Skip to main content
Log in

Femoro-acetabular impingement: what the general radiologist should know

  • Musculoskeletal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Femoro-acetabular impingement (FAI) is a common condition in young active subjects, which can lead to the development of early osteoarthritis if not correctly diagnosed. Imaging evaluation of FAI, mainly based on plain film and magnetic resonance evaluation, must be performed according to precise guidelines and is fundamental for reaching a final diagnosis. The purpose of this paper is to provide a clinical and radiological overview of FAI by describing the most common clinical tests, the imaging techniques used in the diagnosis, and the main radiological signs that may be encountered.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Ganz R, Parvizi J, Beck M et al (2003) Femoro-acetabular impingement: an important cause of early osteoarthritis of the hip. Clin Orthop 417:112–120

    PubMed  Google Scholar 

  2. Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 188:1540–1552

    Article  PubMed  Google Scholar 

  3. Leunig M, Ganz R (2005) Femoroacetabular impingement: a common cause of hip complaints leading to arthrosis. Unfallchirurg 108:9–17

    Article  CAS  PubMed  Google Scholar 

  4. Hoaglund FT, Steinbach LS (2001) Primary osteoarthritis of the hip: etiology and epidemiology. J Am Acad Orthop Surg 9:320–327

    CAS  PubMed  Google Scholar 

  5. Tanzer M, Noiseux N (2004) Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 429:170–177

    Article  PubMed  Google Scholar 

  6. Notzli HP, Wyss TF, Stoecklin CH et al (2002) The contour of the femoral head–neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560

    Article  CAS  PubMed  Google Scholar 

  7. Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85:278–286

    PubMed  Google Scholar 

  8. Leunig M, Beck M, Woo A et al (2003) Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res 413:201–207

    Article  PubMed  Google Scholar 

  9. Beck M, Leunig M, Parvizi J et al (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73

    Article  PubMed  Google Scholar 

  10. Burnett RS, Della Rocca GJ, Prather H et al (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 88:1448–1457

    Article  PubMed  Google Scholar 

  11. Banerjee P, McLean CR (2011) Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med 4:23–32

    Article  PubMed Central  PubMed  Google Scholar 

  12. Clohisy JC, Carlisle JC, Beaulé PE et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 90(Suppl 4):47–66

    Article  PubMed  Google Scholar 

  13. Tannast M, Zheng G, Anderegg C et al (2005) Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res 438:182–190

    Article  CAS  PubMed  Google Scholar 

  14. Beck M, Kalhor M, Leunig M, Ganz R (2005) 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 87:1012–1018

    Article  CAS  PubMed  Google Scholar 

  15. Leunig M, Beck M, Kalhor M et al (2005) Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology 236:237–246

    Article  PubMed  Google Scholar 

  16. Martinez AE, Li SM, Ganz R, Beck M (2006) Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim? Hip Int 16:281–286

    CAS  PubMed  Google Scholar 

  17. Barton C, Salineros MJ, Rakhra KS, Beaulé PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469:464–469

    Article  PubMed  Google Scholar 

  18. Domayer SE, Ziebarth K, Chan J et al (2011) Femoroacetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI. Eur J Radiol 80:805–810

    Article  CAS  PubMed  Google Scholar 

  19. Kappe T, Kocak T, Neuerburg C et al (2011) Reliability of radiographic signs for acetabular retroversion. Int Orthop 35:817–821

    Article  PubMed Central  PubMed  Google Scholar 

  20. Couture A, Baud C, Prodhomme O et al (2011) Ultrasound of the neonatal hip: initial evaluation and follow-up. J Radiol 92:142–165

    Article  CAS  PubMed  Google Scholar 

  21. Sconfienza LM, Perrone N, Lacelli F et al (2008) Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity. J Ultrasound 11:113–117

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Troelsen A, Mechlenburg I, Gelineck J et al (2009) What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop 80:314–318

    Article  PubMed  Google Scholar 

  23. Buck FM, Hodler J, Zanetti M et al (2011) Ultrasound for the evaluation of femoroacetabular impingement of the cam type. Diagnostic performance of qualitative criteria and alpha angle measurements. Eur Radiol 21:167–175

    Article  PubMed  Google Scholar 

  24. Czerny C, Hofmann S, Neuhold A et al (1996) Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 200:225–230

    CAS  PubMed  Google Scholar 

  25. Czerny C, Hofmann S, Urban M et al (1999) MR arthrography of the adult acetabular capsular–labral complex: correlation with surgery and anatomy. AJR 173:345–349

    Article  CAS  PubMed  Google Scholar 

  26. Pfirrmann CW, Mengiardi B, Dora C et al (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240:778–785

    Article  PubMed  Google Scholar 

  27. Leopold SS, Battista V, Oliverio JA (2001) Safety and efficacy of intraarticular hip injection using anatomic landmarks. Clin Orthop Relat Res 391:192–197

    Article  PubMed  Google Scholar 

  28. Bredella MA, Stoller DW (2005) MR imaging of femoroacetabular impingement. Magn Reson Imaging Clin N Am 13:653–664

    Article  PubMed  Google Scholar 

  29. Reichenbach S, Leunig M, Werlen S et al (2011) Association between cam-type deformities and magnetic resonance imaging-detected structural hip damage: a cross-sectional study in young men. Arthritis Rheum 63:4023–4030. doi:10.1002/art.30589

    Article  PubMed  Google Scholar 

  30. Lage LA, Patel JV, Villos RN (1996) The acetabular labral tear: an arthroscopic classification. Arthroscopy 12:269–272

    Article  CAS  PubMed  Google Scholar 

  31. Schmid MR, Nötzli HP, Zanetti M et al (2003) Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 226:382–386

    Article  PubMed  Google Scholar 

  32. Leunig M, Beaulé PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 467:616–622

    Article  PubMed  Google Scholar 

  33. Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 88:1735–1741

    Article  PubMed  Google Scholar 

  34. Espinosa N, Rothenfluh DA, Beck M et al (2006) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 88:925–935

    Article  PubMed  Google Scholar 

  35. Ganz R, Gill TJ, Gautier E et al (2001) 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 83:1119–1124

    Article  CAS  PubMed  Google Scholar 

  36. Lincoln M, Johnston K, Muldoon M, Santore R (2009) Combined arthroscopic and modified open approach for cam femoroacetabular impingement: a preliminary experience. Arthroscopy 25:392–399

    Article  PubMed  Google Scholar 

  37. Philippon MJ, Shenker ML (2006) Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sport Med 25:299–308

    Article  Google Scholar 

  38. Ribas M, Marín-Peña OR, Regenbrecht B et al (2007) Hip osteoplasty by an anterior minimally invasive approach for active patients with femoroacetabular impingement. Hip Int 17:91–98

    CAS  PubMed  Google Scholar 

  39. Matsuda DK, Carlisle JC, Arthurs SC et al (2011) Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy 27:252–269

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Alberto Aliprandi, Francesco Di Pietto, Paolo Minafra, Marcello Zappia, Simona Pozza, and Luca Maria Sconfienza declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luca Maria Sconfienza.

Additional information

All authors contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aliprandi, A., Di Pietto, F., Minafra, P. et al. Femoro-acetabular impingement: what the general radiologist should know. Radiol med 119, 103–112 (2014). https://doi.org/10.1007/s11547-013-0314-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-013-0314-7

Keywords

Navigation