Top

Clinical Orthopaedics and Related Research®

Published in:

01-03-2009 | Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Authors: Michael Leunig, MD, Paul E. Beaulé, MD, Reinhold Ganz, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2009

Abstract

Femoroacetabular impingement (FAI) is a recently proposed mechanism causing abnormal contact stresses and potential joint damage around the hip. In the majority of cases, a bony deformity or spatial malorientation of the femoral head or head/neck junction, acetabulum, or both cause FAI. Supraphysiologic motion or high impact might cause FAI even with very mild bony alterations. FAI became of interest to the medical field when (1) evidence began to emerge suggesting that FAI may initiate osteoarthritis of the hip and when (2) adolescents and active adults with groin pain and imaging evidence of FAI were successfully treated addressing the causes of FAI. With an increased recognition and acceptance of FAI as a damage mechanism of the hip, defined standards of assessment and treatment need to be developed and established to provide high accuracy and precision in diagnosis. Early recognition of FAI followed by subsequent behavioral modification (profession, sports, etc) or even surgery may reduce the rate of OA due to FAI.

Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–779.PubMedCrossRef

Beaule PE, Zaragoza E, Copelan N. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination. A report of four cases. J Bone Joint Surg Am. 2004;86:2294–2298.PubMed

Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–1292.PubMed

Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.PubMedCrossRef

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMed

Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–1457.PubMedCrossRef

Carlioz H, Pous JG, Rey JC. Upper femoral epiphysiolysis [in French]. Rev Chir Orthop Repar Appar Mot. 1968;54:387–491.

Christensen CP, Althausen PL, Mittleman MA, Lee JA, McCarthy JC. The nonarthritic hip score: reliable and validated. Clin Orthop Relat Res. 2003;406:75–83.PubMedCrossRef

Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, Patel RV, Miller AR, McCarthy JC, Lowe WR, Noble PC. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.PubMed

10.

Cunningham T, Jessel R, Zurakowski D, Millis MB, Kim YJ. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia. J Bone Joint Surg Am. 2006;88:1540–1548.PubMedCrossRef

11.

Dora C, Mascard E, Mladenov K, Seringe R. Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B. 2002;11:34–40.PubMedCrossRef

12.

Dora C, Zurbach J, Hersche O, Ganz R. Pathomorphologic characteristics of posttraumatic acetabular dysplasia. J Orthop Trauma. 2000;14:483–489.PubMedCrossRef

13.

Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.PubMedCrossRef

14.

Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech Bristol, Avon. 2000;15:463–468.CrossRef

15.

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;33:953–960.PubMedCrossRef

16.

Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRef

17.

Ganz R, Bamert P, Hausner P, Isler B, Vrevc F. Cervico-acetabular impingement after femoral neck fracture [in German]. Unfallchirurg. 1991;94:172–175.PubMed

18.

Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.PubMedCrossRef

19.

Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.PubMedCrossRef

20.

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed

21.

Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:263–269.PubMed

22.

Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.PubMed

23.

Harris WH, Krushell RJ, Galante JO. Results of cementless revisions of total hip arthroplasties using the Harris-Galante prosthesis. Clin Orthop Relat Res. 1988;235:120–126.PubMed

24.

Herndon CH, Heymann CH, Bell DM. Treatment of slipped capital femoral epiphysis by epiphysiodesis and osteoplasty of the femoral neck. J Bone Joint Surg Am. 1963;45:999–1012.PubMed

25.

Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302.PubMed

26.

Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271.PubMedCrossRef

27.

Ito K, Minka MA II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.PubMedCrossRef

28.

Jager M, Wild A, Westhoff B, Krauspe R. Femoroacetabular impingement caused by a femoral osseous head-neck bump deformity: clinical, radiological, and experimental results. J Orthop Sci. 2004;9:256–263.PubMedCrossRef

29.

Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res. 2007;25:758–765.PubMedCrossRef

30.

Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis : a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.PubMedCrossRef

31.

Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. 2005;236:588–592.PubMedCrossRef

32.

Kim KC, Hwang DS, Lee CH, Kwon ST. Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis. Clin Orthop Relat Res. 2007;456:128–132.PubMedCrossRef

33.

Koch R. Mitt Kaiser Gesundh. 1884;2:1–88.

34.

Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res. 2003;413:201–207.PubMedCrossRef

35.

Leunig M, Slongo T, Ganz R. Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect. 2008;57:499–507.PubMed

36.

Leunig M, Werlen S, Ungersbock A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br. 1997;79:230–234.PubMedCrossRef

37.

Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the hip outcome score. Arthroscopy. 2006;22:1304–1311.PubMedCrossRef

38.

McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.PubMedCrossRef

39.

Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.

40.

Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.PubMed

41.

Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181.PubMedCrossRef

42.

Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38:810–824.PubMedCrossRef

43.

Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.PubMedCrossRef

44.

Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.PubMedCrossRef

45.

Rothenfluh DA, Reedwisch D, Müller U, Ganz R, Tennant A, Leunig M. Construct validity of a 12-item WOMAC for assessment of femoro-acetabular impingement and osteoarthritis of the hip. Osteoarthritis Cartilage. 2008;16:1032–1038.PubMedCrossRef

46.

Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54–60.PubMedCrossRef

47.

Solomon L, Schitzler CM. Pathogenetic types of coxarthrosis and implications for treatment. Arch Orthop Trauma Surg. 1983;101:259–261.PubMedCrossRef

48.

Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. Paper presented at: The hip: Proceedings of the third open scientific meeting of the hip society, 1975.

49.

Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–177.PubMedCrossRef

50.

Vulpius O, Stöffel A. Orthopädische Operationslehre. Stuttgart, Germany: F. Enke; 1913.

51.

Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–150.PubMedCrossRef

Title: The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives
Authors: Michael Leunig, MD
Paul E. Beaulé, MD
Reinhold Ganz, MD
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 3/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0646-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2009

The Effect of Cam FAI on Hip and Pelvic Motion during Maximum Squat

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

Groin Pain after Open FAI Surgery: The Role of Intraarticular Adhesions

Case Reports: Fatal Necrotizing Fasciitis Caused by Aeromonas sobria in Two Diabetic Patients

Femoroacetabular Impingement: Do Outcomes Reliably Improve with Surgical Dislocations?