Femoroacetabular Impingement: Current Status of Diagnosis and Treatment: Editorial Comment

Excerpt

It is with great pleasure that I served as guest editor of this Symposium for Clinical Orthopaedics and Related Research (CORR) dedicated to femoroacetabular impingement (FAI). As one looks at the body of work presented in this symposium, as well as what has been published in the last decade on the subject, it is evident our understanding of the pathology as well as treatment of FAI have substantially evolved. It was in 1999, in CORR, that the term femoroacetabular impingement was first coined in the English literature. In the paper by Myers et al. [3] the etiology of persistent pain in five patients who had undergone a periacetabular osteotomy was believed secondary to specific mechanisms of FAI; ie, insufficient femoral head/neck offset, or what we refer to now as cam type and acetabular overcoverage or pincer type. Since then FAI has been recognized as an important cause of hip pain and labral tears in young adults as well as postulated to be a leading cause of hip arthritis. More importantly, diagnostic criteria on plain radiographs as well as specialized MRI sequences and surgical techniques have been developed for treating FAI. Although there is strong clinical evidence that surgical correction of FAI relieves pain and improves function, there is still a considerable amount of research required in establishing causality between FAI and arthritis. In his 1965 presidential address at the Proceedings of the Royal Society of Medicine [2], Sir Anthony Hill laid out the groundwork on how one should aim for causality by identifying nine key factors to guide us in its establishment: (1) strength of association (2) consistency; (3) specificity; (4) temporality; (5) biological gradient; (6) plausibility; (7) coherence; (8) experiment; and (9) analogy. …