Current concepts and trends for operative treatment of FAI: hip arthroscopy

Abstract

There has been an increasing body of literature regarding arthroscopic management of femoroacetabular impingement (FAI). Refinement of arthroscopic techniques has allowed for more complete management of FAI, and meta-analysis and systematic reviews have shown comparable outcomes to surgical hip dislocation with appropriate indications. There are still, however, pathomorphologies that are not accessible or much more challenging to address arthroscopically, and open corrective procedures should be considered in these situations. Extra-articular FAI is receiving increased attention and can be secondary to anterior inferior iliac spine/subspine impingement, trochanteric-pelvic impingement, and ischio-femoral impingement. Femoral and acetabular version and their impact on hip stability as well as the concept of impingement induced instability are being increasingly recognized. Acetabular labral and capsular management and repair techniques have also received increased attention. Finally, 3-dimensional imaging and dynamic software analysis are beginning to emerge as potential tools to better evaluate hip pathomorphology.

Fig. 1

a, Preoperative AP radiograph for a 22 year old collegiate hockey player with right hip pain reveals a cam deformity that extends lateral/postero-superior. b, Postoperative AP radiograph demonstrates adequate correction of this more challenging Cam deformity location with an arthroscopic approach. c, Preoperative lateral radiograph reveals a typical anterior cam deformity, and a postoperative lateral radiograph (d) demonstrates correction of the cam deformity arthroscopically

Fig. 2

a, Arthroscopic view of the R hip in a female with extreme ROM/capsular laxity induced instability reveals the interportal capsulotomy after labral repair and femoral resection. b, A looped suture is shuttled from the distal to the proximal limb of the capsular incision and retrieved with a penetrating grasper. c, Sutures are then tied in order to close and mildly plicate the capsule