What's New in Femoroacetabular Impingement Surgery: Will We Be Better in 2023?

Sports Health A Multidisciplinary Approach 03/2014; 6(2):162-70. DOI: 10.1177/1941738113513006
Source: PubMed


Femoroacetabular impingement (FAI) has been described as a common cause of hip pain in young adults. This leads to abnormal hip joint mechanics and contact pressures. The associated pathomechanics can lead to the development of early osteoarthritis. Better understanding of the anatomy and pathophysiology, biomechanics, and diagnostic and therapeutic advances has led to improved clinical outcomes. A growing body of evidence has set the foundation for future progress in the treatment of this commonly encountered condition.
The PubMed database was searched for English-language articles pertaining to FAI over the past 15 years (1998-2013).
Retrospective literature review.
Level 4.
The authors evaluated and discussed the current evidence regarding the anatomy, physiology, biomechanics, imaging, and clinical outcomes of surgical intervention for FAI. Based on this information, future directions for improving the diagnosis and management of FAI are proposed.
There remains a diverse approach to the diagnosis and management of cam- and/or pincer-type FAI. Recent advances in clinical diagnosis, imaging, indications, and arthroscopic techniques have led to improved outcomes and have set the foundation for future progress in the management of this condition.

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    ABSTRACT: There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Cohort study (diagnosis); Level of evidence, 2. A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values-at which patients considered their status to be satisfactory-at 1 year after surgery were 74 (mHHS), 87 (HOS-activities of daily living subscale), and 75 (HOS-sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS-activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI. © 2015 The Author(s).
    08/2014; 2(2 Suppl). DOI:10.1177/2325967114S00105
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    ABSTRACT: Where Are We Now?Treatment approaches for femoroacetabular impingement (FAI) are rapidly evolving and remain diverse [2, 11]. The large discrepancy in treatment options likely stems from the broad diagnosis of FAI, the lack of clear understanding between morphology and dynamic injury mechanisms, and the lack of quality long-term outcome studies to support the use of one treatment option above another for particular presentations of FAI [2, 7, 10].Orthopaedists commonly define and diagnose FAI based on radiographic images and passive clinical range of motion testing, two methods that are likely too simplistic to understand the subject-specific three-dimensional (3-D) and dynamic nature of the interaction between bone morphology and soft tissue damage in an FAI hip. As a result, Orthopaedists commonly utilize more sophisticated imaging technologies such as MRI and CT to diagnose and plan surgical treatments, but these imaging modalities are static by nature and do not allow for a direct ...
    Clinical Orthopaedics and Related Research 10/2014; 472(12). DOI:10.1007/s11999-014-3988-9 · 2.77 Impact Factor
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    ABSTRACT: In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known ‘impingement’ syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms.
    07/2015; DOI:10.1093/jhps/hnv049


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