Skip to main content
SpringerLink
Log in

Pathophysiology of Femoroacetabular Impingement (FAI)

  • Chapter
  • First Online:
Diagnosis and Management of Femoroacetabular Impingement

Abstract

The abnormal functional changes and pathology that are associated with FAI of the hip must be considered in a continuum as with any other disease process. The understanding of a pathological condition leads to appropriate intervention and treatment to prevent further pathology or damage and opens the doors for prevention. In this chapter we will examine the evidence surrounding the pathophysiology of FAI and where more research is needed. Only by appreciating the etiology of this condition can we hope to be even more effective in treating it and its sequelae.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 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(8):1119–24.

    Article  CAS  PubMed  Google Scholar 

  2. 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(2):264–72.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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;417:112–20.

    PubMed  Google Scholar 

  4. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–24.

    Article  CAS  PubMed  Google Scholar 

  5. Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br. 1976;58(2):176–83.

    CAS  PubMed  Google Scholar 

  6. Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am. 1997;79(10):1489–97.

    CAS  PubMed  Google Scholar 

  7. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.

    PubMed  Google Scholar 

  8. Harris WH, Bourne RB, Oh I. Intra-articular acetabular labrum: a possible etiological factor in certain cases of osteoarthritis of the hip. J Bone Joint Surg Am. 1979;61(4):510–4.

    CAS  PubMed  Google Scholar 

  9. Stulberg SD, Cordell LD, Harris WH, et al., editors. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthriti of hip. Proceedings of the third meeting of the Hip Society. Saint Louis: The CV Mosby Company; 1975.

    Google Scholar 

  10. Bombelli R. Osteoarthritis of the hip: pathogenesis and consequent therapy. Berlin: Springer; 1976.

    Book  Google Scholar 

  11. Elmslie RC. Aetiological factors in osteoarthritis of hip. Br Med J. 1933;1:1–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Reginster JY. The prevalence and burden of arthritis. Rheumatology. 2002;41(Supp 1):3–6.

    Article  PubMed  Google Scholar 

  13. Murphy SB, Kijewski PK, Millis MB, Harless A. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res. 1990;261:214–23.

    PubMed  Google Scholar 

  14. Price CT, Ramo BA. Prevention of hip dysplasia in children and adults. Orthop Clin North Am. 2012;43(3):269–79.

    Article  PubMed  Google Scholar 

  15. Anderson SE, Siebenrock KA, Tannast M. Femoroacetabular impingement: evidence of an established hip abnormality. Radiology. 2010;257(1):8–13.

    Article  PubMed  Google Scholar 

  16. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8.

    Article  CAS  PubMed  Google Scholar 

  17. Naal FD, Miozzari HH, Wyss TF, Notzli HP. Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med. 2011;39(3):544–50.

    Article  PubMed  Google Scholar 

  18. Johnston TL, Schenker ML, Briggs KK, Philippon MJ. Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy. 2008;24(6):669–75.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999;15(2):132–7.

    Article  CAS  PubMed  Google Scholar 

  21. Eriksson E, Arvidsson I, Arvidsson H. Diagnostic and operative arthroscopy of the hip. Orthopedics. 1986;9(2):169–76.

    CAS  PubMed  Google Scholar 

  22. O’Leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy. 2001;17(2):181–8.

    Article  PubMed  Google Scholar 

  23. Peters CL, Erickson JA, Anderson L, Anderson AA, Weiss J. Hip-preserving surgery: understanding complex pathomorphology. J Bone Joint Surg Am. 2009;91 Suppl 6:42–58.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Bardakos NV, Vasconcelos JC, Villar RN. Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. J Bone Joint Surg Br. 2008;90(12):1570–5.

    Article  CAS  PubMed  Google Scholar 

  26. Bardakos NV, Villar RN. Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. J Bone Joint Surg Br. 2009;91(2):162–9.

    Article  CAS  PubMed  Google Scholar 

  27. 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(4):773–9.

    Article  PubMed  Google Scholar 

  28. Bizzini M, Notzli HP, Maffiuletti NA. Femoroacetabular impingement in professional ice hockey players: a case series of 5 athletes after open surgical decompression of the hip. Am J Sports Med. 2007;35(11):1955–9.

    Article  PubMed  Google Scholar 

  29. Brunner A, Horisberger M, Herzog RF. Sports and recreation activity of patients with femoroacetabular impingement before and after arthroscopic osteoplasty. Am J Sports Med. 2009;37(5):917–22.

    Article  PubMed  Google Scholar 

  30. Leunig M, Beaule PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res. 2009;467(3):616–22.

    Article  PubMed  Google Scholar 

  31. Lincoln M, Johnston K, Muldoon M, Santore R. Combined arthroscopic and modified open approach for cam femoroacetabular impingement: a preliminary experience. Arthroscopy. 2009;25(4):392–9.

    Article  PubMed  Google Scholar 

  32. Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res. 2010;468(2):504–10.

    Article  PubMed  Google Scholar 

  33. Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91(1):16–23.

    Article  CAS  PubMed  Google Scholar 

  34. 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(9):1571–80.

    Article  PubMed  Google Scholar 

  35. Ribas M, Ledesma R, Cardenas C, Marin-Pena O, Toro J, Caceres E. Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage. Hip Int. 2010;20 Suppl 7:S36–42.

    Article  PubMed  Google Scholar 

  36. Ribas M, Marin-Pena OR, Regenbrecht B, De La Torre B, Vilarrubias JM. Hip osteoplasty by an anterior minimally invasive approach for active patients with femoroacetabular impingement. Hip Int. 2007;17(2):91–8.

    CAS  PubMed  Google Scholar 

  37. Mardones R, Lara J, Donndorff A, Barnes S, Stuart MJ, Glick J, et al. Surgical correction of “cam-type” femoroacetabular impingement: a cadaveric comparison of open versus arthroscopic debridement. Arthroscopy. 2009;25(2):175–82.

    Article  PubMed  Google Scholar 

  38. Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. J Bone Joint Surg Am. 2005;87(2):273–9.

    Article  PubMed  Google Scholar 

  39. Yun HH, Shon WY, Yun JY. Treatment of femoroacetabular impingement with surgical dislocation. Clin Orthop Surg. 2009;1(3):146–54.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bedi A, Kelly BT. Femoroacetabular impingement. J Bone Joint Surg Am. 2013;95(1):82–92.

    Article  PubMed  Google Scholar 

  41. Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint. Including the prevalence of the features of the right side. Ann Rheum Dis. 1970;29(1):15–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Hase T, Ueo T. Acetabular labral tear: arthroscopic diagnosis and treatment. Arthroscopy. 1999;15(2):138–41.

    Article  CAS  PubMed  Google Scholar 

  43. 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(2):588–92.

    Article  PubMed  Google Scholar 

  44. Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.

    Article  PubMed  Google Scholar 

  45. Hoaglund FT, Shiba R, Newberg AH, Leung KY. Diseases of the hip. A comparative study of Japanese Oriental and American white patients. J Bone Joint Surg Am. 1985;67(9):1376–83.

    CAS  PubMed  Google Scholar 

  46. Nakamura S, Ninomiya S, Nakamura T. Primary osteoarthritis of the hip joint in Japan. Clin Orthop Relat Res. 1989;241:190–6.

    PubMed  Google Scholar 

  47. Fukushima K, Uchiyama K, Takahira N, Moriya M, Yamamoto T, Itoman M, et al. Prevalence of radiographic findings of femoroacetabular impingement in the Japanese population. J Orthop Surg Res. 2014;9:25.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Takeyama A, Naito M, Shiramizu K, Kiyama T. Prevalence of femoroacetabular impingement in Asian patients with osteoarthritis of the hip. Int Orthop. 2009;33(5):1229–32.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010;92(5):1162–9.

    Article  PubMed  Google Scholar 

  50. Giles AE, Corneman NA, Bhachu S, Rudan JF, Ellis RE, Grant H, et al. Shared morphology of slipped capital femoral epiphysis and femoroacetabular impingement in early-onset arthritis. Orthopedics. 2013;36(11):e1365–70.

    Article  PubMed  Google Scholar 

  51. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am. 2011;93(19):e111(1–10).

    Google Scholar 

  52. Carter CW, Bixby S, Yen YM, Nasreddine AY, Kocher MS. The relationship between cam lesion and physis in skeletally immature patients. J Pediatr Orthop. 2014;34(6):579–84.

    PubMed  Google Scholar 

  53. Philippon MJ, Ejnisman L, Ellis HB, Briggs KK. Outcomes 2 to 5 years following hip arthroscopy for femoroacetabular impingement in the patient aged 11 to 16 years. Arthroscopy. 2012;28(9):1255–61.

    Article  PubMed  Google Scholar 

  54. Hack K, Di Primio G, Rakhra K, Beaule PE. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am. 2010;92(14):2436–44.

    Article  PubMed  Google Scholar 

  55. Monazzam S, Bomar JD, Dwek JR, Hosalkar HS, Pennock AT. Development and prevalence of femoroacetabular impingement-associated morphology in a paediatric and adolescent population: a CT study of 225 patients. Bone Joint J. 2013;95-B(5):598–604.

    Article  CAS  PubMed  Google Scholar 

  56. Carsen S, Moroz PJ, Rakhra K, Ward LM, Dunlap H, Hay JA, et al. The Otto Aufranc Award. On the etiology of the cam deformity: a cross-sectional pediatric MRI study. Clin Orthop Relat Res. 2014;472(2):430–6.

    Article  PubMed  Google Scholar 

  57. 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;413:201–7.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

  59. 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 Off Publ Orthop Res Soc. 2005;23(6):1286–92.

    Article  Google Scholar 

  60. Gebhart JJ, Streit JJ, Bedi A, Bush-Joseph CA, Nho SJ, Salata MJ. Correlation of pelvic incidence with cam and pincer lesions. Am J Sports Med. 2014;42(11):2649–53.

    Article  PubMed  Google Scholar 

  61. Lazennec JY, Riwan A, Gravez F, Rousseau MA, Mora N, Gorin M, et al. Hip spine relationships: application to total hip arthroplasty. Hip Int. 2007;17 Suppl 5:S91–104.

    PubMed  Google Scholar 

  62. Eijer H, Podeszwa DA, Ganz R, Leunig M. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes’ disease. Hip Int. 2006;16(4):273–80.

    CAS  PubMed  Google Scholar 

  63. Ganz R, Huff TW, Leunig M. Extended retinacular soft tissue flap for intra-articular hip surgery: Surgical technique, indications and results of application. Instr Course Lect. 2009;58:241–55.

    PubMed  Google Scholar 

  64. Quain S, Catterall A. Hinge abduction of the hip. Diagnosis and treatment. J Bone Joint Surg Br. 1986;68(1):61–4.

    CAS  PubMed  Google Scholar 

  65. Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of Legg-Calve-Perthes’ disease. J Pediatr Orthop. 1993;13(3):286–9.

    Article  CAS  PubMed  Google Scholar 

  66. Wenger DR, Kishan S, Pring ME. Impingement and childhood hip disease. J Pediatr Orthop B. 2006;15(4):233–43.

    Article  PubMed  Google Scholar 

  67. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1981;63(7):1095–108.

    CAS  PubMed  Google Scholar 

  68. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004;86-A(10):2121–34.

    PubMed  Google Scholar 

  69. Larson AN, Sucato DJ, Herring JA, Adolfsen SE, Kelly DM, Martus JE, et al. A prospective multicenter study of Legg-Calve-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012;94(7):584–92.

    Article  PubMed  Google Scholar 

  70. Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24(10):1135–45.

    Article  PubMed  Google Scholar 

  71. Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010;468(2):555–64.

    Article  PubMed  Google Scholar 

  72. Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010;38(11):2337–45.

    Article  PubMed  Google Scholar 

  73. Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252–69.

    Article  PubMed  Google Scholar 

  74. Resnick D, Niwayama G. Degenerative disease of extraspinal locations. In: Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia: WB Saunders; 1981. p. 1322–35.

    Google Scholar 

  75. Doherty M, Courtney P, Doherty S, Jenkins W, Maciewicz RA, Muir K, et al. Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a case-control study. Arthritis Rheum. 2008;58(10):3172–82.

    Article  PubMed  Google Scholar 

  76. Sankar WN, Nevitt M, Parvizi J, Felson DT, Agricola R, Leunig M. Femoroacetabular impingement: defining the condition and its role in the pathophysiology of osteoarthritis. J Am Acad Orthop Surg. 2013;21 Suppl 1:S7–15.

    PubMed  Google Scholar 

  77. Nicholls AS, Kiran A, Pollard TC, Hart DJ, Arden CP, Spector T, et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum. 2011;63(11):3392–400.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Rasquinha BJ, Sayani J, Rudan JF, Wood GC, Ellis RE. Articular surface remodeling of the hip after periacetabular osteotomy. Int J Comput Assist Radiol Surg. 2012;7(2):241–8.

    Article  PubMed  Google Scholar 

  79. Rylander JH, Shu B, Andriacchi TP, Safran MR. Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking. Am J Sports Med. 2011;39(Suppl):36S–42.

    Article  PubMed  Google Scholar 

  80. Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait Walking biomechanics of FAI. Gait Posture. 2009;30(1):41–4.

    Article  PubMed  Google Scholar 

  81. Alradwan HK, Hamel-Smith M, Ayeni OM. Gait and lower extremity kinematic analysis as an outcome measure after femoroacetabular impingement surgery. Arthroscopy. 2015;31(2):339–44.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Fellow, Queens University, Kingston, ON, Canada

    Gavin C. A. Wood MBChB, FRCS Edin, FRCSC & Michel Taylor MD

  2. Clinical Fellow, Division of Orthopedic Surgery, Queens University, Kingston, ON, Canada

    Hamad Alshahrani SBOS, MD

  3. Department of Orthopaedic Surgery, King Fahad Specialist Hospital, Queens University, Dammam, Saudi Arabia

    Hamad Alshahrani SBOS, MD

Authors
  1. Gavin C. A. Wood MBChB, FRCS Edin, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamad Alshahrani SBOS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel Taylor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gavin C. A. Wood MBChB, FRCS Edin, FRCSC .

Editor information

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

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Wood, G.C.A., Alshahrani, H., Taylor, M. (2017). Pathophysiology of Femoroacetabular Impingement (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_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32000-7_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31998-8

  • Online ISBN: 978-3-319-32000-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation