| Femoroacetabular Impingement |
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The etiology of femoroacetabular impingement is variable. It is most clearly attributed to developmental abnormalities of the hip that occur during the childhood growing years. Perhaps more commonly, it is associated with osteophytes (bone spurs) that form during adulthood. Diagnosis of this condition can be made with xrays and is sometimes aided by computed tomography. The most easily diagnosed type is an abnormal shape of the femoral head and neck. There is a prominence of the bone on the front of the femoral head so that when the hip is flexed upward the bony prominence engages with the front of the acetabulum, resulting in breakdown of both the labrum and articular cartilage. The less distinct type is a lip of bone overhanging the front of the acetabulum that pinches the labrum and causes it to tear. Because of its location, it is harder to see on regular xrays. Many individuals may have this abnormally shaped bone without symptoms and do not require specific treatment. When symptoms do occur, it is usually as a consequence of cartilage breakdown. If arthroscopy is needed to address the cartilage damage, it is important to assess for, and address, impingement that may be the underlying cause. Management of impingement has traditionally been described with open techniques. The transition to arthroscopic treatment carries the advantage of a less invasive procedure. This advantage is especially evident in more advanced cases. Once the articular loss has become severe, correcting the impingement becomes less critical since the irreversible damage has already been done. Sometimes it is simply hard to tell the severity of the articular loss prior to surgery. Arthroscopy has the advantage of being able to assess the severity in addition to addressing the impingement. If the joint is beyond help, at least the surgery has not been too extreme. |
