Download to read offline
Uploaded bySalihi Abdulmalik
Femoral acetabular impingement sydrome
This document discusses hip impingement, including pincer and cam types. It describes the normal anatomy of the hip joint and how impingement arises from uneven surfaces of the femoral head or acetabulum. Common symptoms include groin pain and limited range of motion. Diagnosis involves physical exam, x-rays to evaluate bone shapes, and MRI to view soft tissues. Treatment options range from physical therapy for mild cases to open surgical correction of bone deformities or hip replacement for advanced arthritis.
More Related Content
Similar to Femoral acetabular impingement sydrome
![Femoroacetabular%20 impingement[1]](https://cdn.slidesharecdn.com/ss_thumbnails/femoroacetabular20impingement1-130422051258-phpapp02-thumbnail.jpg?width=640&height=640&fit=bounds)
Femoral acetabular impingement sydrome
- 1. By Dr Salihi Abdulmalik NationalOrthopaedic Hospital-Dala, Kano 12th December, 2020
- 2. Proximal femurabuts acetabulum with range of motion There is reduced ROM of the hip due to uneven surfaces of the head of femur or acetabulum or both Common cause of early onset hip dysfunction and secondary osteoarthritis
- 4. Acetabulum ◦ 45degrees caudally ◦ 15 degrees anteriorly ◦ Allows 170 degrees coverage for the femoral head Femoral head ◦ inclines at 125 degrees ◦ Anteversion of 15 degrees
- 5. Ball andsocket joint Covered by hyaline cartilage Minimal gliding resistance even during peak loading with good ROM ROM ◦ Head-neck ratio ◦ Size of the head ◦ Acetabular socket orientation ◦ Proximal femur orientation
- 6. Pincer Cam Mixed
- 7. Acetabular baseddisorder with ◦ Global over coverage of the femoral head (coxa profunda or protrusio) ◦ Local over coverage of the femoral head anterioly by a retroverted acetabulum or anteriosuperior acetabular overhang Femoral head makes contact with the acetabulum
- 8. Labral lesionoccurs first and subsequent articualr cartilage Labrum is crushed causing intrasubstance tears and sometimes para labaral cysts Healing of labrum forms an ossified rim which further worsens acetabular coverage Increased shearing forces mostly in the posterior part of the joint during medial rotation
- 10. Proximal femoraldisorder ◦ Bony bump at the head neck junction (aspherical femoral head ◦ Decrease head-neck ratio ◦ Femoral neck retroversion ◦ Decrease femoral head offset
- 12.
- 14. Mostly unknown Congenital ◦ Retroversion Acquired ◦ SCFE ◦ Perthes disease ◦ Post femoral/acetabular osteotomy ◦ Post traumatic - #NOF ◦ ? Rigorous physical activity during skeletal development
- 15. Groin pain ◦Excessive demand ◦ Prolonged sitting Limited motion Difficulty sitting
- 16. Antalgic gait Externally rotated limb-SCFE Limited hip flexion (<90 degrees) with internal rotation (<5 degrees) Anterior impingement test (flexion, adduction, internal rotation) elicits pain
- 17. Typical patientwith pincer ◦ Woman ◦ 30-40 years ◦ Pain can be marked from labral injury ◦ Cartilage damage may be moderate
- 18. Typical CAM ◦Male ◦ 20-30 years ◦ Muscular and athletic ◦ Pain less dramatic ◦ Substantial cartilage damage
- 19. PINCER PelvicAP ◦ Pincer Cross over sign Posterior wall sign Cross table lateral ◦ Anterior lateral abnormalities
- 22. Acetabular fossa medialto ilioischial line
- 24. CAM ◦ Crossleg lateral view ◦ Circle drawn over femoral head should show smooth contour, any lesion outside indicate CAM lesion ◦ Measure alpha angle normal is 42 degrees >50.5 degrees is diagnostic ◦
- 26. 1st line– center of femoral head and center of femoral neck 2nd line – center of femoral head to the point on the anterolateral head- neck junction where prominence begins
- 27. CT scan MRI ◦ Labral tears ◦ Paralabral cysts ◦ Articular cartilage defects ◦ Ossification of acetabular rim ◦ Loss of spherity of femoral head due to fibrocystic changes
- 28. Non operative ◦Indications Minimally symptomatic patients No mechanical symptoms ◦ Physical therapy ◦ Restriction of athletic activities ◦ NSAIDS ◦ Benefits questionable ◦ Delays surgical correction ◦ Premature OA
- 29. Surgical ◦ Periacetabularosteotomy Indication: structural deformity of acetabulum with poor coverage of femoral head Retroversion Coxa profunda Technique: osteotomy and fixation
- 30. Open surgicalhip dislocation and trimming of CAM and pincer lesions ◦ Indications Preserved articular cartilage Correctable deformity Reasonable expectations ◦ Contraindications >55 years Morbid obesity Advanced joint disease
- 31. ◦ THR Age>60 years with end stage hip ◦ Correction by arthroscopy
- 32. Femoral neckfracture Heterotropc ossification Failure to preserve