femoroacetabular impingement

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Ch. ChrysovergisResident OrthopaedicUniversity Hospital LarisaDirector : Prof. K. Malizos

www.Ortho-uth.org

Femoro-Acetabular Femoro-Acetabular Impingement F.A.IImpingement F.A.I

Introduction Cause of early degenerative changes in

young adult hips Abnormal impingement (abutment)

between the femoral head – neck junction and the acetabular rim

Reinold Ganz , Javad Parvizzi , Martin Beck , Michael Leunig University of Bern Switzerland

- Occurs in patients with : Abnormal hip morphology Normal hip morphology but excessive

range of hip movement

Patients with F.A.I. Healthy,active adults. Ages 25 – 50 yrs old. Athletic

activities,extreme renge of hip motion,deep hip flexion,pivoting of the hip,Ice Hockey,Martial Arts,Football,Golf

Track - field gymnastics

jumpers,runners

I. A. Kapandji – ‘’Physiologie Articulaire’’

Patients with minor trauma or underlying hip pathology

Post – traumatic free bodies into the joint,lateral impact injury to the grater trochanter

Legg – Calve – Perthes Slipped femoral head epiphysis Aspherical head Previous femoral neck fracture

(decreased head – neck offset,widening of the femoral neck)

Anatomical structures The Hip joint consists

of : Acetabulum,Labrum,Head – Neck junction of Femur,Articular capsule

Labrum : fibrocartilaginous structure,deepens the articular cavity of acetabulum,increases stability

Head – Neck junction : is an intracapsular structure

Αλ. Ε. Αγιος : ‘’Ανατομικη’’

Femoral Head :Almost spherical,covered by the labrum at it’s 2/3,beyond the point of it’s equator

The articular cartilage of the acetabulum and of the femoral head are thicker at the antero – superior point,region of the greater forces that the acetabulum endures during the abutmen (impingement) of the femoral head

Mechanism & AetiologyTypes of F.A.I. 3 Types of

F.A.I. :

‘’cam’’ type

‘’pincer’’ type

mixed type

‘’cam’’ type :

non spherical head

reduce of

head – neck offset

widening of

head – neck junction

‘’pistol – grip’’ deformity

‘’pincer type’’ :

excessive acetabular cover (coxa profunda)

acetabular retroversion

protrusio acetabuli

‘’Cam’’ type : damage to the

antero – superior aeria of the acetabulum

the accenrtic part compresses and shears the labrum and acetabular cartilage causing separation between the labrum and the cartilage

damage location : antero – superior

(1 o’clock)

M : F – 14 : 1

‘’pincer’’ type : range of hip

movement limited by the acetabular rim (overcoverage of the head)

at the ending of motion the neck abuts against the labrum wich acts as a bumper and is compressed between the neck and the rim

danage in a narrow band along the rim with ossification of the labrum (11 – 1 o’clock)

M : F – 1 : 3

Practicaly none of the above types is isolated.’’Mixed’’ type is the most usual

Diagnosis & Differential Diagnosis

Clinical : patient presents with groin pain (anterior hip pain) usualy young and/or middle aged active adults with

minor trauma or no trauma history limitation of hip movement increasing pain with activities,prolonged sitting difficulty to get in – out of the car,arising from seat

or bed difficulty to do the shoes,socks

patient shows his hip with the grip ‘’C’’ sing

positive impingement test – pain in flexion , adduction , internal ritation of the hip

Imaging : plain X – rays : anteroposterior

(face) + profil x - rays

‘’pistol - grip’’ deformity

non spherical head

free intra – articular bodies

Α. Γεωργούλης – Ι. Μίχος : ‘’Χόνδρινες & οστεοχόνδρινες βλάβες’’ ΕΕΧΟΤ 2011

Απ. Καραντανας – ‘’Απεικονιση αθλητικων κακωσεων’’ 2010

UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

CT : more efficent for bone structures , free intra – articular bodies

Α. Γεωργουλης , Ι. Μιχος – ‘’Χονδρινες και οστεοχονδρινες βλαβες’’ ΕΕΧΟΤ 2011

MRI & MRAo MRI : more efficient for soft tissue

structures,labrum,acetabular rimo MRA : is now becoming the standard

investigation of F.A.I. ruptures of the labrum abnormality of the head – neck junction ossification of the labrum meassurement of the α (alfa) angle

Απ. Καραντανας

‘’ΑπεικονισηΑθλητικων Κακωσεων’’2010

Απ. Καραντανας – ‘’Απεικονιση αθλητικων κακωσεων’’ 2010

Differential diagnosiso inguinal herniao low back disorderso trohanteric bursitis

Conservative Treatment The aim is to improve the symptoms Rest,modofication of activities Avoid excessive motion activities NSAIDS Intensive physicotherapy might

aggrevate the condition trying to improve hip movement

usualy temporary relief of symptoms with conservative treatment

Surgical treatment The aim is to correct the cause of F.A.I. ,

improve hip motion

Open surgery

Hip arthroscopy

Open surgery Lateral or posterolateral approach Dislocation of the femural head with

care to it’s blood supply Osteoplasty of the (‘’cam’’) head – neck

junction , with caution not to resect over 30% of the antero – lateral quadrant of the neck.Risc of neck fracture

Resection osteoplasty of the (‘’pincer’’) acetabular rim , reorientation of the acetabulum

Hip arthroscopy Performed in lateral or supine position

with traction applied C – Arm imaging is essential for safe

entry of the portals 3 portals : Anterior Anterolateral Posterolateral

Debridement of free bodies

Debridement of labral and cartilage lesions

Microfractures technique for the acetabular cartilage

Correction of the acetabular rim

Head – neck junction osteoplasty

Open vs Arthroscopy : both have good results although patients operated with arthroscopy recovered much earlier

Conclusions F.A.I. usualy occurs in young to middle – aged

active adults and athletes Can be a limitation to the level of activity Conservative treatment improves the symptoms

but not the cause Final solution could be the surgical treatment

with verry good results

thank you