Sacramento Office
2825 J Street,#440
Sacramento, CA 95816  
(916) 492-2110
Walnut Creek Office
130 La Casa Via, Bldg 2, Suite110
Walnut Creek, CA  94598
(925) 322-2908
   

Hip Impingement (Femoroacetabular Impingement, FAI) and Labral Tears

by Amir Jamali, MD

Date last updated 01/01/2017

Hip Impingement


Hip impingement is a disease in which the femoral head and acetabulum (hip socket) abnormally contact each other thereby injuring one or both structures. It has been subclassified into a Pincer type and a Cam type impingement. In the Pincer impingement, the hip socket is excessively deep with walls that protrude outward. The walls abnormally contact the neck of the femur damaging both the neck as well as the soft-tissue structure around the hip socket known as the hip labrum. Cam impingement is the condition where the femoral head is excessively large to fit into the hip socket and causes a shearing injury to the articular cartilage at the edge of the socket. The large head can be secondary to a malformation of the femoral head seen in some individuals. Professor Reinhold Ganz and his collaborators are greatly responsible for the recognition and treatment of hip impingement in its current form. They have developed a surgical technique for safe surgical dislocation of the hip joint to allow evaluation and correction of both the abnormalities of the hip socket and the femoral head. Recently, surgeons familiar with arthroscopic treatment of the hip have also made progress in the correction of morphological abnormalities of the femoral head by using intraoperative x-ray and motorized arthroscopic instruments.

Labral Tears

The hip labrum is a soft-tissue structure located at the edge of the hip socket or acetabulum. It is highly innervated meaning that when it is damaged, it can lead to a high degree of pain. The labrum can be injured from a severe twisting injury to the hip or simply as a result of abnormal contact against the head of the femur. The labrum has a relatively poor blood supply and therefore has a limited healing potential. Although there have been reports of labrum tears slowly healing, most cases require surgery consisting of hip arthroscopy. Hip arthroscopy is a recently available procedure for the treatment of certain abnormalities of the hip.

1.            Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma. Sep-Oct 2001;15(7):475-481.

2.            Ito K, Minka MA, 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. Mar 2001;83(2):171-176.

3.            Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. Dec 2003(417):112-120.

4.            Schmid MR, Notzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology. Feb 2003;226(2):382-386.

5.            Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. Jan 2004(418):67-73.

6.            Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. Dec 2004(429):262-271.

7.            Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. Jan 2004(418):61-66.

8.            Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res. Jan 2004(418):74-80.

9.            Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. Jan 2004(418):54-60.

10.          Beall DP, Sweet CF, Martin HD, et al. Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol. Nov 2005;34(11):691-701.

11.          Clohisy JC, McClure JT. Treatment of anterior femoroacetabular impingement with combined hip arthroscopy and limited anterior decompression. Iowa Orthop J. 2005;25:164-171.

12.          Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology. Aug 2005;236(2):588-592.

13.          Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology. Jul 2005;236(1):237-246.

14.          Sampson. Arthroscopic treatment of femoroacetabular impingement. . Tech Orthoped. 2005;20:56-62.

15.          Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of the resection. Surgical technique. J Bone Joint Surg Am. Mar 2006;88 Suppl 1 Pt 1:84-91.

16.          Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res. Sep 2007;462:115-121.

17.          Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. May 2007;458:117-124.

18.          Parvizi J, Leunig M, Ganz R. Femoroacetabular Impingement. American Academy of Orthopaedic Surgeons. 2007;15(9):10.