الفهرس 
Arthroscopic anatomy of Hip jointOnly 14 pages are availabe for public view
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Abstract
F
emoroacetabular impingement is a well-recognized cause of joint damage and osteoarthritis among young adults. With this study, we have tried to reflect on the response to arthroscopic treatment for cam-type FAI.
There are 2 primary mechanisms of FAI: cam and pincer impingement. Cam impingement is the result of contact between an abnormal femoral head-neck junction and the acetabulum, whereas pincer impingement is typically the result of a deep acetabulum, local anterior overcoverage (retroversion), or posterior overcoverage. The most common type of FAI is mixed type with both Cam and Pincer lesions.
The prevalence of the anatomy of FAI in the asymptomatic population is approximately 30 %, and thus, FAI morphology does not necessarily indicate the presence of clinical impingement; and vice versa, impingement may also occur with apparently normal anatomy, for example, in the case of supra-physiologic extreme range of motion of the hip joint in an athlete.
FAI morphology by itself does not cause pain; however, it may alter the biomechanics of the joint and eventually lead to injuries to the soft tissues of the hip that can be a source of pain. Chondral lesions and labral tears are the most common intra-articular pathologies associated with FAI; both may result from abutment of the femoral head-neck region with the acetabulum in FAI.
Patients with symptomatic FAI generally present with aching pain in the hip and groin, which may be with insidious or acute onset and may or may not follow a trauma. Common complaints include difficulty or soreness with putting on socks and shoes, with sitting for a prolonged period of time, and with impact activity such as running or sports that require cutting, pivoting, or kicking.
Complete physical examination of the hip including gait and core strength is fundamental for making the diagnosis. Flexion-adduction and internal rotation of the hip, also known as the “Anterior Impingement Test,” can reproduce the FAI pain.
The first and most basic imaging tool for FAI diagnosis is plain radiography. The series should include a minimum of anteroposterior (AP) pelvis radiograph and a lateral image of the femoral head-neck area (e.g., frog lateral) to assess femoral head-neck morphology, assessing for loss of femoral head-neck offset, varus or short femoral neck, and subchondral cystic change, as indicators of impingement, particularly cam impingement. On the lateral view of the proximal femur, increased alpha angle and decreased femoral head-neck offset are considered anatomically consistent with cam-type FAI, while subchondral cystic change or notching of the anterior femoral neck may also be clues for FAI.
Although plain radiography is enough to diagnose FAI morphology, in most cases before surgery, magnetic resonance imaging (MRI) and/or computer tomography (CT) is performed as well. Direct MR arthrography (MRA) is more sensitive for detecting labral tears than MRI without contrast.
Conservative treatment may even be tried at first, with restriction of athletic activities and the use of NSAIDs.
In cases of conservative management failure to alleviate FAI symptoms, surgical intervention may be indicated. The aim of surgical treatment is to diminish the abutment between abnormally shaped proximal femur and acetabulum. Open approach with surgical hip dislocation had been invented first, followed by mini-open and arthroscopic approach in management of FAI.
Hip Arthroscopy became a state of art in management of Cam type FAI nowadays. It is safe minimally invasive technique which allow adequate visualization and assessment of central and peripheral compartment of the hip with management of intra-articular pathology.
Our study confirmed that excellent results are correlated directly with accurate patient selection with reasonable indication. The more arthritic hip joint is, the worse results expected.
Arthroscopic management of patients with FAI results in significant improvement in outcomes measures, with good to excellent results being observed in 85% of hips at a minimum follow-up of 1 year.