Connect
MJA
MJA

Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

Flavia M Cicuttini, Andrew J Teichtahl and Yuanyuan Wang
Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00821
Published online: 5 June 2017

There is a concerning lack of data comparing surgical with non-surgical management of femoroacetabular impingement

Femoroacetabular impingement (FAI) is a common cause of groin pain in physically active young adults, accompanied by limited hip movements. It occurs when bony anatomical abnormalities of the femoral head-neck junction (cam deformity) and acetabular rim (pincer deformity) result in abnormal contact between the two joint surfaces during hip motion. Radiological evidence of FAI is present in about 25% of asymptomatic young adults in the general community.1 FAI increases the risk of end-stage hip osteoarthritis (OA) in later life and is a long term risk factor for joint replacement;2 it may be very disabling. The quality of life of young adults with FAI is comparable to that of older adults who had a total hip replacement for OA.3


  • 1 Monash University, Melbourne, VIC
  • 2 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
  • 3 Alfred Health, Melbourne, VIC


Correspondence: flavia.cicuttini@monash.edu

Acknowledgements: 

Andrew Teichtahl is the recipient of a National Health and Medical Research Council (NHMRC) Early Career Fellowship (no. 1073284). Yuanyuan Wang is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, no. 1065464).

Competing interests:

No relevant disclosures.

  • 1. Ergen FB, Vudali S, Sanverdi E, et al. CT assessment of asymptomatic hip joints for the background of femoroacetabular impingement morphology. Diagn Interv Radiol 2014; 20: 271-276.
  • 2. Nicholls AS, Kiran A, Pollard TC, et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case–control study. Arthritis Rheum 2011; 63: 3392-3400.
  • 3. Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 2009; 17: 843-847.
  • 4. Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29: 661-665.
  • 5. Palmer AJ, Malak TT, Broomfield J, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med 2016; 2: e000082.
  • 6. Fairley J, Wang Y, Teichtahl AJ, et al. Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage 2016; 24: 1682-1696.
  • 7. Harris JD, Erickson BJ, Bush-Joseph CA, Nho SJ. Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 2013; 6: 207-218.
  • 8. Nwachukwu BU, Rebolledo BJ, McCormick F, et al. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med 2016; 44: 1062-1068.
  • 9. Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R 2013; 5: 418-426.
  • 10. Siebenrock KA, Ferner F, Noble PC, et al. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res 2011; 469: 3229-3240.
  • 11. Teichtahl AJ, Wang Y, Smith S, et al. Bone geometry of the hip is associated with obesity and early structural damage - a 3.0 T magnetic resonance imaging study of community-based adults. Arthritis Res Ther 2015; 17: 112.
  • 12. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88.
  • 13. Bohensky MA, Sundararajan V, Andrianopoulos N, et al. Trends in elective knee arthroscopies in a population-based cohort, 2000–2009. Med J Aust 2012; 197: 399-403. <MJA full text>
  • 14. Hawker G, Guan J, Judge A, Dieppe P. Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008; 90: 2337-2345.
  • 15. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93: 994-1000.
  • 16. Katz JN, Losina E. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med 2013; 369: 677-678.
  • 17. Wang Y, Dempsey AR, Lloyd DG, et al. Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2012; 20: 970-978.
  • 18. Mezhov V, Teichtahl AJ, Strasser R, et al. Meniscal pathology — the evidence for treatment. Arthritis Res Ther 2014; 16: 206.
  • 19. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med 2012; 40: 1015-1021.
  • 20. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369: 2515-2524.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.