Review Question - QID 216824

A professional athlete with FAI and no evidence of osteoarthritis would be expected to return to the same level of play at a rate of >85% after undergoing arthroscopic or open decompression.

Femoroacetabular impingement is a dynamic pathology that results in a mechanical conflict in the hip(s), leading to adverse contact between the acetabulum and the femoral head-neck junction. This can lead to labral-chondral injury, pain, and a limited range of motion. FAI has been postulated as an important cause of primary osteoarthritis in non-dysplastic hips. Diagnosis is made radiographically with hip radiographs showing an aspherical femoral (cam impingement) or anterosuperior acetabular overhang (pincer impingement), or a combination of both. Surgical treatment for cam impingement can be effective for symptomatic patients. Even among high-level athletes, open surgical dislocation of the hip has been shown to have good results. Most patients with cam impingement can be treated with arthroscopic osteoplasty and achieve results comparable with those realized with open surgical dislocation. The literature describes success in terms of athletes returning to sports (even professional athletes) to be approximately 90% after arthroscopic treatment.

Philippon et al. 2007 evaluated 45 professional athletes with FAI that underwent arthroscopic surgical intervention. They reported that forty-two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. They concluded that arthroscopic treatment of FAI allows professional athletes to return to professional sport.

Naal et al. 2011 reviewed 22 professional athletes after treatment of FAI by surgical hip dislocation. At an average follow up of 45 months, 96% were still competing professionally. They concluded surgical hip dislocation for the treatment of FAI allows athletes to resume sports and continue professional careers at the same level for several years. Clinical outcomes in terms of subjective ratings and scores were favorable.

Figures A and B are an AP and lateral radiograph of a right hip, respectively, demonstrating cam-type femoroacetabular impingement.

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Answers 1-4: A professional athlete with FAI and no evidence of osteoarthritis would be expected to return to the same level of play at a rate of >85% after undergoing arthroscopic or open decompression.