What is the femoroacetabular impingement?

Also known as femoroacetabular impingement in Central European and Anglo-Saxon languages, this pathology discovered by Swiss and German orthopedic surgeons at the end of the 20th century represents today the main cause of osteoarthritis of the hip, that is to say wear of this joint. It has been published in scientific journals that has been the cause of hip osteoarthritis in patients who underwent a total prosthesis between 60 and 70%.

This pathology is characterized because in the movements of internal flexion-rotation (inward) an impaction occurs between the lower part of the head of the femur against the own dome of the acetabulum. This produces a characteristic pain that the patient points around the hip, especially more directed towards the groin. There are two different mechanisms, which can sometimes appear separately or both at the same time:

Pincer effect

Where the femoral head-neck interface strikes the antero-superior wall of the acetabulum and at the same time rubs against the posterior-inferior wall in a “counterattack”. The acetabulum has an overcoverage or is even retroverted (Figures A and B).

Cam effect

There is an anesthetic of the femoral head-neck interface in the form of gibbosity that presses and abrades the anterosuperior wall of the acetabulum in flexion (Figures C and D).

The femoroacetabular impingement is the most frequent cause of hip pain in the athlete, according to a recent publication by Dr. Marc Philippon in the American Journal of Sports Medicine, although it is not necessarily an athlete-only pathology, e.g. after long sittings driving vehicles, sitting in an office, … A study conducted by Dr. Michael Leunig in the Swiss population shows that 15% of the population has hip deformities with a predisposition to suffer femoroacetabular impingement. Whether they suffer it or not will depend on many factors, but what we know today is that:

  • We must treat patients with symptoms as soon as possible, because there is no spontaneous remission without correction.
  • Deformities should not be treated for prevention in the absence of symptoms.

Certain forms of hip are more likely to suffer a femoroacetabular shock: for example a gibbous femoral head in which the flexing of the upper part of the hump hits the acetabulum and does not allow the femur to progress into the joint. This rubs the carpet or cartilage and eventually deteriorates it. The patient notices at the beginning since adolescence or youth that it is difficult to flex and turn the leg inward. Some people walk a lot, especially on slopes, getting in and out of cars, practicing sports such as golf, running, skating, kicking, … whether the pivoting leg or the moving leg produces a ” tiredness, “feeling of” loaded hip “and even pain.

It is important to consult these symptoms, although there are few specialists around the world who are still aware of this pathology. It is an example that the discoverer of the femoroacetabular impingement, Professor Reinhold Ganz, was nominated in 2006 for the Nobel Prize in Medicine for his entire career by the AO Foundation of North America.

Femoroacetabular impingement treatment

Existen técnicas quirúrgicas denominadas comúnmente “Osteocondroplastias u Osteoplastias” que consisten en devolver la forma de la cadera, p.e. quitando la “giba” y la “sobrecobertura del actábulo” y restauran la movilidad completa eliminando el choque femoroacetabular. En concreto una de las técnicas quirúrgicas más aceptadas en el mundo es la desarrollada por nuestra unidad y conocida como la Osteoplastia por abordaje Mini-invasivo de Ribas de 6 a 8 cms, que es una variante menos agresiva a la Osteoplastia de Ganz (entre 20 y 30 cms). Esta técnica, que combina la cirugía mini-invasiva y el uso de la artroscopia y sus instrumentos, permite una gran exactitud en el remodelado de la cadera, así como una recuperación mucho más precoz a la actividad física comparada con la técnica de osteoplastia de Ganz, que obliga a realizar una osteotomía de trocánter mayor y luxar la cadera, mientras que en la técnica de Ribas estos gestos quirúrgicos no son necesarios.

Hoy día ya se tiene una experiencia de 15 años en esta técnica quirúrgica , con más de 700 pacientes intervenidos Su reconocimiento y eficacia para tratar el choque femoroacetabular ha cruzado fronteras y océanos y son ya numerosos los cirujanos que la realizan.

Una tercera variante del tratamiento, cada vez más popularizada es la osteoplastia vía puramente artroscópica, es decir, a través de la visualización por un sistema de fibra óptica y dos a tres portales artroscópicos, cada uno de 10 a 14 mms. Su recuperación es muy parecida a la osteoplastia de Ribas. Nuestra Unidad de Artroscopia, cuenta figuras nacional e internacionalmente reconocidas como el Dr. Carlomagno Cárdenas-Nylander como especialistas en artroscopia de cadera, lo que da a este equipo médico uno de los más experimentados en Europa en esta variante de tratamiento. Sin embargo no toda deformidad causante de choque femoroacetabular es susceptible de ser tratada sólo artroscópicamente. Por dicho motivo, según el tipo de deformidad y el estadio en que se encuentra esta articulación la Unidad de Cadera decide si es más idóneo hacer el tratamiento por vía mini-invasiva de Ribas (en la cual se emplea asimismo el artroscópico) o sólo por artroscopia simple. La recuperación postoperatoria y funcional es, en ambos casos, la misma.

There are surgical techniques commonly called “Osteochondroplasties or Osteoplasties” that consist in restoring the shape of the hip, e.g. removing the “hump” and the “overcoverage of the actábulo” and restore the complete mobility eliminating the femoroacetabular shock. Specifically, one of the most accepted surgical techniques in the world is the one developed by our unit and known as the Mini-invasive Ribas Osteoplasty from 6 to 8 cms, which is a less aggressive variant to Ganz Osteoplasty (between 20 and 30 cms). This technique, which combines mini-invasive surgery and the use of arthroscopy and its instruments, allows great accuracy in the remodeling of the hip, as well as a much earlier recovery to physical activity compared to the Ganz osteoplasty technique, which forces to perform a greater trochanter osteotomy and dislocate the hip, while in the Ribas technique these surgical gestures are not necessary.

Today we already have 15 years of experience in this surgical technique, with more than 700 patients operated on. Its recognition and effectiveness in treating femoroacetabular impingement has crossed borders and oceans and there are already many surgeons who perform it.

A third variant of the treatment, increasingly popularized is osteoplasty via purely arthroscopic, that is, through visualization by a fiber optic system and two to three arthroscopic portals, each 10 to 14 mm. His recovery is very similar to Ribas osteoplasty. Our Arthroscopy Unit has nationally and internationally recognized figures such as Dr. Carlomagno Cárdenas-Nylander as specialists in hip arthroscopy, which gives this medical team one of the most experienced in Europe in this treatment variant. However, not every deformity that causes femoroacetabular impingement is susceptible to being treated only arthroscopically. For this reason, depending on the type of deformity and the stage in which this joint is located, the Hip Unit decides if it is more suitable to do the mini-invasive treatment of Ribas (in which arthroscopy is also used) or only for simple arthroscopy. The postoperative and functional recovery is, in both cases, the same.

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