Clinical analysis and advances in treatment in the femoroacetabular impingement: Literature review
Keywords:
Impingement, Femoroacetabular, FAI, CAM, PincerAbstract
Femoroacetabular impingement is a structural alteration of the hip characterized by abnormal contact between the femoral head and the acetabulum, causing pain and restriction of movement, with the risk of osteoarthritis, especially in young people and athletes. An electronic search was carried out for scientific articles published from January 2018 to 2024 in the PubMed, Scopus, Web of Science and ScieLO databases. The Femoroacetabular impingement is classified into CAM, Pincer and mixed. The CAM variant involves an irregular femoral head that generates friction; the Pinza, acetabular overcoverage that limits movement; and the mixed, the combination of both. Its diagnosis includes symptoms, physical examination and imaging studies, where MRI and x-ray are key. Initial treatment is conservative (physiotherapy and analgesia), but if symptoms persist or there is progression of damage, surgery is required. Hip arthroscopy is preferred for its lower morbidity and faster recovery compared to open surgery, although the choice depends on the structural damage and the experience of the surgeon. In conclusion, the treatment of Femoroacetabular impingement must be adapted to each patient. While conservative approaches control initial pain, surgery, especially arthroscopy, is the best option to restore functionality and avoid complications. In advanced cases it should be carefully evaluated, since the prognosis may be limited.
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References
Aguirre Rodríguez, V. H. M. y Pinal Cavarrubio, J. P. (2024). Evaluación sistemática de la cadera dolorosa. Acta Ortopédica Mexicana, 38(4), 246-56. https://doi.org/10.35366/116311
Benito Carles, S., Fornés Albors, M. y García Rozier, D. (2024). Evaluación y Abordaje Fisioterapéutico del Síndrome de Pinzamiento Femoroacetabular dentro de las Lesiones de Cadera en Corredores/as Adultos/as. [Trabajo final de grado, Escoles universitaries gimbernat i Tomas Cerdá]. https://eugdspace.eug.es/bitstream/handle/20.500.13002/981/Evaluaci%C3%B3n%20y%20Abordaje%20Fisioterap%C3%A9utico%20del%20S%C3%ADndrome%20de%20Pinzamiento%20Femoroacetabular%20dentro
Carton, P. F. y Filan, D. J. (2019). The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips. Hip International, 29(6), 665–673. https://doi.org/10.1177/1120700018825430
Dessouky, R., Chhabra, A., Zhang, L., Gleason, A., Chopra, R., Chatzinoff, Y., Fey, N.P., Yin, X. y Wells, J. (2019). Cam-type femoroacetabular impingement: Correlations between alpha angle versus volumetric measurements and surgical findings. European Radiology, 29(7), 3431-3440. http://doi.org/10.1007/s00330-018-5968-z
Domb, B. G., Annin, S., Shapiram, J., Chen, J. W., Kyin, C., Rosinsky, P. J. y Maldonado, D. R. (2020). Optimal treatment of cam morphology may change the natural history of femoroacetabular impingement. American Journal of Sports Medicine, 48(12), 2887–2896. https://doi.org/10.1177/0363546520949541
Dwyer, T., Whelan, D., Shah, P. S., Ajrawat, P., Hoit, G., y Chahal, J. (2020). Operative versus nonoperative treatment of femoroacetabular impingement syndrome: A meta-analysis of short-term outcomes. Arthroscopy, 36(1), 263–273. https://doi.org/10.1016/j.arthro.2019.07.025
Ferreira, G. E., O'Keeffe, M., Maher, C. G., Harris, I. A., Kwok, W. S., Peek, A. L., y Zadro, J. R. (2021). The effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome: A systematic review and meta-analysis. Journal of science and medicine in sport, 24(1), 21–29. https://doi.org/10.1016/j.jsams.2020.06.013
Fortier, L. M., Popovsky, D., Durci, M. M., Norwood, H., Sherman, W. F., & Kaye, A. D. (2022). An updated review of femoroacetabular impingement syndrome. Orthopedic Reviews (Pavia), 14(3), 37513. https://doi.org/10.52965/001c.37513
Frasson, V. B., Vaz, M. A., Morales, A. B., Torresan, A., Teloken, M. A., Fortis, P.D., Crestani, M.V., y Manfredini, B. (2020). Hip muscle weakness and reduced joint range of motion in patients with femoroacetabular impingement syndrome: A case-control study. Brazilian Journal of Physical Therapy, 24(1), 39–45. https://doi.org/10.1016/j.bjpt.2018.11.010
Gatz, M., Driessen, A., Eschweiler, J., Tingart, M., & Migliorini, F. (2020). Arthroscopic surgery versus physical therapy for femoroacetabular impingement: a meta-analysis. European Journal of Orthopaedic Surgery & Traumatology, 30(7), 1151-1162. https://doi.org/10.1007/s00590-020-02675-6
Goodman, D. A., Feighan, J. E., Smith, A. D., Latimer, B., Buly, R. L., y Cooperman, D.R. (1997). Subclinical slipped capital femoral epiphysis: Relationship to osteoarthrosis of the hip. The Journal of Bone and Joint Surgery, American Volume, 79(10), 1489–1497. https://doi.org/10.2106/00004623-199710000-00005
Hale, R. F., Melugin, H. P., Zhou, J., LaPrade, M. D., Bernard, C., Leland, D., Levy, B.A., y Krych, A.J. (2021). Incidence of femoroacetabular impingement and surgical management trends over time. American Journal of Sports Medicine, 49(1), 35-41. https://doi.org/10.1177/0363546520970914
Heerey, J., Srinivasan, R., Agricola, R., Smith, A., Kemp, J., Pizzari, T., King, M.G., Lawrenson, P.R., Scholes, M.J., Souza, R.B., Link, T., Majumdar, S., y Crossley, K.M. (2021). Prevalence of early hip OA features on MRI in high-impact athletes: The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthritis and Cartilage, 29(3), 323–334. https://doi.org/10.1016/j.joca.2020.12.013
Ishøi, L., Nielsen, M. F., Krommes, K., Husted, R. S., Hölmich, P., Pedersen, L. L., y Thorborg, K. (2021). Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and nonoperative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med, 55(22), 1301-1310. https://doi.org/10.1136/bjsports-2021-104060
Krishnamoorthy, V. P., Kunze, K. N., Beck, E. C., Cancienne, J. M., O’Keefe, L. S., Ayeni, O. R., y Shane, J. (2019). Radiographic prevalence of symphysis pubis abnormalities and clinical outcomes in patients with femoroacetabular impingement syndrome. American Journal of Sports Medicine, 47(6), 1467–1472. https://doi.org/10.1177/0363546519837203
Langhout, R., Weir, A., Litjes, W., Gozeling, M., Stubbe, J. H., Kerkhoffs, G., Tak, I. (2019). Hip and groin injury is the most common non-time-loss injury in female amateur football. Knee Surgery Sports Traumatology Arthroscopy, 27(10), 3133-3141. https://doi.org/10.1007/s00167-018-4996-1
Leibold, C.S., Schmaranzer, F., Tannast, M., Siebenrock, K.-A., y Steppacher, S. (2019). Femoroacetabular impingement–current understanding. Z Orthop Unfall, 157(3), 317–336. https://doi.org/10.1055/a-0659-2989
Matsumoto, K., Ganz, R., & Khanduja, V. (2020). The history of femoroacetabular impingement. Bone Joint Research, 9(9), 572-577. https://doi.org/10.1302/2046-3758.99.BJR-2020-0003
McCrum, C. L. (2021). Editorial commentary: Lumbosacral anatomy and mechanics influence femoroacetabular impingement syndrome and surgical outcomes: The hip bone is connected to the back bone. Arthroscopy, 37(1), 156-158. https://doi.org/10.1016/j.arthro.2020.10.030
Mok, T. N., He, Q. Y., Teng, Q., Sin, T. H., Wang, H. J., Zha, Z. G., Zheng, X.F., Pan, J.H., Hou, H-G., y Li, J.R. (2021). Arthroscopic Hip surgery versus conservative treatment in femoroacetabular impingement syndrome: A meta-analysis of RCTs. Orthopaedic Surgery, 13(6), 1755-1764. https://doi.org/10.1111/os.13099
Nepple, J., Zaltz, I., Larson, MC., Beaule, PE., Kim, YJ., Millis, MB., Sierra, RJ., y Clohisy, J.C. (2020). Surgical Treatment of Femoroacetabular Impingement: Hip Arthroscopy Versus Surgical Hip Dislocation A Propensity-Matched Analysis. The Journal Of Bone And Joint Surgery, 102(2), 51-8. http://dx.doi.org/10.2106/JBJS.20.00265
Nikolova, A. y Yordanov, Y. P. (2022). Conservative physiotherapy treatmentof femoroacetabular impingement. Acta Médica Bulgárica, 49(3), 50-53. https://doi.org/10.2478/amb-2022-0030
Sarassa, C., Carmona, D., Vanegas, D., Restrepo, C., Gomez, L., y Herrera, AM. (2021). Pinzamiento femoroacetabular tratado con luxación quirúrgica de la cadera: resultados a corto plazo. Revista Española de Cirugía Ortopédica y traumatología, 65(6), 425-432. https://doi.org/10.1016/j.recot.2021.02.002
Trigg, S. D., Schroeder, J. D., & Hulsopple, C. (2020). Femoroacetabular Impingement Syndrome. Current sports medicine reports, 19(9), 360-366. https://doi.org/10.1249/JSR.0000000000000748
Wylie, J. D. y Kim, Y.J. (2019). The natural history of femoroacetabular impingement. Journal of Pediatric Orthopaedics, 39 (6), S28-S32. https://doi.org/10.1097/BPO.0000000000001385
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