Editorial Commentary: Symptomatic Femoroacetabular Impingement Resulting in Severe Hip Osteoarthritis: Predicting the "Perfect Storm"

Abstract

In the last 20 years, femoroacetabular impingement (FAI) has transitioned from a disputed disease to a well-established cause of hip pain and osteoarthritis (OA). Cam-type FAI, specifically, is supported by several studies as a risk factor for osteoarthritis. Elevated α-angle is also a mild-to-moderate risk factor for OA in patients with FAI. Other risk factors include age, sex, body mass index, activity level, range of motion, 3D acetabular and femoral morphology, and femoral version. To further complicate the picture, when we look at the contralateral hip (where many of these factors are held constant), only about 25% of patients appear to report symptoms over a 5-year period after their presentation with ipsilateral FAI. In the setting of an FAI bony morphology, some individuals end up with early symptoms and cartilage damage at a young age, while others go their whole life without hip pain. We still have a long way to go to understand the multitude of factors that drive the "perfect storm" that leads to symptomatic FAI and eventual OA in certain patients.