Download - Femoroacetabular impingement
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Ορθ
οπαι
δική
Κλι
νική
Παν
επισ
τημί
ου Θ
εσσα
λίας
Ch. ChrysovergisResident OrthopaedicUniversity Hospital LarisaDirector : Prof. K. Malizos
www.Ortho-uth.org
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Femoro-Acetabular Femoro-Acetabular Impingement F.A.IImpingement F.A.I
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Introduction Cause of early degenerative changes in
young adult hips Abnormal impingement (abutment)
between the femoral head – neck junction and the acetabular rim
Reinold Ganz , Javad Parvizzi , Martin Beck , Michael Leunig University of Bern Switzerland
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- Occurs in patients with : Abnormal hip morphology Normal hip morphology but excessive
range of hip movement
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Patients with F.A.I. Healthy,active adults. Ages 25 – 50 yrs old. Athletic
activities,extreme renge of hip motion,deep hip flexion,pivoting of the hip,Ice Hockey,Martial Arts,Football,Golf
Track - field gymnastics
jumpers,runners
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I. A. Kapandji – ‘’Physiologie Articulaire’’
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Patients with minor trauma or underlying hip pathology
Post – traumatic free bodies into the joint,lateral impact injury to the grater trochanter
Legg – Calve – Perthes Slipped femoral head epiphysis Aspherical head Previous femoral neck fracture
(decreased head – neck offset,widening of the femoral neck)
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Anatomical structures The Hip joint consists
of : Acetabulum,Labrum,Head – Neck junction of Femur,Articular capsule
Labrum : fibrocartilaginous structure,deepens the articular cavity of acetabulum,increases stability
Head – Neck junction : is an intracapsular structure
Αλ. Ε. Αγιος : ‘’Ανατομικη’’
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Femoral Head :Almost spherical,covered by the labrum at it’s 2/3,beyond the point of it’s equator
The articular cartilage of the acetabulum and of the femoral head are thicker at the antero – superior point,region of the greater forces that the acetabulum endures during the abutmen (impingement) of the femoral head
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Mechanism & AetiologyTypes of F.A.I. 3 Types of
F.A.I. :
‘’cam’’ type
‘’pincer’’ type
mixed type
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‘’cam’’ type :
non spherical head
reduce of
head – neck offset
widening of
head – neck junction
‘’pistol – grip’’ deformity
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‘’pincer type’’ :
excessive acetabular cover (coxa profunda)
acetabular retroversion
protrusio acetabuli
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‘’Cam’’ type : damage to the
antero – superior aeria of the acetabulum
the accenrtic part compresses and shears the labrum and acetabular cartilage causing separation between the labrum and the cartilage
damage location : antero – superior
(1 o’clock)
M : F – 14 : 1
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‘’pincer’’ type : range of hip
movement limited by the acetabular rim (overcoverage of the head)
at the ending of motion the neck abuts against the labrum wich acts as a bumper and is compressed between the neck and the rim
danage in a narrow band along the rim with ossification of the labrum (11 – 1 o’clock)
M : F – 1 : 3
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Practicaly none of the above types is isolated.’’Mixed’’ type is the most usual
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Diagnosis & Differential Diagnosis
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Clinical : patient presents with groin pain (anterior hip pain) usualy young and/or middle aged active adults with
minor trauma or no trauma history limitation of hip movement increasing pain with activities,prolonged sitting difficulty to get in – out of the car,arising from seat
or bed difficulty to do the shoes,socks
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patient shows his hip with the grip ‘’C’’ sing
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positive impingement test – pain in flexion , adduction , internal ritation of the hip
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Imaging : plain X – rays : anteroposterior
(face) + profil x - rays
‘’pistol - grip’’ deformity
non spherical head
free intra – articular bodies
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Α. Γεωργούλης – Ι. Μίχος : ‘’Χόνδρινες & οστεοχόνδρινες βλάβες’’ ΕΕΧΟΤ 2011
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Απ. Καραντανας – ‘’Απεικονιση αθλητικων κακωσεων’’ 2010
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UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA
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UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA
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UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA
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CT : more efficent for bone structures , free intra – articular bodies
Α. Γεωργουλης , Ι. Μιχος – ‘’Χονδρινες και οστεοχονδρινες βλαβες’’ ΕΕΧΟΤ 2011
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MRI & MRAo MRI : more efficient for soft tissue
structures,labrum,acetabular rimo MRA : is now becoming the standard
investigation of F.A.I. ruptures of the labrum abnormality of the head – neck junction ossification of the labrum meassurement of the α (alfa) angle
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Απ. Καραντανας
‘’ΑπεικονισηΑθλητικων Κακωσεων’’2010
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Απ. Καραντανας – ‘’Απεικονιση αθλητικων κακωσεων’’ 2010
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Differential diagnosiso inguinal herniao low back disorderso trohanteric bursitis
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Conservative Treatment The aim is to improve the symptoms Rest,modofication of activities Avoid excessive motion activities NSAIDS Intensive physicotherapy might
aggrevate the condition trying to improve hip movement
usualy temporary relief of symptoms with conservative treatment
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Surgical treatment The aim is to correct the cause of F.A.I. ,
improve hip motion
Open surgery
Hip arthroscopy
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Open surgery Lateral or posterolateral approach Dislocation of the femural head with
care to it’s blood supply Osteoplasty of the (‘’cam’’) head – neck
junction , with caution not to resect over 30% of the antero – lateral quadrant of the neck.Risc of neck fracture
Resection osteoplasty of the (‘’pincer’’) acetabular rim , reorientation of the acetabulum
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Hip arthroscopy Performed in lateral or supine position
with traction applied C – Arm imaging is essential for safe
entry of the portals 3 portals : Anterior Anterolateral Posterolateral
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Debridement of free bodies
Debridement of labral and cartilage lesions
Microfractures technique for the acetabular cartilage
Correction of the acetabular rim
Head – neck junction osteoplasty
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Open vs Arthroscopy : both have good results although patients operated with arthroscopy recovered much earlier
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Conclusions F.A.I. usualy occurs in young to middle – aged
active adults and athletes Can be a limitation to the level of activity Conservative treatment improves the symptoms
but not the cause Final solution could be the surgical treatment
with verry good results
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thank you