5. Osteoarthritis of Hip
• Loss of articular cartilage > damage to
underlying bone
• Often associated with overuse or trauma
• Causes :
Mechanical
- FAI , DDH, PT
Non mechanical
- AN , AS , RA
6. Femoro-Acetabular Impingement
• Impingement between proximal femur and
acetabulum leading to cartilage injury and
pain ( Pathological abutment ).
• Mechanical cause of Hip OA ?
• Types
• 1 . Cam
• 2. Pincer
3. Combined : Most common type of FAI
7. Cam FAI
• Pathology :
Bony thickening at femoral head-neck
junction
Loss of femoral head sphericity
Jamming of the femoral neck against the front
of the acetabulum.
• Most common in young males (high activity)
10. Pincer FAI
• Pathology :
• Anomaly in acetabular structure
• Over-coverage of the femoral head >
impingement of the femoral neck on the
anterior acetabulum with flexion .
• most commonly in athletic middle aged
females
14. Clinical features of FAI
Initially
• Groin pain
• Decreased range of movement
• Pincer type FAI : Age & gender
• Cam type FAI : Age & gender
• Late stage : established OA
25. Other Radiological Ix
• MRI scans allow a more detailed assessment
of hip morphology .
• MRI arthrogram
• 3-Tesla system
• dGEMRIC
26. Treatment
• NON-OPERATIVE TREATMENT
• symptom management and modification of
activity .
• involving physical therapy
_ Muscle stretching
_ Hip traction
27. Operative treatment
• Indication : If pain persist
• Joint preservation of the hip can be performed
either
• Open or Arthroscopic surgery
• The principle : Resection of the ‘impingement
lesion’ > osteo-chondroplasty
28. Operative treatment
• In cam-type FAI : recontouring of the
head-neck junction > re-establish the
sphericity
• In pincer-type : Rim resection for focal
anterior over-coverage .
• Associated labral tears are repaired
• Realignment osteotomies of acetabulum
