This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing early hip degeneration. FAI has three types based on anatomy: cam, pincer, and mixed. Diagnosis involves clinical exams, x-rays to detect bone abnormalities, and MRI to view soft tissues. Conservative treatment provides temporary relief while surgery corrects the underlying impingement through osteoplasty or labral repair. Both open surgery and hip arthroscopy are effective surgical options for FAI.

1. ΟρθοπαιδικήΚλινική
ΠανεπιστημίουΘεσσαλίας
Ch. Chrysovergis
Resident Orthopaedic
University Hospital Larisa
Director : Prof. K. Malizos
www.Ortho-uth.org

2. Femoro-Acetabular ImpingementFemoro-Acetabular Impingement
F.A.IF.A.I

3. Introduction
 Cause of early degenerative changes in
young adult hips
 Abnormal impingement (abutment)
between the femoral head – neck
junction and the acetabular rim
 Reinold Ganz , Javad Parvizzi , Martin
Beck , Michael Leunig University of Bern
Switzerland

4. - Occurs in patients with :
 Abnormal hip morphology
 Normal hip morphology but excessive
range of hip movement

5. Patients with F.A.I.
Healthy,active adults. Ages 25 – 50 yrs old.
 Athletic
activities,extreme
renge of hip
motion,deep hip
flexion,pivoting of
the hip,Ice
Hockey,Martial
Arts,Football,Golf
 Track - field
gymnastics
 jumpers,runners

6.  I. A. Kapandji – ‘’Physiologie
Articulaire’’

7. Patients with minor trauma or
underlying hip pathology
 Post – traumatic free bodies into the
joint,lateral impact injury to the grater
trochanter
 Legg – Calve – Perthes
 Slipped femoral head epiphysis
 Aspherical head
 Previous femoral neck fracture (decreased
head – neck offset,widening of the femoral
neck)

8. Anatomical structures
 The Hip joint consists of :
Acetabulum,Labrum,Head
– Neck junction of
Femur,Articular capsule
 Labrum :
fibrocartilaginous
structure,deepens the
articular cavity of
acetabulum,increases
stability
 Head – Neck junction : is
an intracapsular structure
Αλ. Ε. Αγιος : ‘’Ανατομικη’’

9.  Femoral Head :Almost
spherical,covered by the
labrum at it’s 2/3,beyond
the point of it’s equator
 The articular cartilage of
the acetabulum and of the
femoral head are thicker at
the antero – superior
point,region of the greater
forces that the acetabulum
endures during the
abutmen (impingement) of
the femoral head

10. Mechanism & Aetiology
Types of F.A.I.
 3 Types of
F.A.I. :
 ‘’cam’’ type
 ‘’pincer’’ type
 mixed type

12.  ‘’cam’’
type :
 non spherical
head
 reduce of
head – neck offset
 widening of
head – neck
junction
 ‘’pistol – grip’’
deformity

13.  ‘’pincer
type’’ :
 excessive
acetabular
cover (coxa
profunda)
 acetabular
retroversion
 protrusio
acetabuli

14. ‘’Cam’’ type :
 damage to the
antero – superior aeria of
the acetabulum
 the accenrtic part
compresses and shears
the labrum and
acetabular cartilage
causing separation
between the labrum
and the cartilage
 damage location :
antero – superior
(1 o’clock)
 M : F – 14 : 1

15. ‘’pincer’’ type :
 range of hip
movement limited by
the acetabular rim
(overcoverage of the
head)
 at the ending of
motion the neck abuts
against the labrum
wich acts as a bumper
and is compressed
between the neck and
the rim
 danage in a narrow
band along the rim with
ossification of the
labrum (11 – 1 o’clock)

17.  Practicaly none of
the above types is
isolated.’’Mixed’’
type is the most
usual

18. Diagnosis & Differential
Diagnosis

19. Clinical :
 patient presents with groin pain (anterior hip pain)
 usualy young and/or middle aged active adults with
minor trauma or no trauma history
 limitation of hip movement
 increasing pain with activities,prolonged sitting
 difficulty to get in – out of the car,arising from seat or
bed
 difficulty to do the shoes,socks

20. patient shows
his hip with
the grip
‘’C’’ sing

21.  positive
impingement test –
pain in flexion ,
adduction , internal
ritation of the hip

22. 
Imaging :
 plain X – rays :
 anteroposterior
(face) + profil x -
rays
 ‘’pistol - grip’’
deformity
 non spherical
head
 free intra –
articular bodies

23.  Α. Γεωργούλης – Ι. Μίχος : ‘’Χόνδρινες & οστεοχόνδρινες βλάβες’’
ΕΕΧΟΤ 2011

24.  Απ. Καραντανας – ‘’Απεικονιση
αθλητικων κακωσεων’’ 2010

25. UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

26. UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

27. UNIVERSITY HOSPITAL LARISAUNIVERSITY HOSPITAL LARISA

28.  CT : more efficent for bone structures , free intra –
articular bodies
Α. Γεωργουλης , Ι. Μιχος – ‘’Χονδρινες και οστεοχονδρινες βλαβες’’ ΕΕΧΟΤ
2011

32. 
MRI & MRA
o MRI : more efficient for soft tissue
structures,labrum,acetabular rim
o MRA :
 is now becoming the standard
investigation of F.A.I.
 ruptures of the labrum
 abnormality of the head – neck junction
 ossification of the labrum
 meassurement of the α (alfa) angle

33.  Απ.
Καραντανας
‘’Απεικονιση
Αθλητικων
Κακωσεων’’
2010

34.  Απ. Καραντανας – ‘’Απεικονιση αθλητικων
κακωσεων’’ 2010

35. Differential diagnosis
o inguinal hernia
o low back disorders
o trohanteric bursitis

37. Conservative Treatment
 The aim is to improve the symptoms
 Rest,modofication of activities
 Avoid excessive motion activities
 NSAIDS
 Intensive physicotherapy might aggrevate
the condition trying to improve hip
movement
 usualy temporary relief of symptoms with
conservative treatment

38. Surgical treatment
 The aim is to correct the cause of F.A.I. , improve
hip motion
 Open surgery
 Hip arthroscopy

39. Open surgery
 Lateral or posterolateral approach
 Dislocation of the femural head with care
to it’s blood supply
 Osteoplasty of the (‘’cam’’) head – neck
junction , with caution not to resect over
30% of the antero – lateral quadrant of
the neck.Risc of neck fracture
 Resection osteoplasty of the (‘’pincer’’)
acetabular rim , reorientation of the
acetabulum

41. Hip arthroscopy
 Performed in lateral or supine position with
traction applied
 C – Arm imaging is essential for safe entry
of the portals
 3 portals :
 Anterior
 Anterolateral
 Posterolateral

42.  Debridement of free
bodies
 Debridement of labral
and cartilage lesions
 Microfractures
technique for the
acetabular cartilage
 Correction of the
acetabular rim
 Head – neck junction
osteoplasty

44.  Open vs Arthroscopy : both have good
results although patients operated with
arthroscopy recovered much earlier

45. Conclusions
 F.A.I. usualy occurs in young to middle – aged
active adults and athletes
 Can be a limitation to the level of activity
 Conservative treatment improves the symptoms
but not the cause
 Final solution could be the surgical treatment with
verry good results

46. thank you