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Femoroacetabular Impingment

WHAT IS IT?

Femoroacetabular impingement is a clinical condition characterised by pain and functional constraints on the hip due to the, generally repetitive impact, between the femoral head-neck join and the pelvic acetabulum rim when rotation or flexion actions take place.

CAUSES

This tends to occur in patients with a particular hip anatomy, either in the femur (non-spherical head, jib or cam type) or in the acetabulum (excessive enclosure of the femoral head or Pincer type), generally associated with activities which require the hip to perform an excessively rotating or flexing action.

These patients, after many cycles of femoroacetabular impingement end up damaging mainly two joint structures in the acetabular labrum (a fibrocartilage similar in structure to the meniscus in the knee) and the acetabular cartilage.

SYMPTOMS

The patient suffers pain in the hip area, mainly in the groin, yet also at the base of the limb, in the gluteus and even in the knee, which is aggravated by physical activity or adopting postures requiring the hip to flex (sitting in low chairs or even in a car).

If the diagnosis and corresponding treatment are not performed promptly, this pathology may lead to hip arthrosis, generally at an earlier age than primary idiopathic hip arthrosis.

DIAGNOSIS

The clinical interview is incredibly important as is the information provided by the patient and the physical examination on the examination table. With these, in general, a traumatologist who is an expert in hip pathology is able to move towards or discard the diagnosis of femoroacetabular impingement.

An X-ray examination of specific hips (the radiographic protocol for femoroacetabular impingement) and even a simple or contrasting MRI and at times the use of a scanner, are usually requested in the diagnosis process for femoroacetabular impingement.

TREATMENT

According to the symptoms and the condition of the joint at the time of the diagnosis, the alternative treatments and the outcome of these may vary.

The ideal situation is to diagnose femoroacetabular impingement in its early stages before the injuries have had a serious effect and the cartilage has been severely damaged. There is a clear relationship between prompt treatment and a good prognosis and late treatment when the damage to the joint has already taken place and where the medium-term outcome is far less uncertain.

Firstly it is recommended that the patient modifies the intensity and type of activity that is causing or exacerbating the symptoms and also undergoes physiotherapy treatment and even pharmaceutical treatment. In some cases intra-articular injections may be provided.

In those cases where with the aforementioned measures the symptoms are not alleviated, surgical treatment may be necessary which may involve osteochondroplasty that may be performed using open surgery through the safe dislocation of the hip or a minimally invasive incision without dislocation; or hip arthroscopy.

In the Arthroscopic Surgery Unit, an arthroscopic intervention is normally made with two or three approximately 2 cm incisions to the hip area. The patient is positioned face up on a special operating table in order to be able to perform hip traction and this way separate the femoral head from the acetabulum in order to gain access to the interior of the joint.

In the event that a hip prosthesis is necessary, the doctor shall assess what type of prosthesis can be used in each case depending on different factors: hip morphology, bone quality, patient weight, etc.

The Arthroscopic Surgery Unit is a pioneer in the use of Plasma Rich in Growth Factors (PRGF®-Endoret®). In cases of arthroscopic surgery its application is recommended to help repair the labrum, the cartilage and the soft articular and periarticular tissue. In cases of arthrosis, its use is recommended to delay joint replacement.