Abstract
Femoroacetabular impingement (FAI) is a clinical condition characterised by abnormal contact between the femoral head-neck junction and the acetabular rim. The pathology is defined by the consequential rise in stresses across both articulating surfaces, which may eventually lead to labral damage and articular cartilage injury [1]. Other ramifications of this atypical association include osteoarthritis, which has been described by Ganz and colleagues in 2003 to be an eventuality of FAI syndrome based upon the repetitive pathological motion of the hip joint [2]. In the last two decades, several interventions have been developed focused on treating FAI in order to prevent or stop this progression to osteoarthritis, with severe cases often requiring open surgical procedures. There are three major types of FAI that have been described depending on the nature of the deformity; (1) Cam impingement affecting the femoral head-neck junction arising because of an asphericity of the femoral head, defined as an alpha angle of >55°, (2) Pincer impingement, owing to an overcoverage or retroversion of the acetabulum and (3) Mixed involving features of both cam and pincer type impingement [2]. This article provides a brief overview of the arthroscopic management of Cam femoroacetabular impingement.
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Summary
Our understanding of FAI has improved tremedously since the concept was introduced by Ganz in the 1990s, and as such the forms of intervention too have progressively matured. The management of cam type FAI must be practiced with considerate prior clinical and radiological assessment of the patient to successfully guide treatment. Nonoperative measures should not be disregarded, with physiotherapy, NSAIDs and activity modification being a suitable choice for many patients. However, recent results from two large scale multicentre RCTs—FAIT and UK FASHIoN, have suggested that hip arthroscopy has resulted in significant improvement in the short term and may be of preference over conservative measures. Future large-scale, long-term RCTs are pivotal in assessing the long-term outcomes of patients who decide to undergo such procedures, and whether this improvement is sustained.
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Sunil Kumar, K.H., Khokher, Z.H., Khanduja, V. (2020). Managing Cam FAI: Intermediate Hip Arthroscopy. In: Hirschmann, M., Kon, E., Samuelsson, K., Denti, M., Dejour, D. (eds) ESSKA Instructional Course Lecture Book . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61264-4_17
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DOI: https://doi.org/10.1007/978-3-662-61264-4_17
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