Femoro-acetabular impingement

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Different types of FAI

In femoro-acetabular impingement , or FAI for short (narrow syndrome between the femoral head and socket), there is a bony stop between the part of the femur near the joint and the socket of the hip joint . Bending the hips or twisting the leg inward causes shooting groin pain. This pain can be caused by a mechanical conflict between the anterior rim of the pelvis or its circular cartilaginous joint lip and the anterior femoral neck of the femur.

A basic distinction is made between a Pincer -FAI (misalignment of the hip socket in the form of retrotorsion or excessively pronounced roofing of the thigh head) and a Cam -FAI (bony protrusions on the femoral neck near the joint). However, pure pincer or cam FAIs are rather rare. In most cases, a combination of both types occurs.

Symptoms

• deep groin pain
• piercing pain when flexing the hips
• shooting pain when sitting for long periods
• sharp pain on the outside of the hip joint when standing or walking for long periods of time, which over time can spread down the leg to the foot
• dull hip pain during sexual intercourse (e.g. in the woman lying on her back)
• Movement restrictions in the hip, especially when bending
• With appropriate physical exertion, there is a painful restriction in hip mobility.

The pain can be triggered by adduction and simultaneous internal rotation. In contrast to coxarthrosis , the pain in internal rotation disappears even with slight abduction. When the femoral head hits the socket, injuries to the acetabular labrum as well as tears or hemorrhages in cartilage, ligaments or the joint lip often occur. In the long term, it leads to chronic irritation and irreparable joint damage.

In the late stages, coxarthrosis almost always occurs . Even in younger patients, this can lead to premature and progressive wear and tear of the hip joint, which can result in restricted mobility in everyday life.

Diagnosis

• Roentgen:
  • Disproportion in the roofing of the hip joint: especially the retroversion of the acetabulum is a risk factor of the Pincer type. It can be determined using the ischial spine sign , the posterior wall sign , the cross-over sign and the acetabular retroversion index (ARI) derived from them on standard x-rays of the hip joint.
  • Bony deposits on the femoral neck (via Lauenstein image )
• Magnetic resonance imaging
  • conventional MRI
  • MR arthrogram (MRI after previous injection of contrast agent )
• special tests:
  • Movement tests e.g. B. Adduction and simultaneous internal rotation → sharp pain in the groin
  • Impingement test
  • Infiltration of the hip joint with local anesthetics
• Dynamic simulation of the movement of the hip: CT scans or MRIs can be upgraded to create an analysis with 3D movement simulations. This allows the movements of the hip joint to be viewed dynamically and three-dimensionally and any impingement to be simulated. This examination is not a standard and it is unclear when one can speak of an impingement, because at some point there will always be a bony conflict, i.e. H. its significance for diagnostics has not been clarified.

therapy

• conservative:
  • NSAIDs
  • Intra-articular injections
  • Physical therapy :
    • Electrotherapy, e.g. B. iontophoresis
    • Baths
    • Fango
  • physical therapy
• operational:
  • Hip arthroscopy . If the conservative therapy fails, hip arthroscopy is a minimally invasive treatment method with few complications to eliminate the symptoms sustainably and prevent the development of coxarthrosis. The above CAM impingement is a domain of arthroscopic therapy. Pure pincer impingement is difficult to tackle arthroscopically, but symptoms (restricted movement due to hardening / contracture of the joint capsule, soft tissue growths and inflammation of the synovial membrane) can also occur with pincer impingement secondary tightness syndrome in the area of ​​the anterior joint, fraying of the joint lip, corresponding bony attachments on the femoral neck, etc.) can be well addressed arthroscopically.
  • Surgical hip dislocation with offset correction
  • Corrective osteotomy
  • Joint replacement (with pronounced coxarthrosis)

Individual evidence

1. ↑ M. Tannast, M. Kubiak-Langer, F. Langlotz, M. Puls, SB Murphy, KA Siebenrock: Noninvasive three-dimensional assessment of femoroacetabular impingement . In: J. Orthop. Res . tape 25 , no. 1 , January 2007, p. 122-131 , doi : 10.1002 / jor.20309 , PMID 17054112 .
2. ↑ http://www.clinicalgraphics.com/ Dynamic motion simulation for hip impingement .

Web links

Commons : Femoro-acetabular Impingement  - Collection of Images, Videos, and Audio Files

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !