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  1. 1. RCH Education meeting7/5/2013
  2. 2. FAI-3 types Cam Pincer Mixed Primary (idiopathic/subclinical pre-exisitng hip condition)or secondary (pre-existing hip condition)
  3. 3. Cam type Prominent area antero-lat fem neck headjunction Abuts acetabular rim esp in flex and IR Damage to labral-chondral complex
  4. 4. Pincer type Acetabular sided over coverage of head Leads to impaction of fem head neck region Labral damage
  5. 5. Primary FAI ? Subclinical pre-existingcondition(SUFE/Perthe’s) ?Genetic-siblings of patients with primaryFAI have a RR of 2.8 and 2 for having camand pincer lesions ?high intensity sport activity increases risk
  6. 6. Secondary FAI SUFE-prominence of antero-lateral femoralmetaphysis Severity of slip correlates with poor longterm outcome Perthe’s- asphericity of head, acetabularretroversion, post-surgical deformity
  7. 7. Clinical assessment Slow onset groin pain, insidious, increasingwith sport Exacerbated by flexion(sitting) Locking or catching if labral tear or chondralflap Impingement test-supine, IR and passiveflexion and adduction
  8. 8. Radiological assessment Xr-AP-3 signs for abnormal acetabulum Posterior wall sign Crossover sign Ischial spine signCam signs- Flattened femoral head Increases alpha angle
  9. 9. CT and MRI Direct measurement of acetabular version Detection of chondral or labral damage
  10. 10. Treatment of FAI Non-op 24 month follow up of patients with alphaangles less than 60 with activitymodification Improved function and symtpoms but notrom
  11. 11. Operative Management Surgical Dislocation andOsteochondroplasty(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 changesat time of SDO
  12. 12. Hip Arthroscopy 82 patients with bilateral FAI All had arthroscopic osteochondroplasties MHHS and NAHS all improved significantly
  13. 13. Hip scope with mini-open Also generally improved scores Small incidence of femoral neck fracture Minor wound complications, HO and DVTnoted
  14. 14. SUFE related FAIOptions: Proximal femoral osteotomy- Schoenecker-valgusderotating osteotomy with cervicalosteochondroplasty gave satisfactory outcomes SCRO(prevention)-modified Dunn-no ON. Slongo-1/23 ON Arthroscopic and mini-open OCP-Leunig-3 caseswith good outcome at 6 and 23 month reviews
  15. 15. Perthe’sOptions: Intertrochanteric osteotomy Relative neck lengthening with trochantericdistalization Femoral head reduction ostoeotomy
  16. 16. Anderson: 14 hips treated with SDO and TA Allows treatment of femoral head lesions Findings- 4 OCD lesions treated withautograft HHS 63-95 with OCD HHS 71-88.6 without
  17. 17. PAO +/- PFO for combinedAcetabular and Femoral deformityClohisy: 26 patients treated with PAO, 13 hadcombined PFO HHS 68.8-91.3
  18. 18. Acetabular RetroversionPeters et al Algorithm for management: CEA<20 and no crossover sign- acetabular rimdebridement CEA>20 and crossover sign-PAO if cartilageintact, SD and rim debridement +/-femoral OCP Results of this algorithm HHS 72-91 in PAOgroup, 52-90 in SDO
  19. 19. Summary FAI being increasingly recognised Variety of treatment option that need to beindividually tailored Arthroscopic treatment allows fasterrecovery and initial results are favourable Early intervention for FAI improves hip pain No long term data available to say thatprogression to OA can be prevented