Although the syndrome of femoroacetabular impingement of the cam and pincer type is a common and well-established cause of chronic pain in the hip, particularly in people who take part in sport, there are many aspects of this condition that remain poorly clarified. Questions such as the causes of the syndrome, its progression with age and the ideal treatment for each individual patient remain partly unanswered.
In a new study published recently in the journal Hip International the authors analyse the pathogenesis and the clinical presentation of sport-related femoroacetabular impingement syndrome in a large consecutive series of symptomatic athletes.
Data were analysed from high-level athletes taking part in the Gaelic Athletic Association who underwent arthroscopic treatment of femoroacetabular impingement syndrome between 2009 and 2017. The data were collected using the specific hip outcome scales (Harris Hip Score, UCLA, SF-36, WOMAC), together with recognised clinical parameters (range of motion, presentation of symptoms, symptom-provocation tests) and radiological examinations (anteroposterior radiograph of the hip, Dunn view and profil views).
The study included 1021 consecutive patient cases (mean age 26.6 ± 6.2 years). In every case conservative treatment had failed to resolve the problem, and the mean duration of symptoms was 2.4 ± 1.1 years. The patients’ symptoms came on gradually and included pain in the groin (76.1%) and stiffness of the hip (76.5%) after activity.
The pincer lesion was present in all cases and the cam lesion in 72.1%. The incidence of the grade of the cam lesion increased with
advancing age (p<0.001). The mean centre-edge angle remained static (p=0.476). An increasing centre-edge angle, the alpha angle and the presence of a fracture of the acetabular rim were associated with restriction of movement of the hip (p<0.001).
The authors concluded that the symptomatic, sport-related femoroacetabular impingement syndrome presented in this large series of athletes had failed to respond to conservative treatment. The increasing anatomical abnormality of the hip resulted in a smaller range of motion. The abnormal morphology of the acetabulum remains static with age, whereas the cam deformity increases with it and is probably a secondary pathological condition.
Source: “Hip International”, February 2019