Femoroacetabular impingement in young adults Dr.sandeep agrawal agrasen hospital,gondia maharashtra A cause of groin or hip pain in adults other than commoner cause of Avascular necrosis femoral head Cam mechanism ,Pincer mechanism,Femoral neck head junction Osteochondroplasty Pelvic osteotomy ,outerbridge classification

1. Treatment of Femoro-Acetabular Impingement in Young
Adults
cam type
pincer
type
Dr.Sandeep Agrawal,
Agrasen Hospital,
Gondia
Maharashtra
India
09960122234
drsandeep123@gmail.com

2. Femoroacetabular impingement
(FAI)
An impingement of the chondro-labral structures
between the femur and acetabulum. Whilst the
diagnosis of femoroacetabular impingement has only
recently gained attention, it is more common in the
athletic population. particularly athletes who
participate in sports which require them to frequently
move into a position of internal rotation and flexion.
2

3. TYPES OF FAI
3

4. Cam impingement occurs when the patient
has an aspherical femoral head and there is an
abnormal head/neck junction with an
increased radius at the waist. At extremes of
ROM this will result in femoral abutment
causing sheer stress on the articular cartilage
and a subsequent labral tear or detachment.
4

5. • Pincer impingement occurs when the
patient has excessive acetabular coverage
(or “over coverage”). This over coverage
will cause femoral abutment against the
chondrolabral tissues at extremes of ROM.

6. • MIXED: The majority of cases are a mixed
presentation of both

7. Case Present
A 34 year male, Right hip dull pain > 1/2
year
No trauma history, aggravated after
exercise
Failed for analgesics and rehabilitation

8. Case Present
FABERE test (+), groin pain, can’t
squat
Painful arc:
*Flexion: 65, Extension: 10 
*Abd: 30, Add: 35
*IR: 25, ER: 40 

9. In This Case
Young age, unilateral Pain
No major trauma history
No alcohol, steroid use
No DDH, no AVNFH

10. OKU 8 Reviews
The typical patient is young with groin pain
that is exacerbated by activity or long periods
of sitting
Limitation of motion, particularly internal
rotation and abduction in flexion

11. Acetabular overcoverage
or retroversion
Anterior femoral
deformity

12. 12

13. 13

14. 14

16. 16

17. In This Case
Failed for conservative treatment
Surgical improvement of the femoral
head-neck contour

18. OKU 8 Reviews
A possible etiology for the development of
OA in young patients with normal skeletal
structures and intra-articular pressures
A result of morphologic abnormality
*Involve femur: cam type
*Involve acetabulum: pincer type

19. Discussion
The surgical treatment of femoro-acetabular
impingement
*The cam-type: directed at restoring a normal femoral
head-
neck offset
*The pincer type: Addressed with an acetabular
redirectional
osteotomy and trimming of the femoral
head-neck area

20. 20
Review Of Literature

21. Background
First recognized as a consequence of
periacetabular osteotomy, occurring when a
dysplastic acetabulum was repositioned into a
more anterior and lateral position
Was subsequently recognized in active young
adults who presented with groin pain

22. Background
Surgical treatment demonstrated damage to the
anterior aspect of the acetabular labrum and to the
underlying articular cartilage
~ Beck M, et al. Clin Orthop Relat Res. 2004;418:67-73.
Using trochanteric flip osteotomy and anterior
capsulotomy, preserving the posteriorly based
femoral head blood supply
~ Ganz R, et al. J Bone Joint Surg Br. 2001;83:1119-24.

23. Background
The surgical goal is to eliminate impingement
of the femoral head-neck junction on the
anterior aspect of the acetabular rim
*Debriding the excessive bone from the femoral head and
neck
*Reorienting the anterior aspect of the acetabulum with a
periacetabular osteotomy

24. Treatment of Femoro-Acetabular
Impingement with Surgical
Dislocation and Debridement in Young Adults
Christopher L. Peters and Jill A. Erickson
J. Bone Joint Surg. Am. 88:1735-1741, 2006

25. Materials and Methods
Clinical evaluation
*Physical Examination, intra-articular pathological, Harris
hip score
Radiographic evaluation
*AP pelvic and lateral radiographs made
preoperatively, immediately postoperatively, at six
weeks, at
six months, and then yearly
*Preoperative magnetic resonance arthrogram .

26. Materials and Methods
Operative procedure
*Lateral incision and a greater trochanteric flip osteotomy
*A z-shaped anterior capsulotomy
*Femoral head was dislocated anteriorly

27. 27

28. 28

29. 29

30. 30

31. Results
Surgical findings
*Damage to the acetabular labrum was located in the
anterior superior quadrant of the acetabulum
*Osteochondroplasty of the femoral head-neck junction
to improve femoral head-neck offset was performed.

33. Discussion
Trochanteric flip osteotomy and anterior
dislocation of the femoral head is a safe
technique
Does not appear to jeopardize the vascularity
of the femoral head, as no cases of
osteonecrosis postoperatively

34. Discussion
4 failed hips had severe damage to the
acetabular hyaline cartilage on surgical
inspection
Radiographic signs of progression of OA did
not correlated to clinical function

35. Discussion
The chondral injury subjacent to the labrum is
the primary injury and that labral damage
occurs secondarily
The prognosis for hips with femoro-
acetabular impingement depends on the state
of the acetabular articular cartilage

36. OKU 8 Reviews
Conservative treatment
Surgical dislocation of the hip and improve
the femoral head-neck contour

37. Conclusion
The results support the patients with minimal
damage to the articular cartilage (Outerbridge grade
0, I, or II) can be treated effectively with this
technique
The optimum treatment of severe acetabular
chondral injury (Outerbridge grade III or IV) is unknown

38. Conclusion
The major challenge and limitation of the
treatment of femoro-acetabular impingement
*The lack of a cartilage imaging technique that allows
accurate
assessment of the damage to the articular cartilage
*The time of treatment can be performed before there is
progression to advanced stages of arthrosis

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