RCH Education meeting

7/5/2013

FAI-3 types Cam

Pincer

Mixed

Primary (idiopathic/subclinical pre-exisitng hip condition) or secondary (pre-existing hip condition)

Cam type Prominent area antero-lat fem neck head

junction

Abuts acetabular rim esp in flex and IR

Damage to labral-chondral complex

Pincer type Acetabular sided over coverage of head

Leads to impaction of fem head neck region

Labral damage

Primary FAI ? Subclinical pre-existing

condition(SUFE/Perthe’s)

?Genetic-siblings of patients with primary FAI have a RR of 2.8 and 2 for having cam and pincer lesions

?high intensity sport activity increases risk

Secondary FAI SUFE-prominence of antero-lateral femoral

metaphysis Severity of slip correlates with poor long

term outcome

Perthe’s- asphericity of head, acetabular retroversion, post-surgical deformity

Clinical assessment Slow onset groin pain, insidious, increasing

with sport Exacerbated by flexion(sitting) Locking or catching if labral tear or chondral

flap Impingement test-supine, IR and passive

flexion and adduction

Radiological assessment Xr-AP-3 signs for abnormal acetabulum Posterior wall sign Crossover sign Ischial spine sign

Cam signs- Flattened femoral head Increases alpha angle

CT and MRI Direct measurement of acetabular version

Detection of chondral or labral damage

Treatment of FAI Non-op

24 month follow up of patients with alpha angles less than 60 with activity modification

Improved function and symtpoms but not rom

Operative Management Surgical Dislocation and

Osteochondroplasty(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 changes

at time of SDO

Hip Arthroscopy 82 patients with bilateral FAI

All had arthroscopic osteochondroplasties

MHHS and NAHS all improved significantly

Hip scope with mini-open Also generally improved scores

Small incidence of femoral neck fracture

Minor wound complications, HO and DVT noted

SUFE related FAIOptions: Proximal femoral osteotomy- Schoenecker-valgus

derotating osteotomy with cervical osteochondroplasty gave satisfactory outcomes

SCRO(prevention)-modified Dunn-no ON. Slongo-1/23 ON Arthroscopic and mini-open OCP-Leunig-3 cases

with good outcome at 6 and 23 month reviews

Perthe’s

Options: Intertrochanteric osteotomy Relative neck lengthening with trochanteric

distalization Femoral head reduction ostoeotomy

Anderson: 14 hips treated with SDO and TA Allows treatment of femoral head lesions Findings- 4 OCD lesions treated with

autograft HHS 63-95 with OCD HHS 71-88.6 without

PAO +/- PFO for combined Acetabular and Femoral deformity

Clohisy: 26 patients treated with PAO, 13 had

combined PFO HHS 68.8-91.3

Acetabular RetroversionPeters et al Algorithm for management:

CEA<20 and no crossover sign- acetabular rim debridement

CEA>20 and crossover sign-PAO if cartilage intact, SD and rim debridement +/-femoral OCP

Results of this algorithm HHS 72-91 in PAO group, 52-90 in SDO

Summary FAI being increasingly recognised Variety of treatment option that need to be

individually tailored Arthroscopic treatment allows faster

recovery and initial results are favourable Early intervention for FAI improves hip pain No long term data available to say that

progression to OA can be prevented