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Femoroacetabular Impingement

Femoroacetabular Impingement

Femoroacetabular impingement is an abnormality that results in damage to the hip joint (D’Lima, Darryl.D., 2013) and typically occurs in younger patients, often leading to secondary osteoarthritis. (Ganz R, et.al., 2004).  The most common forms of the condition are cam FAI and pincer FAI, and these can occur together in which case the condition is called mixed FAI.

The conditions are characterised by an abnormal contact between the hip ball (proximal femur) and the rim of the hip socket (acetabulum). Typically, patients have either a deformity of the ball, a poorly positioned junction between the ball and the socket, or both of these.

Although the condition can occur at any age, it is see most often in patients with ages ranging from teenage to middle age. Young athletes are prone to the condition which is often experienced as groin pain; often it occurs following a minor injury.

 

Cam Femoroacetabular Impingement

Cam impingement occurs when an abnormally shaped femoral head, typically a bump, jams and tears the labrum or causes it to pull away from the rim; mostly in the top front labrum. Athletes and young active males are particularly prone to this condition.

Many people have such femoral head abnormalities, but not all of them go on to develop the condition. Generally, the cam impingement results from trauma, explaining why active males and athletes are particularly susceptible.

 

Pincer Femoroacetabular Impingement

Pincer impingement occurs a when there is abnormal contact between the rim of the socket and the femoral neck. Commonly the problem is that too much of the femoral head is covered. This condition tends to affect older females.

 

Symptoms and Diagnosis

Typically, a patient will present with hip pain which is experienced as a dull ache in the groin. Although the area is painful most days, it becomes significantly worse following intense activity. Often there is also lateral and posterior hip pain.  Left untreated the pain is likely to intensify over time and movement can become progressively restricted.

Not all hip pain is caused by femoroacetabular impingement, so it is important to rule out other causes. The first step is to take a detailed pain history. While many patients report an initial trauma, this isn’t always the case, and the condition can begin with just a mild discomfort.

 

Physical Examination

Physical examination is important. This involves checking the gait pattern for antalgic or gluteus medius gait. In this test you will be asked to sway your torso laterally over your affected hip. You will also be asked to lie on your back and your range of motion using both the affected and unaffected hips will be checked. There is likely to be significant differences in internal rotation and flexion and abduction may also be limited.

The most important test is the “impingement test”. While lying on your back, the affected hip and knee will be flexed at 90 degrees and the hip will be moved inward to your body and rotated. A resulting sudden sharp pain in the hip is a strong indicator (90%) that you have femoroacetabular impingement

 

Radiological imaging

Radiological testing may involve specialist x-ray imaging, computed tomography, and magnetic resonance scan. More often, x-rays showing an anteroposterior pelvis view and a lateral hip view are all that is required to confirm the condition.

 

Managing Femoroacetabular Impingement

For many patients, conservative therapies can help significantly. A physical treatment regimen will generally involve modifying physical activities and in particular avoiding activities that exacerbate the condition. Appropriate rest is important, but you should continue with exercises and physical activities that do not aggravate the condition.

Physical therapy has been shown to help with mobility improvement and pain reduction. A recent study of the effect of personalised exercise programmes designed to improve pelvic and femoral control in conjunction with posture improvement and pacing of physical activities (Smeatham et. al.,2016) demonstrated that the treatment had a positive clinically significant particularly in the case of the Lower Extremity Functional Score.

 

Surgical Intervention

While physical therapies can help manage the condition, they can’t cure it, and surgical intervention is often necessary.  This is usually undertaken by a specialist orthopedic surgeon. Usually the procedure involves repairing labral tears and adjusting the contour joints. Often arthroscopic treatments can be used as an effective alternative to open surgical treatment.

 

Recovery

Patients receiving arthroscopy need around three to four months to recover while open surgical treatment requires longer recovery times, possibly up to twelve months. Physiotherapy is an important part of the recovery programme.

 

Finally

Femoroacetabular impingement can be a difficult problem, especially for athletes and other young active adults. While physical therapies can bring relief, often surgical intervention is the only way to fully return the patient to full functionality. Fortunately, the outcomes are highly positive with 80% of patients who receive arthroscopic hip treatments fully recovering in three to four months and 95% fully recovering within a year.

 

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    References

    D’Lima, Darryl.D., 2013. Inflammatory Events in Cartilage in Early Stages of Femoroacetabular Impingement. J Bone Joint Surg Am, 95(16), p.e121.

    Ganz R  Parvizi J  Beck M  Leunig M  Nötzli H  Siebenrock KA . Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003 Dec;417:112-20

    Smeatham, A., Powell, R., Moore, S., Chauhan, R. and Wilson, M., 2016. Does physiotherapy change pain and function in young adults with symptoms from femoroacetabular impingement? A pilot project for a randomised controlled trial. Physiotherapy.

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