Treatment of Femoro-Acetabular Impingement in Young

Adults

cam type

pincer

type

Dr.Sandeep Agrawal,

Agrasen Hospital,

Gondia

Maharashtra

India

09960122234

drsandeep123@gmail.com

Femoroacetabular impingement

(FAI)

An impingement of the chondro-labral structures between the femur and acetabulum. Whilst the

diagnosis of femoroacetabular impingement has only recently gained attention, it is more common in the

athletic population. particularly athletes who participate in sports which require them to frequently move into a position of internal rotation and flexion.

2

TYPES OF FAI

3

Cam impingement occurs when the patient

has an aspherical femoral head and there is an

abnormal head/neck junction with an

increased radius at the waist. At extremes of

ROM this will result in femoral abutment

causing sheer stress on the articular cartilage

and a subsequent labral tear or detachment.

4

• Pincer impingement occurs when the patient has excessive acetabular coverage (or “over coverage”). This over coverage will cause femoral abutment against the chondrolabral tissues at extremes of ROM.

• MIXED: The majority of cases are a mixed presentation of both

Case Present

A 34 year male, Right hip dull pain > 1/2

year

No trauma history, aggravated after

exercise

Failed for analgesics and rehabilitation

Case Present

FABERE test (+), groin pain, can’t

squat

Painful arc:*Flexion: 65, Extension: 10

*Abd: 30, Add: 35

*IR: 25, ER: 40

In This Case

Young age, unilateral Pain

No major trauma history

No alcohol, steroid use

No DDH, no AVNFH

OKU 8 Reviews

The typical patient is young with groin pain

that is exacerbated by activity or long periods

of sitting

Limitation of motion, particularly internal

rotation and abduction in flexion

Acetabular overcoverage

or retroversion

Anterior femoral

deformity

12

13

14

16

In This Case

Failed for conservative treatment

Surgical improvement of the femoral

head-neck contour

OKU 8 Reviews

A possible etiology for the development of

OA in young patients with normal skeletal

structures and intra-articular pressures

A result of morphologic abnormality *Involve femur: cam type

*Involve acetabulum: pincer type

Discussion

The surgical treatment of femoro-acetabular

impingement *The cam-type: directed at restoring a normal femoral

head-

neck offset

*The pincer type: Addressed with an acetabular

redirectional

osteotomy and trimming of the femoral

head-neck area

20

Review Of Literature

Background

First recognized as a consequence of

periacetabular osteotomy, occurring when a

dysplastic acetabulum was repositioned into a

more anterior and lateral position

Was subsequently recognized in active young

adults who presented with groin pain

Background

Surgical treatment demonstrated damage to the

anterior aspect of the acetabular labrum and to the

underlying articular cartilage~ Beck M, et al. Clin Orthop Relat Res. 2004;418:67-73.

Using trochanteric flip osteotomy and anterior

capsulotomy, preserving the posteriorly based

femoral head blood supply~ Ganz R, et al. J Bone Joint Surg Br. 2001;83:1119-24.

Background

The surgical goal is to eliminate impingement

of the femoral head-neck junction on the

anterior aspect of the acetabular rim*Debriding the excessive bone from the femoral head and

neck

*Reorienting the anterior aspect of the acetabulum with a

periacetabular osteotomy

Treatment of Femoro-Acetabular

Impingement with Surgical

Dislocation and Debridement in Young Adults

Christopher L. Peters and Jill A. Erickson

J. Bone Joint Surg. Am. 88:1735-1741, 2006

Materials and Methods

Clinical evaluation*Physical Examination, intra-articular pathological, Harris

hip score

Radiographic evaluation*AP pelvic and lateral radiographs made

preoperatively, immediately postoperatively, at six

weeks, at

six months, and then yearly

*Preoperative magnetic resonance arthrogram .

Materials and Methods

Operative procedure*Lateral incision and a greater trochanteric flip osteotomy

*A z-shaped anterior capsulotomy

*Femoral head was dislocated anteriorly

27

28

29

30

Results

Surgical findings

*Damage to the acetabular labrum was located in the

anterior superior quadrant of the acetabulum

*Osteochondroplasty of the femoral head-neck junction

to improve femoral head-neck offset was performed.

Discussion

Trochanteric flip osteotomy and anterior

dislocation of the femoral head is a safe

technique

Does not appear to jeopardize the vascularity

of the femoral head, as no cases of

osteonecrosis postoperatively

Discussion

4 failed hips had severe damage to the

acetabular hyaline cartilage on surgical

inspection

Radiographic signs of progression of OA did

not correlated to clinical function

Discussion

The chondral injury subjacent to the labrum is

the primary injury and that labral damage

occurs secondarily

The prognosis for hips with femoro-

acetabular impingement depends on the state

of the acetabular articular cartilage

OKU 8 Reviews

Conservative treatment

Surgical dislocation of the hip and improve

the femoral head-neck contour

Conclusion

The results support the patients with minimal

damage to the articular cartilage (Outerbridge grade

0, I, or II) can be treated effectively with this

technique

The optimum treatment of severe acetabular

chondral injury (Outerbridge grade III or IV) is unknown

Conclusion

The major challenge and limitation of the

treatment of femoro-acetabular impingement *The lack of a cartilage imaging technique that allows

accurate

assessment of the damage to the articular cartilage

*The time of treatment can be performed before there is

progression to advanced stages of arthrosis

"Success is not the key tohappiness. Happiness is the key to success. If you love

what you are doing,you will be successful"

- Albert Schweitzer

Happiness is the key to success

"Act happy, feel happy, be happy, without a reason in the world. Then you

can love, and do what you will."

"Gratefulness is the keyto a happy life that we hold in our hands, because if we are not grateful, then no matter how much we have we will

not be happy --because we will alwayswant to have something

else or something more."- David Steindl-Rast