Introduction A common cause of early onset hip dysfunction secondary osteoarthritis Epidemiology Cam impingement refers to femoral based disorder (femoral acetabular impingement - "FAI") usually in young athletic males and includes decreased head-to-neck ratio aspherical femoral head decreased femoral offset femoral neck retroversion can be due to previous SCFE deformity Pincer impingement refers to acetabular based disorder usually in active middle-aged women and includes anterosuperior acetabular rim overhang acetabular retroversion acetabular protrusio coxa profunda combined Cam/Pincer impingement can include both patient populations refers to combinations of above (up to 80%) Mechanism result of impingement of the femoral neck against anterior edge of acetabulum Pathoanatomy proximal femur abuts acetabulum with range of motion, especially in flexion occurs if femoral head/neck bone is too broad in Cam impingement occurs if acetabular bone/labrum overhang is too broad in Pincer impingement Associated injuries labral degeneration and tears cartilage damage and flap tears secondary hip osteoarthritis Presentation Symptoms activity related groin or hip pain, exacerbated by hip flexion difficulty sitting mechanical hip symptoms can present with gluteal or trochanteric pain due to aberrant gait mechanics Exam limited hip flexion (<90 degrees), especially with internal rotation (<5 degrees) anterior impingement test (flexion, adduction, internal rotation) elicits pain externally rotated extremity can be due to post-SCFE deformity Imaging Radiographs radiographic views false profile view to assess anterior coverage of the femoral head standing position at an angle of 65° between the pelvis and the film characteristic findings asphericity and contour of femoral head and neck pistol grip deformity indicates Cam impingement examine for acetabular protrusio, retroversion, and coxa profunda crossover sign indicates acetabular retroversion in Pincer impingement measurements alpha angle method measured frog-leg lateral radiograph first line is drawn connecting the center of the femoral head and the center of the femoral neck. second line is drawn from the center of the femoral head to the point on the anterolateral head-neck junction where prominence begins the intersection of these two lines forms the alpha angle normal values values of >42° are suggestive of a head-neck offset deformity head-neck offset ratio method measured from lateral radiographs a line #1 is drawn through the center of the long axis of the femoral neck line #2 is drawn parallel to line 1 through the anteriormost aspect of the femoral neck line #3 is drawn parallel to line 2 through the anteriormost aspect of the femoral head the head-neck offset ratio is calculated by measuring the distance between lines 2 and 3, and dividing by the diameter of the femoral head normal values If the ratio is <0.17, a cam deformity is likely present CT can be used as adjunct to assess for structural abnormalities MRI best modality to evaluate for articular cartilage, and labral degeneration and tears can assess anatomy of femoral head/neck junction abnormalities Treatment Nonoperative observation indications minimally symptomatic patient no mechanical symptoms Operative arthroscopic hip surgery indications symptomatic patient mechanical symptoms outcomes recent literature supports arthroscopy shows equivalent results to open hip surgery open surgical hip dislocation indications gold standard for management of FAI for patients with clinical signs and structural evidence of impingement and preserved articular cartilage, correctable deformity, reasonable expectations contraindications age >55, morbid obesity, advanced joint disease periacetabular osteotomy indications structural deformity of acetabulum with poor coverage of femoral head technique osteotomy and fixation total hip arthroplasty indications age >60 years and end-stage hip degeneration Techniques Arthroscopic hip surgery approach arthroscopic approach to the hip technique trim femoral head/neck in Cam impingement acetabular rim labral debridement vs repair isolated labral debridement will not solve problem without treatment of underlying pathology Open surgical hip dislocation approach anterior (Smith-Peterson) approach best for isolated femoral head/neck pathology due to limited exposure, although it is possible that acetabular side could be treated acetabular treatment involves take down of rectus femoris reflected head femoral osteotomy and fixation technique uses a "trochanteric flip" for safe access to proximal femur and acetabulum provides best visualization for hip surgery preserves all external rotators and blood supply to femoral head (medial circumflex femoral artery) no increase in AVN risk provides wide exposure of femoral head and acetabulum outcomes median expected time to return to sports is 7 months in adolescent athletes Complications Femoral neck fracture at risk during open or arthroscopic debridement of Cam lesions risk is minimized by limiting depth of femoral head-neck osteochondroplasty to <30% of femoral neck diameter Heterotopic ossification Persistent Cam and Pincer lesions following arthroscopic treatment
QUESTIONS 1 of 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.259) In the radiographic evaluation of femoroacetabular impingment (FAI), which of the following views is obtained with a standing radiograph and an angle of 65 degrees between the pelvis and the film? Review Topic QID: 3682 Type & Select Correct Answer 1 AP pelvis 2% (85/5194) 2 Inlet 5% (256/5194) 3 Outlet 3% (154/5194) 4 Frog lateral 5% (280/5194) 5 False profile 85% (4402/5194) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.44) Figure 24 shows the radiograph of a 36-year-old volleyball player with right hip pain. What is the cause of the pain? Review Topic QID: 6004 FIGURES: A Type & Select Correct Answer 1 Osteonecrosis 1% (2/208) 2 Rheumatoid arthritis 0% (1/208) 3 Developmental dysplasia of the acetabulum 3% (6/208) 4 Femoral neck fracture 0% (1/208) 5 Femoral acetabular impingement 95% (198/208) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07HK.35) A patient reports pain in the hip with functional positioning. With the patient supine, pain in which of the following positions would be typical for femoral acetabular impingement? Review Topic QID: 5995 Type & Select Correct Answer 1 Hip is internally rotated, passively flexed to 90 degrees, and adducted 77% (150/195) 2 Hip is internally rotated, passively flexed to 90 degrees, and abducted 9% (17/195) 3 Hip is externally rotated, maximally flexed to 90 degrees, and adducted 2% (4/195) 4 Hip is externally rotated, passively flexed to 90 degrees, and abducted 10% (19/195) 5 Hip is externally rotated, maximally flexed, and abducted 2% (3/195) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 1
All Videos (22) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Ischiofemoral Impingement - Allston J. Stubbs, MD (CSMS #99, 2018) Allston Stubbs Knee & Sports - Femoroacetabular Impingement 11/25/2018 267 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery FAI, Labrum Case Presentations, Question and Answer - Moderator: Shane J. Nho, MD, MS (CSMS #96, 2018) Knee & Sports - Femoroacetabular Impingement 11/25/2018 143 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Subspine Impingement: Pearls and Pitfalls - Richard C. 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Nho, MD, MS (CSMS #85, 2017) Knee & Sports - Femoroacetabular Impingement 11/17/2017 115 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Alterations in Hip Function in Persons with Femoroacetabular Impingement Syndrome - Phillip Malloy, MSPT, CSC (CSMS #82, 2017) Knee & Sports - Femoroacetabular Impingement 11/17/2017 31 views Upgrade to View Premium Videos Upgrade to View Premium Videos Adult Reconstruction Core Webinars - by AAHKS, Hip Society, Knee Society, and AAOS Core Webinar - HIP CONDITIONS & PRESERVATION - by AAHKS Knee & Sports - Femoroacetabular Impingement 2/10/2017 1132 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium FAI, Labrum Case Presentations, Question and Answer - Michael Salata, MD (CSMS #83, 2016) Michael Salata Knee & Sports - Femoroacetabular Impingement 10/26/2016 421 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Chondral Defects: When to Debride or Microfracture? 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