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Femoro-Acetabular Impingement

Current Treatment Options

Hip Impingement

The hip joint is formed by the thighbone that presents as a round ball (called the femoral head) to a socket on the side of the pelvis called the acetabulum. The normal shape of the ball and the socket allow close contact through a large range of motion. The end point for hip movement in any direction is usually from the edge of the ball jamming against the rim of the socket.

As we all need to bend the hip forwards more than in any other direction, the normal socket and ball are turned forwards allowing more motion to bend the hip forward before they jam. Due to congenital and developmental factors, the shape of the ball and the socket may not be ideal, and can cause limitation of hip motion from premature jamming. Most active people do not feel the jamming and force their hips beyond the possible range to continue their activities.

Femoro-Acetabular Impingement

Repetitive forceful jamming of the ball against the socket wall is the most common cause of hip labral tears. Continued jamming causes further damage to the joint cartilage and leads to arthritis at a young age. Repetitive jamming can also thicken the ball and the socket and lead to jamming at lesser range of hip motion. This condition does not cause significant pain in the early stages when treatment can prevent arthritis.

This jamming is called Femoro-Acetabular Impingement (FAI) as described by Professor Reinhold Ganz from Switzerland in the early nineties. This phenomenon explains the previously unknown causes of hip pain and premature arthritis in young adults. However, the concept was not tested in any long-term studies yet and several surgeons are still skeptical in spite of not having a different explanation.
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Current Treatment Options

The current treatment options for this condition are limited to simple observation or surgical intervention. There are no known medications to correct the impingement and physiotherapy can do more damage. Surgery is an option if the surgeon can safely identify and correct the bony abnormalities without causing further damage. This can be done with arthroscopic, open, or combined techniques (See Figure A1, Figure A2, Figure E1 and Figure E2). Each of these techniques has unique advantages and disadvantages.
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