joint Surg Am. 1963;45:999–1012.PubMedGoogle Scholar
  25. 25.
    Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302.PubMedGoogle Scholar
  26. 26.
    Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.PubMedCrossRefGoogle Scholar
  27. 27.
    Ito K, Minka MA II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.PubMedCrossRefGoogle Scholar
  28. 28.
    Jager M, Wild A, Westhoff B, Krauspe R. Femoroacetabular impingement caused by a femoral osseous head-neck bump deformity: clinical, radiological, and experimental results. J Orthop Sci. 2004;9:256–263.PubMedCrossRefGoogle Scholar
  29. 29.
    Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res. 2007;25:758–765.PubMedCrossRefGoogle Scholar
  30. 30.
    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis : a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.PubMedCrossRefGoogle Scholar
  31. 31.
    Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;236:588–592.PubMedCrossRefGoogle Scholar
  32. 32.
    Kim KC, Hwang DS, Lee CH, Kwon ST. Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis. Clin Orthop Relat Res. 2007;456:128–132.PubMedCrossRefGoogle Scholar
  33. 33.
    Koch R. Mitt Kaiser Gesundh. 1884;2:1–88.Google Scholar
  34. 34.
    Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res. 2003;413:201–207.PubMedCrossRefGoogle Scholar
  35. 35.
    Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect. 2008;57:499–507.PubMedGoogle Scholar
  36. 36.
    Leunig M, Werlen S, Ungersbock A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br. 1997;79:230–234.PubMedCrossRefGoogle Scholar
  37. 37.
    Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the hip outcome score. Arthroscopy. 2006;22:1304–1311.PubMedCrossRefGoogle Scholar
  38. 38.
    McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.PubMedCrossRefGoogle Scholar
  39. 39.
    Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.Google Scholar
  40. 40.
    Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.PubMedGoogle Scholar
  41. 41.
    Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.PubMedCrossRefGoogle Scholar
  42. 42.
    Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–824.PubMedCrossRefGoogle Scholar
  43. 43.
    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.PubMedCrossRefGoogle Scholar
  44. 44.
    Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.PubMedCrossRefGoogle Scholar
  45. 45.
    Rothenfluh DA, Reedwisch D, Müller U, Ganz R, Tennant A, Leunig M. Construct validity of a 12-item WOMAC for assessment of femoro-acetabular impingement and osteoarthritis of the hip. Osteoarthritis Cartilage. 2008;16:1032–1038.PubMedCrossRefGoogle Scholar
  46. 46.
    Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54–60.PubMedCrossRefGoogle Scholar
  47. 47.
    Solomon L, Schitzler CM. Pathogenetic types of coxarthrosis and implications for treatment. Arch Orthop Trauma Surg. 1983;101:259–261.PubMedCrossRefGoogle Scholar
  48. 48.
    Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. Paper presented at: The hip: Proceedings of the third open scientific meeting of the hip society, 1975.Google Scholar
  49. 49.
    Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–177.PubMedCrossRefGoogle Scholar
  50. 50.
    Vulpius O, Stöffel A. Orthopädische Operationslehre. Stuttgart, Germany: F. Enke; 1913.Google Scholar
  51. 51.
    Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–150.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Michael Leunig
    • 1
    • 2
  • Paul E. Beaulé
    • 4
  • Reinhold Ganz
    • 3
  1. 1.Hip ServiceSchulthess ClinicZurich Switzerland
  2. 2.University of BerneBernSwitzerland
  3. 3.Department of Orthopaedic Surgery InselspitalUniversity of BerneBernSwitzerland
  4. 4.Adult Reconstruction, Ottawa HospitalUniversity of OttawaOttawaCanada

Personalised recommendations