Best Practices: Hip Femoroacetabular Impingement

Area of Science:

• Orthopedics
• Radiology
• Sports Medicine

Background:

• Femoroacetabular impingement (FAI) diagnosis relies heavily on imaging.
• Advances in joint-preserving surgery necessitate optimized imaging protocols for FAI.
• Understanding FAI pathomechanics guides appropriate imaging selection.

Purpose of the Study:

• To provide guidance on best practices for imaging patients with FAI.
• To align imaging strategies with recent advances in corrective FAI surgery.
• To define the most appropriate imaging workup for FAI.

Main Methods:

• Pelvic radiography with dedicated hip projections for initial assessment.
• Unenhanced MRI or MR arthrography for chondrolabral lesions.
• Specific MRI sequences including large field-of-view fluid-sensitive and radial imaging.
• CT for complex surgical planning.
• Consideration of advanced techniques like 3D simulation and MR arthrography with traction.

Main Results:

• Radiography is foundational for assessing arthritis, acetabular coverage, and cam deformities.
• MRI protocols should evaluate chondrolabral lesions, exclude mimics, and assess cam deformities.
• Radial imaging is vital for accurate cam deformity assessment.
• CT is valuable for pre-operative planning of complex FAI surgeries.

Conclusions:

• Standard radiography and MRI form the basis of FAI imaging.
• Advanced imaging techniques show promise for enhancing surgical decision-making in FAI.
• Further research is needed to validate the clinical utility of advanced FAI imaging modalities.