Skip to main content
Top
Published in: Current Reviews in Musculoskeletal Medicine 3/2013

01-09-2013 | Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

Current concepts and trends for operative treatment of FAI: hip arthroscopy

Authors: Christopher M. Larson, Rebecca M. Stone

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2013

Login to get access

Abstract

There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and meta-analysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischio-femoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.
Literature
1.
go back to reference Lavigne M, Parvizi J, Beck M, et al. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–6.PubMedCrossRef Lavigne M, Parvizi J, Beck M, et al. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–6.PubMedCrossRef
2.
go back to reference Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.PubMedCrossRef Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.PubMedCrossRef
3.
go back to reference Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.PubMed Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.PubMed
4.
go back to reference Ferguson SJ, Liechti EF, Tannast M. Joint degeneration pattern in severe pincer impingement and its implications for surgical therapy. In: 2012 ORS annual meeting program. Rosemont, IL: Orthopaedic Research Society, 2012. Ferguson SJ, Liechti EF, Tannast M. Joint degeneration pattern in severe pincer impingement and its implications for surgical therapy. In: 2012 ORS annual meeting program. Rosemont, IL: Orthopaedic Research Society, 2012.
5.
go back to reference Büchler L, Neumann M, Schwab JM, et al. Arthroscopic versus open cam resection in the treatment of femoroacetabular impingement. Arthroscopy. 2013;29:653–60.PubMedCrossRef Büchler L, Neumann M, Schwab JM, et al. Arthroscopic versus open cam resection in the treatment of femoroacetabular impingement. Arthroscopy. 2013;29:653–60.PubMedCrossRef
6.
go back to reference Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med. 2011;39(Suppl):20S–8S.PubMedCrossRef Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med. 2011;39(Suppl):20S–8S.PubMedCrossRef
7.
go back to reference Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010;38:2337–45.PubMedCrossRef Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010;38:2337–45.PubMedCrossRef
8.
go back to reference Botser IB, Smith Jr TW, Nasser R, Domb BG. Open surgical dislocation vs arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27:270–8.PubMedCrossRef Botser IB, Smith Jr TW, Nasser R, Domb BG. Open surgical dislocation vs arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27:270–8.PubMedCrossRef
9.
go back to reference Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010;468:555–64.PubMedCrossRef Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010;468:555–64.PubMedCrossRef
10.
go back to reference Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27:252–69.PubMedCrossRef Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27:252–69.PubMedCrossRef
11.
go back to reference Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24:1135–45.PubMedCrossRef Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24:1135–45.PubMedCrossRef
12.
go back to reference • Hetsroni I, Larson CM, Dela Torre K, et al. Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy. 2012;28:1644–53. This case series reported on 10 patients that underwent an arthroscopic subspine/AIIS decompression for prior avulsion injury. At a mean 14.7 month follow-up the modified HHS improved a mean 34 points and hip flexion range of motion improved a mean 18 degrees. This further supports the concept of various patterns of extra-articular hip impingement and the fact that impingement is more than just an acetabular rim and femoral head-neck junction disorder in some patients. PubMedCrossRef • Hetsroni I, Larson CM, Dela Torre K, et al. Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy. 2012;28:1644–53. This case series reported on 10 patients that underwent an arthroscopic subspine/AIIS decompression for prior avulsion injury. At a mean 14.7 month follow-up the modified HHS improved a mean 34 points and hip flexion range of motion improved a mean 18 degrees. This further supports the concept of various patterns of extra-articular hip impingement and the fact that impingement is more than just an acetabular rim and femoral head-neck junction disorder in some patients. PubMedCrossRef
13.
go back to reference Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT. Anterior Inferior Iliac Spine Morphology Correlates With Hip Range of Motion: A Classification System and Dynamic Model. Clin Orthop Relat Res. 2013. doi:10.1007/s11999-013-2847-4. Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT. Anterior Inferior Iliac Spine Morphology Correlates With Hip Range of Motion: A Classification System and Dynamic Model. Clin Orthop Relat Res. 2013. doi:10.​1007/​s11999-013-2847-4.
14.
go back to reference Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concepts. Arthroscopy. 2011;27:1732–7.PubMedCrossRef Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concepts. Arthroscopy. 2011;27:1732–7.PubMedCrossRef
15.
go back to reference Macnicol MF, Makris D. Distal transfer of the greater trochanter. J Bone Joint Surg Br. 1991;73:838–41.PubMed Macnicol MF, Makris D. Distal transfer of the greater trochanter. J Bone Joint Surg Br. 1991;73:838–41.PubMed
16.
go back to reference Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62–7.PubMed Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62–7.PubMed
17.
go back to reference Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI. Clin Orthop Relat Res. 2013. doi:10.1007/s11999-013-2895-9. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI. Clin Orthop Relat Res. 2013. doi:10.​1007/​s11999-013-2895-9.
18.
go back to reference Taneja AK, Bredella MA, Torriani M. Ischiofemoral impingement. Magn Reson Imaging Clin N Am. 2013;21:65–73.PubMedCrossRef Taneja AK, Bredella MA, Torriani M. Ischiofemoral impingement. Magn Reson Imaging Clin N Am. 2013;21:65–73.PubMedCrossRef
19.
go back to reference Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg Br. 2011;93:1300–2.PubMed Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg Br. 2011;93:1300–2.PubMed
20.
go back to reference Buller LT, Rosneck J, Monaco FM, et al. Relationship between proximal femoral and acetabular alignment in normal hip joints using 3-dimensional computed tomography. Am J Sports Med. 2012;40:367–75.PubMedCrossRef Buller LT, Rosneck J, Monaco FM, et al. Relationship between proximal femoral and acetabular alignment in normal hip joints using 3-dimensional computed tomography. Am J Sports Med. 2012;40:367–75.PubMedCrossRef
21.
go back to reference Fabricant PD, Bedi A, De La Torre K, Kelly BT. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. Arthroscopy. 2012;28:965–71.PubMedCrossRef Fabricant PD, Bedi A, De La Torre K, Kelly BT. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. Arthroscopy. 2012;28:965–71.PubMedCrossRef
22.
go back to reference Steppacher SD, Albers CE, Siebenrock KA, Tannast M, Ganz R. Femoroacetabular impingement predisposes to traumatic posterior hip dislocation. Clin Orthop Relat Res. 2013;471(6):1937-43. doi:10.1007/s11999-013-2863-4. Steppacher SD, Albers CE, Siebenrock KA, Tannast M, Ganz R. Femoroacetabular impingement predisposes to traumatic posterior hip dislocation. Clin Orthop Relat Res. 2013;471(6):1937-43. doi:10.​1007/​s11999-013-2863-4.
23.
go back to reference Manner HM, Mast NH, Ganz R, Leunig M. Potential contribution of femoroacetabular impingement to recurrent traumatic hip dislocation. J Pediatr Orthop B. 2012;21:574–8.PubMedCrossRef Manner HM, Mast NH, Ganz R, Leunig M. Potential contribution of femoroacetabular impingement to recurrent traumatic hip dislocation. J Pediatr Orthop B. 2012;21:574–8.PubMedCrossRef
24.
go back to reference Krych AJ, Thompson M, Larson CM, Byrd JW, Kelly BT. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res. 2012;470:3390–7.PubMedCrossRef Krych AJ, Thompson M, Larson CM, Byrd JW, Kelly BT. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res. 2012;470:3390–7.PubMedCrossRef
25.
go back to reference • Duthon VB, Charbonnier C, Kolo FC, et al. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013;29:411–9. This recent study supports the concept of extreme ROM induced FAI. They evaluated impingement tests, hip range of motion, and MRI findings (additional splits position for dancers) in professional female ballet dancers compared with healthy matched females. Hip MRI’s for dancers in the splits position revealed femoral head subluxations and labral and chondral pathology that was typically postero-superior compared with antero-superior in location for non-dancers. PubMedCrossRef • Duthon VB, Charbonnier C, Kolo FC, et al. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013;29:411–9. This recent study supports the concept of extreme ROM induced FAI. They evaluated impingement tests, hip range of motion, and MRI findings (additional splits position for dancers) in professional female ballet dancers compared with healthy matched females. Hip MRI’s for dancers in the splits position revealed femoral head subluxations and labral and chondral pathology that was typically postero-superior compared with antero-superior in location for non-dancers. PubMedCrossRef
26.
go back to reference Kolo FC, Charbonnier C, Pfirrmann CW, et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol. 2013;42:689–98.PubMedCrossRef Kolo FC, Charbonnier C, Pfirrmann CW, et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol. 2013;42:689–98.PubMedCrossRef
27.
go back to reference Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–60.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–60.PubMedCrossRef
28.
go back to reference Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg. 2006;88A:925–35.CrossRef Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoroacetabular impingement: preliminary results of labral refixation. J Bone Joint Surg. 2006;88A:925–35.CrossRef
29.
go back to reference Larson CM, Giveans MR. Arthroscopic debridement vs refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25:369–76.PubMedCrossRef Larson CM, Giveans MR. Arthroscopic debridement vs refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25:369–76.PubMedCrossRef
30.
go back to reference Larson CM, Giveans MR, Stone RM. Arthroscopic debridement vs refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40:1015–21.PubMedCrossRef Larson CM, Giveans MR, Stone RM. Arthroscopic debridement vs refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40:1015–21.PubMedCrossRef
31.
go back to reference Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair vs selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29:46–53.PubMedCrossRef Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair vs selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29:46–53.PubMedCrossRef
32.
go back to reference Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med. 2012;40:2218–23.PubMedCrossRef Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med. 2012;40:2218–23.PubMedCrossRef
33.
go back to reference Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26:750–6.PubMedCrossRef Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26:750–6.PubMedCrossRef
34.
go back to reference Bedi A, Galano G, Walsh C, Kelly BT. Capsular management during hip arthroscopy: from femoroacetabular impingement to instability. Arthroscopy. 2011;27:1720–31.PubMedCrossRef Bedi A, Galano G, Walsh C, Kelly BT. Capsular management during hip arthroscopy: from femoroacetabular impingement to instability. Arthroscopy. 2011;27:1720–31.PubMedCrossRef
35.
go back to reference Domb BG, Philippon MJ, Giordano BD. Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to a traumatic instability. Arthroscopy. 2013;29:162–73.PubMedCrossRef Domb BG, Philippon MJ, Giordano BD. Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: relation to a traumatic instability. Arthroscopy. 2013;29:162–73.PubMedCrossRef
36.
go back to reference Blakey CM, Field MH, Singh PJ, Tayar R, Field RE. Secondary capsular laxity of the hip. Hip Int. 2010;20:497–504.PubMed Blakey CM, Field MH, Singh PJ, Tayar R, Field RE. Secondary capsular laxity of the hip. Hip Int. 2010;20:497–504.PubMed
37.
go back to reference Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy. 2012;28:440–5.PubMedCrossRef Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy. 2012;28:440–5.PubMedCrossRef
38.
go back to reference Milone MT, Bedi A, Poultsides L, et al. Novel CT-based Three-dimensional Software Improves the Characterization of Cam Morphology. Clin Orthop Relat Res. 2013. doi:10.1007/s11999-013-2809-x. Milone MT, Bedi A, Poultsides L, et al. Novel CT-based Three-dimensional Software Improves the Characterization of Cam Morphology. Clin Orthop Relat Res. 2013. doi:10.​1007/​s11999-013-2809-x.
40.
go back to reference Wassilew GI, Heller MO, Diederichs G, et al. Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion. J Orthop Res. 2012;30:1369–76.PubMedCrossRef Wassilew GI, Heller MO, Diederichs G, et al. Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion. J Orthop Res. 2012;30:1369–76.PubMedCrossRef
41.
go back to reference Wassilew GI, Janz V, Heller MO, et al. Real time visualization of femoroacetabular impingement and subluxation using 320-slice computed tomography. J Orthop Res. 2013;31:275–81. This study evaluated CT range of motion analysis in 30 patients undergoing surgical hip dislocation for FAI. The accuracy of the CT range of motion analysis was compared with the intra-operative findings at the time of surgical hip dislocation and was found to have a high degree of accuracy for defining the areas of impingement. The use of 3D motion analysis in the future may significantly improve surgical planning and accuracy of the procedures performed. PubMedCrossRef Wassilew GI, Janz V, Heller MO, et al. Real time visualization of femoroacetabular impingement and subluxation using 320-slice computed tomography. J Orthop Res. 2013;31:275–81. This study evaluated CT range of motion analysis in 30 patients undergoing surgical hip dislocation for FAI. The accuracy of the CT range of motion analysis was compared with the intra-operative findings at the time of surgical hip dislocation and was found to have a high degree of accuracy for defining the areas of impingement. The use of 3D motion analysis in the future may significantly improve surgical planning and accuracy of the procedures performed. PubMedCrossRef
Metadata
Title
Current concepts and trends for operative treatment of FAI: hip arthroscopy
Authors
Christopher M. Larson
Rebecca M. Stone
Publication date
01-09-2013
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 3/2013
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-013-9170-2

Other articles of this Issue 3/2013

Current Reviews in Musculoskeletal Medicine 3/2013 Go to the issue

Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

Treatment of femoroacetabular impingement: a systematic review

Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

History and physical examination of the hip: the basics

Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

Guidelines and pitfalls for the rehabilitation following hip arthroscopy

Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

Hip arthroscopy for extra-articular hip disease

Hip Arthroscopy (SJ Nho and HD Martin, Section Editors)

Operative treatment of FAI: open hip preservation surgery