Hip Arthroscopy: Where We Are, and Where We Are Going

In 2003, Ganz et al. described anterior femoroacetabular impingement (FAI) as an under recognized cause of early hip osteoarthritis. Impingement is a purely mechanical hip disorder defined as abnormal contact between skeletal prominence of the acetabula rim or femoral head-neck junction that leads to painful, periarticular joint. If untreated, FAI can lead to endstage osteoarthritis of the hip joint and may be one of the main causes of so-called primary osteoarthritis of the hip. Depending on the pathomechanism, two types of FAI, pincer and cam can be distinguished. Isolated cam or pincer lesions are not very common; 86% of all affected patients showed combined deformity. But imaging studies according to Byrd and Jones, Bellal̈che et al. showed a cam effect in 58% to 73% of cases and mixed cam and pincer effects in 9 to 19% of cases. Anterior FAI has been increasingly recognized over the last five to six years as a cause of hip pain in adults younger than 50 years of age. This FAI was newly identified and recognized as a risk factor for labral, cartilage damage, and early hip osteoarthritis is now understood as a major role of hip primary osteoarthritis. Clinical signs of FAI often present themselves in active, young adults as groin pain of slow onset, usually noticed after an episode of minor trauma. Most patients are 20 to 50 years old. In 70% of all patients were athletically active and 30% of patients were elite athletes. Patients complain of sharp pain or lasting aches in the groin which can last from a few minutes to a few hours. Some patients feel apprehension or discomfort in the seated position, particularly when sitting on low seats or while driving. Usually patients report no pain during walking. Sports most implicated in this condition require repeated forceful flexion of the hip (combat sports, dancing, gymnastics, rowing, hurdle racing, golfing and taekwondo practice). Imaging studies are very important to find a FAI. We usually use pelvis anteroposterior radiographs (AP), frogleg lateral view, Dunn 45。, 90。views and false profile views. Pelvis AP view should be used as the standard method to check rotation or tilting deformities. AP view should be taken with the patient in a supine position and the leg internally rotated (15。). The distance between the symphysis pubis and sacro-coccygeal joint should be 1-4 cm. The physician should carefully evaluate: 1 the cross-over sign (local retroversion) which indicates acetabular focal retroversion. In a normal hip, the acetabulum is anteverted; the anterior wall runs medial to the posterior rim without crossing it. In anterior acetabular over coverage, the anterior acetabular rim is projected more lateral than the posterior rim 2 the posterior acetabular over coverage can be evaluated by determining the position of the posterior acetabular rim Hip Arthroscopy: Where We Are, and Where We Are Going