Common Indications:

1. Femoroacetabular impingement (FAI) is a condition where the shape of the femoral neck of acetabulum are abutting one another causing pain or damage. There are two types (or a combination of both):

  • CAM impingement: is when there is a bump lesion on the femoral neck that impinges on the acetabulum (the socket)
  • Pincer impingement: is when the acetabulum (the socket) is protruding out and impinging on the femoral neck.

Illustration demonstrating cam (A) and pincer (B) femoroacetabular impingement. (Reproduced with permission from Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA: Femoroacetabular impingement: A cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003;417:112-120.)

2. Labral lesions;

3. Removal of loose and foreign bodies;

4. Removal of osteochondral fracture fragments;

5. Treatment of synovial diseases.

Common causes include:

  • Trauma during a sporting event or accident;
  • Underlying anatomic abnormality of the hip (FAI);

Common symptoms include:

  • Pain with prolonged sitting and walking positions;
  • Pain with deep flexion of the hip;
  • Pain when getting in and out of the car.

Patient’s often feel pain in the anterior, lateral and posterior area of the hip, which is called the C-sign.

Clinical assessment includes doing the following testing:

Straight Leg Raise (SLR) and the resisted Straight Leg Raise (rSLR)

FADDIR: (Flexion Adduction Internal Rotation of the hip)

FABER: (Flexion Abduction and external rotation of the hip)

If some or all of these tests proves to be positive, it usually indicates presence of impingement. Investigations should include:

AP pelvis of the hips, 45 degree Dunn view of both hips and an MRI arthrogram in order to help identify possibility of labral tear and FAI.

AP Pelvis

45 deg Dunn view

MRI arthro, axial view

MRI arthro, coronal view

Diagnostic hip injection:

Once these investigations are done, diagnostic testing can include a xylocaine injection to the hip. In some patients who present with back pain and hip pain it is important to ensure that surgery to the hip will help alleviate the pain. The purpose of the injection is to separate the back pain from the hip pain, by injecting a local anaesthetic inside the hip. This injection is done under fluoroscopy or ultrasound in order to ensure that the injection is done within the adequate structure. The hip pain should then be alleviated for several hours. This injection can also help patients better understand the relief they may expect to have after arthroscopic surgery.

Surgical technique:

1. Patient is put in a lateral position on the operating table.

2. Patient’s leg is put at 45 degree on a hydraulic leg support.

3. The hip is indirectly distracted by pulling down the leg to horizontal with the leg support.

4. Insertion of the arthroscope and the instruments.

5. Capsular release.

6. Identification of the different anatomic structures and the labral tear if present.

7. If presence of labral tear, identification of the extent of the tear is ascertained and thenthe labral remnant on acetabular edge is debrided.

8. If the patient has a pincer component to the impingement, then the bony protrusion isremoved with a burr (labrum pinched by bony structures) until bony surface is clear andlabrum is not protruding.

9. Set up anchors and repair labrum.

10. Assess CAM impingement on femoral side, if present, remove with burr.

11. Verify complete excision of CAM with fluoroscopy and with a variety of hip movements using the hydraulic leg support (i.e. flexion, adduction and internal rotation).

12. Close the wound, apply standard dressing and intra-articular injection of anesthetic for pain management.

Patient is brought to recovery room.

Potential complications:

  • Extravasation of fluid into the thigh or retroperineal space.
  • Numbness in groin, thigh, leg or foot that can persist for several days to severalweeks (Neuropraxia).
  • Scope trauma to articular cartilage.
  • Hip dislocation post op (rare)( in patients at risk a brace will be prescribed).
  • Superficial infections, deep vein thrombosis, neuro-vascular injuries which arepotential risks in any surgical procedure but are rare.
  • Continued pain in hip or future pain in hip due to underlying process of arthritis.

For a complete list of the risks and complications, please see Patient info.

Patients who will undergo this procedure should read the following sections in the Patient information tab.

1- Immediate post-operative care 

2- Physiotherapy recommendations

Source : Dr. Ivan Wong : http://www.drivanwong.com