femoroacetabular impingement

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  • Ch. ChrysovergisResident OrthopaedicUniversity Hospital LarisaDirector : Prof. K. Malizoswww.Ortho-uth.org

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  • Femoro-Acetabular Impingement 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,GolfTrack - field gymnasticsjumpers,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

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  • Femoral Head :Almost spherical,covered by the labrum at its 2/3,beyond the point of its 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 oclock) 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 oclock) 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

  • . . : & 2011

  • . 2010

  • UNIVERSITY HOSPITAL LARISA

  • UNIVERSITY HOSPITAL LARISA

  • UNIVERSITY HOSPITAL LARISA

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

    . , . 2011

  • MRI & MRA

    MRI : more efficient for soft tissue structures,labrum,acetabular rim 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 (alfa) angle

  • .

    2010

  • . 2010

  • Differential diagnosis inguinal hernia low back disorders 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 its 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

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