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  • Review Article
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New perspectives on femoroacetabular impingement syndrome

Nature Reviews Rheumatology volume 12, pages 303–310 (2016)Cite this article

Subjects

Key Points

  • Femoroacetabular impingement (FAI) between an abnormal proximal femur or acetabulum, or both, results in repetitive microtrauma and early damage to the cartilage and labrum of the hip joint

  • Restricted hip range of motion in FAI can increase the risk of other associated injuries

  • Arthroscopic management of FAI is minimally invasive and results in reduced morbidity compared with open surgery techniques

  • Prospective studies are required to clarify the progression of subtle FAI morphology into hip osteoarthritis

Abstract

Femoroacetabular impingement (FAI) is characterized by an abnormality in the shape of the femoral head–neck or acetabulum that results in impingement between these two structures. Arthroscopic treatment has become the preferred method of management of FAI owing to its minimally invasive approach. Surgical correction involves resection of impinging osseous structures as well as concurrent management of the associated chondral and labral pathology. Research from the past 5 years has shown that repair of the labrum results in a better anatomic correction and improved outcomes compared with labral debridement. Research is underway to improve cartilage assessment by using innovative imaging techniques and biochemical tests to inform predictions of prognosis. Several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), will provide critical information regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI.

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Figure 1: Different types of femoroacetabular impingement (FAI).
Figure 2: Cam femoroacetabular impingement (FAI) pathology.
Figure 3: Pincer femoroacetabular impingement (FAI) pathology.
Figure 4: Diagnostic approach to guide surgical and conservative management of femoroacetabular impingement (FAI).
Figure 5: Arthroscopic repair of labral tear.

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Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, L8S 4L8, Ontario, Canada

    Moin Khan, Olufemi R. Ayeni & Mohit Bhandari

  2. Department of Orthopaedic Surgery, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, 48105, Michigan, USA

    Asheesh Bedi

  3. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue 1011, Pittsburgh, 15213, Pennsylvania, USA

    Freddie Fu

  4. Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 413 45, Sweden

    Jon Karlsson

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M.K. and O.R.A. wrote the manuscript. M.K., A.B., O.R.A. and M.B. researched data for the article. All authors (M.K., A.B., F.F., J.K., O.R.A. and M.B.) contributed to discussions of the content and review or editing of the manuscript before submission.

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Correspondence to Mohit Bhandari.

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Competing interests

O.R.A. declares that he has received consulting fees from Smith & Nephew. A.B. declares that he has received consulting fees from A3 Surgical and Smith & Nephew. M.B. declares that he has received consulting fees from Amgen, Bioventus, Depuy, Eli Lilly, Smith and Nephew, Stryker and Zimmer. All consulting fees declared by O.R.A, A.B. and M.B. relate to matters outside the submitted manuscript. All other authors declare no competing interests.

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Khan, M., Bedi, A., Fu, F. et al. New perspectives on femoroacetabular impingement syndrome. Nat Rev Rheumatol 12, 303–310 (2016). https://doi.org/10.1038/nrrheum.2016.17

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