In cases of FAI (Femoro acetabular impingement), there is most often a combination of a pincer lesion (acetabular side) and the cam lesion (head neck side) .
When the conflict occurs between the two boney sides on flexion and internal rotation damage is caused to the labrum (seal around the femoral head) and to the articular cartilage (lining of the acetabulum). In most cases the labrum is damaged and torn. When surgery is the option for treatment, I utalise hip arthroscopy to treat the condition.
In these cases I will take down the labrum expose the pincer lesion and recess lesion and then reattached the labrum to the rim of the acetabulum, with 2 or 3 bone anchors and sutures, this recreates the seal around the femoral head.
Then I will address the cam lesion, removing as much as required to allow the femoral head to enter the acetabulum with out causing damage to the repaired labrum on flexion and internal rotation, this I check and confirm visually at the time of hip arthroscopy. Most often I use two portals (incisions 0.5 to cm) rarely three to perform the hip arthroscopy.
Below is is a case of 25 your female athlete netball player, who had gradual onset of symptoms, with groin pain, catching, clicking, feeling of giving way of her hip and inability to exercise. Examination showed me positive C -sign, positive impingement test on flexion and internal rotation as well as a reproducible click. Investigation with radiographs and MRI arthrogram confirm the diagnosis of FAI and a turn in the labrum.
After detailed discussion an explanation of the pathology we agree to go ahead with hip arthroscopy.
Following surgery the patient was on crutches for four weeks having physiotherapy and hydrotherapy. She returned to full sporting activity at 5 months, with no complications.
Pincer exposed. Labral tear (Star)
Pincer recesseion with burr
Anchor holes and sutures around labrum
Hip reduced seal checked
Cam removed. Range of movement checked, to ensure no conflict or impingement