Diagnosis and management of femoroacetabular impingement: a review of the literature

Femoroacetabular impingement (FAI) is being increasingly diagnosed as a cause of hip pain among young and middle-aged adults, and is now recognised as a likely cause of early osteoarthritis (OA) of the hip. There are two main forms, “cam” impingement and “pincer” impingement, although the vast majority of cases have a combination of both forms known as “mixed” impingement. Over time, repetitive abnormal contact between the femoral head and acetabulum can result in chondral, labral, and eventually osseous pathology. A detailed history and physical examination in conjunction with radiological imaging help in the diagnosis of FAI. Diagnosis is made difficult by the fact that many asymptomatic patients have the characteristic features of FAI on imaging. Most patients should have a trial of conservative management prior to consideration for surgery. Arthroscopic and open surgical treatments are available, with neither showing superior outcomes. In general, early outcomes of surgical treatment appear to be favourable, however these outcomes are limited to a hip joint with little or no evidence of OA. Further high quality research is required to investigate the optimal approach to diagnosing and managing this complex condition