FEMORO-ACETABULAR IMPINGEMENT SYNDROME

Femoracetabular impingement syndrome is a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs and imaging findings. It represents symptomatic premature contact between the proximal femur and the acetabulum.

The primary symptom of femoroacetabular impingement syndrome is motion-related or position-related pain in the hip or groin. Pain may also be felt in the back, buttock or thigh. In addition to pain, patients may also describe clicking, catching, locking, stiffness, restricted range of motion or giving way.

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Diagnosis of femoroacetabular impingement syndrome does not depend on a single clinical sign; many have been described and are used in clinical practice. Clinical tests usually reproduce the patient's typical pain; the most commonly used test, flexion adduction internal rotation (FADIR). There is often a limited range of hip motion, typically restricted internal rotation in flexion.

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Radiographs (x-rays) of the pelvis and of the symptomatic hip should initially be performed to obtain an overview of the hips, identify cam or pincer morphologies, and identify other causes of hip pain. Where further assessment of hip morphology and associated cartilage and labral lesions is desired, cross-sectional imaging is appropriate.

Femoroacetabular impingement syndrome can be treated by conservative care, rehabilitation or surgery. Conservative care may involve education, watchful waiting, lifestyle and activity modification. Physiotherapy-led rehabilitation aims to improve hip stability, neuromuscular control, strength, range of motion and movement patterns. Surgery, either open or arthroscopic, aims to improve the hip morphology and repair damaged tissue. The good management of the variety of patients with femoroacetabular impingement syndrome requires the availability of all of these approaches.

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