1. RCH Education meeting
7/5/2013

2. FAI-3 types
 Cam
 Pincer
 Mixed
 Primary (idiopathic/subclinical pre-exisitng hip condition)
or secondary (pre-existing hip condition)

3. Cam type
 Prominent area antero-lat fem neck head
junction
 Abuts acetabular rim esp in flex and IR
 Damage to labral-chondral complex

4. Pincer type
 Acetabular sided over coverage of head
 Leads to impaction of fem head neck region
 Labral damage

5. Primary FAI
 ? Subclinical pre-existing
condition(SUFE/Perthe’s)
 ?Genetic-siblings of patients with primary
FAI have a RR of 2.8 and 2 for having cam
and pincer lesions
 ?high intensity sport activity increases risk

6. Secondary FAI
 SUFE-prominence of antero-lateral femoral
metaphysis
 Severity of slip correlates with poor long
term outcome
 Perthe’s- asphericity of head, acetabular
retroversion, post-surgical deformity

7. Clinical assessment
 Slow onset groin pain, insidious, increasing
with sport
 Exacerbated by flexion(sitting)
 Locking or catching if labral tear or chondral
flap
 Impingement test-supine, IR and passive
flexion and adduction

8. Radiological assessment
 Xr-AP-3 signs for abnormal acetabulum
 Posterior wall sign
 Crossover sign
 Ischial spine sign
Cam signs-
 Flattened femoral head
 Increases alpha angle

9. CT and MRI
 Direct measurement of acetabular version
 Detection of chondral or labral damage

10. Treatment of FAI
 Non-op
 24 month follow up of patients with alpha
angles less than 60 with activity
modification
 Improved function and symtpoms but not
rom

11. Operative Management
 Surgical Dislocation and
Osteochondroplasty(SDO)
 Ganz described safe procedure-213 hips
 Zero AVN
 SDO outcomes- 25 with FAI, HHS 70-87,
 No ON
 3 converted to THA but all had grade 4 changes
at time of SDO

12. Hip Arthroscopy
 82 patients with bilateral FAI
 All had arthroscopic osteochondroplasties
 MHHS and NAHS all improved significantly

13. Hip scope with mini-open
 Also generally improved scores
 Small incidence of femoral neck fracture
 Minor wound complications, HO and DVT
noted

14. SUFE related FAI
Options:
 Proximal femoral osteotomy- Schoenecker-valgus
derotating osteotomy with cervical
osteochondroplasty gave satisfactory outcomes
 SCRO(prevention)-modified Dunn-no ON.
 Slongo-1/23 ON
 Arthroscopic and mini-open OCP-Leunig-3 cases
with good outcome at 6 and 23 month reviews

15. Perthe’s
Options:
 Intertrochanteric osteotomy
 Relative neck lengthening with trochanteric
distalization
 Femoral head reduction ostoeotomy

16. Anderson:
 14 hips treated with SDO and TA
 Allows treatment of femoral head lesions
 Findings- 4 OCD lesions treated with
autograft
 HHS 63-95 with OCD
 HHS 71-88.6 without

17. PAO +/- PFO for combined
Acetabular and Femoral deformity
Clohisy:
 26 patients treated with PAO, 13 had
combined PFO
 HHS 68.8-91.3

18. Acetabular Retroversion
Peters et al Algorithm for management:
 CEA<20 and no crossover sign- acetabular rim
debridement
 CEA>20 and crossover sign-PAO if cartilage
intact, SD and rim debridement +/-femoral OCP
 Results of this algorithm HHS 72-91 in PAO
group, 52-90 in SDO

19. Summary
 FAI being increasingly recognised
 Variety of treatment option that need to be
individually tailored
 Arthroscopic treatment allows faster
recovery and initial results are favourable
 Early intervention for FAI improves hip pain
 No long term data available to say that
progression to OA can be prevented