Abstract
Femoroacetabular im**ement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior im**ement test. Hip flexion and internal rotation in flexion were limited to an average 97° and 9°, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder.
Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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References
Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–942.
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular im**ement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular im**ement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.
Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–1457.
Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–587.
Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam im**ement abnormalities. Clin Orthop Relat Res. 2007;462:115–121.
Eijer H, Myers SR, Ganz R. Anterior femoroacetabular im**ement after femoral neck fractures. J Orthop Trauma. 2001;15:475–481.
Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular im**ement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935.
Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular im**ement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular im**ement. Arthroscopy. 2006;22:95–106.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
Hunt D, Clohisy J, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am. 2007;18:497–520, ix–x.
Ilizaliturri VM, Jr., Nossa-Barrera JM, Acosta-Rodriguez E, Camacho-Galindo J. Arthroscopic treatment of femoroacetabular im**ement secondary to paediatric hip disorders. J Bone Joint Surg Br. 2007;89:1025–1030.
Ito K, Minka MA, 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular im**ement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.
Larson CM, Giveans MR. Arthroscopic management of femoroacetabular im**ement: early outcomes measures. Arthroscopy. 2008;24:540–546.
Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular im**ement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.
MacDonald S, Garbuz D, Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplasty. 1997;8:3–9.
Magee D. Orthopedic Physical Assessment. Philadelphia, PA: Saunders; 1997:463.
Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008;38:71–77.
Mason JB. Acetabular labral tears in the athlete. Clin Sports Med. 2001;20:779–790.
McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47.
McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.
Parvizi J, Leunig M, Ganz R. Femoroacetabular im**ement. J Am Acad Orthop Surg. 2007;15:561–570.
Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC. Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res. 2005;441:327–333.
Peters CL, Erickson JA. Treatment of femoro-acetabular im**ement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.
Philippon MJ, Maxwell RB, Johnston TL, Schenker M, Briggs KK. Clinical presentation of femoroacetabular im**ement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–1047.
Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular im**ement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.
Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular im**ement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278–286.
Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.
Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233.
Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Partial support was received from a Zimmer Clinical Research Grant (JCC). This work was supported in part by Award Number UL1RR024992 from the National Center for Research Resources (JCC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. This work was also supported in part by the Curing Hip Disease Fund (JCC).
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Clohisy, J.C., Knaus, E.R., Hunt, D.M. et al. Clinical Presentation of Patients with Symptomatic Anterior Hip Im**ement. Clin Orthop Relat Res 467, 638–644 (2009). https://doi.org/10.1007/s11999-008-0680-y
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DOI: https://doi.org/10.1007/s11999-008-0680-y