Review Question - QID 6042

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Femoroacetabular Impingement QID: 6042 (SAE07HK.82)

QID 6042 (Type "6042" in App Search)

Figure 50 shows the cross table lateral radiograph of a 31-year-old paratrooper who has recalcitrant groin pain. The pain is worse after activities such as standing or sitting (driving). Examination reveals that pain can be reproduced by internal rotation of the leg with the hip and knee in 90 degrees of flexion. Extensive nonsurgical management has failed to provide relief. What is the treatment of choice?

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Periacetabular osteotomy

6/124

Femoral neck osteotomy

6/124

Femoroacetabular osteoplasty

85%

106/124

Hip arthroscopy and labral debridement

5/124

Hip arthrodesis

0/124

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The radiograph reveals the classic “bump” that is seen in patients with femoroacetabular impingement (FAI). Ganz and associates described two types of FAI. This patient has cam impingement, which describes a nonspherical femoral head being forced into the acetabulum during hip motion and resulting in labral and chondral injury. Hip arthroscopy and labral debridement is unlikely to control the symptoms because the underlying anatomic abnormality is often difficult to address with arthroscopy. The treatment involves surgical dislocation of the hip with preservation of the blood supply to the femoral head, removal of the asphericity on the femoral side (femoral osteoplasty), and removal of the acetabular rim (acetabular osteoplasty) if the latter is found to contribute to impingement.