Historical Background of the Treatment of Femoroacetabular Impingement

Abstract

Early degenerative hip disease has often been noted in patients with abnormal acetabular morphology usually secondary to developmental dysplasia of the hip (DDH), and it has been hypothesized to be the consequence of abnormal edge loading on the anterosuperior acetabular cartilage from an eccentrically centered femoral head. However, the role femur morphology played in the development of degenerative hip disease was not as defined. In 1936, Smith-Petersen classically described a concept of impingement in which hip pain was theorized to be caused the femoral neck impinged against anterior acetabular margin [1]. Surgical correction, by way of impingement correction, was successful in his small case series. Decades later, Murray et al. described a tilt deformity of the proximal femur and its association with the development of osteoarthritis of the hip [2]. In 1986, Harris described his theory on how derangements in femoral anatomy development caused primary or “idiopathic osteoarthrosis of the hip” in the non-dysplastic hip [3]. Harris wrote that based on his numerous radiographic observations, the convex, “pistol grip” femoral deformity at the femoral head-neck junction following the sequelae of a recognized or undetected slipped capital femoral epiphysis (SCFE), Legg-Calve-Perthes disease, or the congenital epiphyseal dysplasia was a common pathway for development of the so-called “idiopathic” degenerative hip disease. Although Harris reported of the association of abnormal femoral head-neck deformity and osteoarthritis, he did not elaborate on the underlying mechanisms that such deformity can result in the development of primary degenerative hip disease.