Current concepts in management of femoroacetabular impingement

Femoroacetabular impingement (FAI) is an increasingly recognized condition, which is believed to contribute to degenerative changes of the hip. This correlation has led to a great deal of interested in diagnosis and treatment of FAI. FAI can be divided into two groups: cam and pincer type impingement. FAI can lead to chondral and labral pathologies, that if left untreated, can progress rapidly to osteoarthritis. The diagnosis of FAI involves a detailed history, physical exam, and radiographs of the pelvis. Surgical treatment is indicated in anatomic variants known to cause FAI. The primary goal of surgical treatment is to increase joint clearance and decrease destructive forces being transmitted through the joint. Treatment has been evolving rapidly over the past decade and includes three primary techniques: open surgical dislocation, mini-open, and arthroscopic surgery. Open surgical dislocation is a technique for dislocating the femoral head from the acetabulum with a low risk of avascular necrosis in order to reshape the neck or acetabular rim to improve joint clearance. Mini-open treatment is performed using the distal portion of an anterior approach to the hip to visualize and to correct acetabular and femoral head and neck junction deformities. This does not involve frank dislocation. Recently, arthroscopic treatment has gained popularity. This however does have a steep learning curve and is best done by an experienced surgeon. Short- to mid-term results have shown relatively equal success with all techniques in patients with no or only mild evidence of degenerative changes. Additionally, all techniques have demonstrated low rates of complications.