The hip
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The concept of femoroacetabular impingement (FAI) as a cause of hip OA is relatively new and its pathogenesis has been elaborated significantly only in the last 10-15 years. It is considered a mechanical cause of hip OA due to loss of sphericity and essentially over-coverage of the ball-and-socket joint. The work of Ganz and co-workers has provided a major understanding into the pathomechanics of FAI that can be summarized by the ‘pathological abutment’ that occurs in two main subtypes of FAI: pincer and cam types.
Hip and knee
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Femoroacetabular impingement has recently been recognised as a cause of hip pain in the young adult and may lead to secondary hip OA. The non-spherical portion of the femoral head is assumed to exert abnormal shear and compressive forces on the corresponding portion of the acetabular cartilage during deep hip flexion with internal rotation. Patients typically present with groin pain, and MRI-arthrograms typically reveal acetabular rim lesions and aberrant femoral head morphology.
Paper 1
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw in The Final FRCR, 2020
A 37 year old semi-professional footballer attends the orthopaedic clinic due to left hip pain which is causing him difficulty when playing. Following clinical review, radiographs and subsequent MRI, a diagnosis of cam femoroacetabular impingement is made.
Femoroacetabular impingement: a common cause of hip pain
Published in The Physician and Sportsmedicine, 2018
Travis J Menge, Nathan W Truex
Femoroacetabular impingement (FAI) is a common cause of hip pain, decreased function, and progression to early osteoarthritis. It was first described by Ganz et al. as ‘abnormal contact that may arise as a result of either abnormal morphological features or as the result of subjecting the hip to excessive and supraphysiological range of motion’ [1]. The Warwick Agreement later expanded this definition to include a triad of symptoms, clinical signs, and imaging findings [2]. FAI is due to altered bony anatomy of the acetabulum and proximal femur, which can be further sub-classified based on the type of specific deformity present. Asphericity of the femoral head and neck is described as cam-type impingement, whereas global or focal over-coverage of the acetabulum results in pincer-type FAI [3,4]. The most common form of FAI, however, is combined-type impingement where there are features of both cam and pincer morphology [5]. Repetitive abnormal contact between these structures can damage the labrum and articular cartilage if not properly treated [1].
Correspondence: Isometric hip strength impairments in patients with hip dysplasia are improved but not normalized 1 year after periacetabular osteotomy: a cohort study of 82 patients
Published in Acta Orthopaedica, 2021
Mingjin Zhong, Weimin Zhu, Jacobsen Julie Sandell, Jakobsen Stig Storgaard, Søballe Kjeld, Hölmich Per, Thorborg Kristian
Point 1: The healthy volunteers were asymptomatic and excluded in case of pain, comorbidity, previous trauma or surgery. Radiology was used only in the patient population as it was considered unethical to expose the asymptomatic population to radiation. Therefore, “asymptomatic” would have been a better term than “healthy” volunteers. Regarding imaging findings, we agree that imaging alone cannot be used to determine whether (or not) participants are healthy. Instead a combination of symptoms, clinical signs and imaging should be used to assess the presence of “hip disease”, as agreed for femoroacetabular impingement syndrome (Griffin et al. 2016). This is why the findings of positive FADIR/FABER tests do not indicate whether participants are healthy. Painful FADIR tests have been documented in 12–15% of asymptomatic participants (Czuppon et al. 2017); this is most likely due to the high sensitivity and false positive rate of this test (Reiman et al. 2013). We consider the FADIR test to be positive only if it replicates known symptoms (Troelsen et al. 2009). Therefore, in the asymptomatic volunteers, it would have been less confusing if we had described whether a test was painful instead of labeling the test as positive or negative. In the case of missing “hidden” pathology in the asymptomatic volunteers, the muscle strength deficit seen in the patients in our study might have been larger, but this would not have changed our conclusion that “isometric hip muscle strength is impaired in patients with symptomatic dysplastic hips.”
Pelvic incidence and hip disorders
Published in Acta Orthopaedica, 2018
Mikhail Saltychev, Katri Pernaa, Matti Seppänen, Keijo Mäkelä, Katri Laimi
The sample sizes of the included studies varied from 19 to 150 patients (Table 3, see Supplementary data). As expected, the patients with coxarthrosis and subchondral insufficiency fractures were older (around 60 years or older) than patients with ankylosing spondylitis or femoroacetabular impingement (< 40 years). Across the samples, there was a slight predomination of women. The estimates of pelvic incidence varied more than 10 degrees from 47 (SD 4) to 59 (SD 14). The authors of a few studies concluded that pelvic incidence might play some role in hip disorders, even though the sample sizes were considered underpowered to detect statistically significant results. 2 studies concluded that higher pelvic incidence might contribute to the development of coxarthrosis (Yoshimoto et al. 2005, Bredow et al. 2015). Conversely, 1 study (Weng et al. 2015) reported that pelvic incidence might not be involved in coxarthrosis. Gao et al. (2015) reported that pelvic incidence might be correlated with life quality, body pain, “vitality,” and “emotional role” in patients with ankylosing spondylitis when comparing the data gathered before and after hip replacement. Hellman et al. (2017) stated that pelvic incidence in patients with femoroacetabular impingement was lower than in the general population—49 (SD 12) versus 55 (SD 11), respectively. Weinberg et al. (2016a) specified further that this effect only exists in the Cam type of femoroacetabular impingement.
Related Knowledge Centers
- Acetabulum
- Arthrogram
- Cartilage
- Femur
- Femoral Head
- Osteoarthritis
- Ball-and-Socket Joint
- Acetabular Labrum
- Projectional Radiography
- Magnetic Resonance Imaging