Femoroacetabular impingement: treatment of the acetabular side

Over the past decade, femoroacetabular impingement (FAI) has become an increasingly recognized pathomechanism that may explain why some hips that were previously considered to have normal morphology fail early in life. Subtle morphologic alterations in the acetabulum or femur, as well as the degree of hypermobility or impact on the hip, affect the potential for joint damage. The most frequent location of FAI is the anterosuperior acetabular rim, and the most critical motion is internal rotation of the hip in flexion. Because medication, activity restrictions, and physical therapy are rarely successful in treating symptoms caused by FAI, surgery has become a mainstay of treatment. Acetabular causes of FAI, called pincer FAI, can be treated by improving hip clearance. Independent of whether local or global overcoverage is present, rim reduction should be combined with labral preservation whenever possible.