A painful hip can be a major cause of disability in athletes, particularly in activities that demand explosive effort, acceleration, deceleration and rotational, impact movements. Femoroacetabular impingement, cam or Pincer, is the commonest cause of hip pain in these groups of patients. This syndrome disrupts the normal mechanics of the joint because of an abnormal morphology, either at the head-neck junction of the femur (cam morphology) or on the side of the acetabulum (pincer morphology). In a large study in which 1021 hips in athletes were assessed with regard to the clinical picture, the diagnosis and the pathogenesis of symptomatic femoroacetabular impingement syndrome, important observations were made about this condition.
The study was based on a prospective analysis of cases seen between January 2009 and February 2017, and the data were obtained from high-level athletes who underwent arthroscopic treatment for symptomatic femoroacetabular impingement syndrome. The clinical data were collected with the help of patient-reported assessment scores (Harris Hip Score, UCLA, SF-36, WOMAC) and of clinical signs (range of movement, presentation of symptoms, special tests), while radiographic measurements were also assessed (anteroposterior radiographs of the pelvis and hips, the Dunn view and lateral views).
A total of 1021 consecutive cases were studied. In every case conservative treatment had failed to improve the athletes' symptoms. In these cases the symptoms developed gradually and consisted of pain in the groin and stiffness of the hip (76.5%) after sporting activity.
Pincer-type femoroacetabular impingement was present in every case, while cam morphology was present in 72.1%. The incidence and the degree of cam morphology increased across successive age groups, whereas no such observation was made for the measurements of hip dysplasia.
The authors concluded that symptomatic femoroacetabular impingement syndrome in this large series of athletes could not be managed with conservative treatment, and that the cam-type femoroacetabular impingement lesion worsens with age, which probably indicates that it is a secondary pathology.
Source: “Hip International”, 2019