الفهرس 
Relevant anatomy of hip jointOnly 14 pages are availabe for public view
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Abstract
Femoroacetabular impingement is a more recently noticed cause of hip pain in young patients. It should be noted that FAI may be part of a more complex disorder. Despite extensive publications in recent years, the exact etiology of this condition remains elusive.
The cause of FAI is a diminished femoroacetabular joint clearance, that means, the range of motion, mainly in flexion and internal rotation, is restricted because of bony abnormalities. There are basically 2 types of impingement, the pincer and the cam type with mixed pathologies being present. Cam impingement occurs when an abnormally shaped (i.e., nonspherical) femoral head with increased radius is jammed into the acetabulum during normal motion, especially flexion. The pincer impingement is the result of abnormal contact between the acetabular rim and the femoral neck. The femoral head in this situation may be normal, and the abutment is mostly a result of overcoverage of the femoral head in conditions such as coxa profunda or acetabular retroversion.
FAI affects mostly adolescent and young adults who regularly participate in hip demanding physical activities and sports. The peak incidence of men lies between 20 and 30 years, and for women is a decade older. In clinical examination, there is pain in internal rotation during flexion of the hip joint. It has been shown that plain films cannot be used to effectively diagnose the pathological characteristics of FAI and even more so the extent of the intraarticular damage. Only special MRA is capable to assess all important changes within the hip joint and gives the surgeon information for decision making in favor or against joint preserving surgery. This fact is very important because most of the patients are young adults.
FAI is a pathologic entity, which becomes more and more recognized, as it seems to be an important cause of osteoarthritis of the hip joint. The objective of any diagnostic procedure is early diagnosis because early diagnosis is crucial for surgical joint preservation to postpone total hip replacement.[31]
Appropriate management of patients with FAI commences with a trial of conservative treatment, which may include activity modification, restriction of athletic activities, and reduction of excessive motion and demand on the hip. A trial of non-steroidal anti-inflammatory medications may be appropriate to relieve acute pain. Physical therapy, with emphasis on improving ROM or stretching, is not productive; rather, it is counterproductive. Although conservative management is likely to be temporarily successful in some patients, the young age of these patients and their high activity levels and athletic ambitions usually jeopardize their compliance. Conservative nonsurgical therapy should be exhausted before any decision is made for surgical intervention.
Surgical intervention involves arthroscopic or open debridement of the hip and restoration of femoral neck offset. Currently, there is an ongoing debate as to the role of each surgical technique in addressing this problem. There are advantages and disadvantages to each of these techniques. Surgical dislocation of the hip allows 360° visualization of the hip and better examination of the acetabulum. During this open technique, labral tears and, more importantly, the chondral lesions can be identified and possibly repaired. Furthermore, surgical dislocation allows reduction of the anterior acetabular overcoverage by excising the bony prominences at the acetabular rim.
Hip arthroscopy is also being used for surgical management of FAI. The advocates of this technique cite minimal invasiveness of this procedure as the main advantage over the open technique. The disadvantage of hip arthroscopy is that because of limited space in the hip joint, proper visualization of the femoral neck is difficult, posing a problem with adequate osteoplasty in some cases. In addition, repair of the labrum and resection of the underlying chondral lesion is difficult. Furthermore, resection of the acetabular rim using hip arthroscopy is not possible, and because of this, most cases of pincer impingement cannot be addressed with hip arthroscopy alone. In recent years, some surgeons have moved toward a combined arthroscopic and mini incision approach. The hip joint can first be visualized by hip arthroscopy, and an appropriate degree of osteoplasty can be carried out. This is then followed by an anterior approach to the hip and completion of the remaining osteoplasty and labral repair.
As it had been proposed that FAI is the principal cause of OA in young adults early surgery had been advised in the hope of not only mitigating symptoms but delaying the development of OA. But recently that theory is not supported by clinical confirmation, so long term radiological studies of asymptomatic young adults is recommended to resolve the uncertainty.
Conclusion
The previously accepted view that patients with FAI would necessarily progress to develop OA, are now being questioned. Hip arthroscopy, in combination with a limited anterior approach, is the least invasive surgical procedure available for the treatment of FAI.