Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement

Abstract

Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless, the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status, activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips) with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments was performed. Patients completed demographic and validated hip questionnaires (Baecke et al., SF-12, Modified Harris hip, and UCLA activity score). The average patient age was 35 years and 57% were male. Symptom onset was commonly insidious (65%) and activity-related. Pain occurred predominantly in the groin (83%). The mean time from symptom onset to definitive diagnosis was 3.1 years. Patients were evaluated by an average 4.2 healthcare providers prior to diagnosis and inaccurate diagnoses were common. Thirteen percent had unsuccessful surgery at another anatomic site. On exam, 88% of the hips were painful with the anterior impingement test. Hip flexion and internal rotation in flexion were limited to an average 97°and 9°, respectively. The patients were relatively active, yet demonstrated restrictions of function and overall health. These data may facilitate diagnosis of this disorder.

Surgical Treatment of Femoroacetabular Impingement: A Systematic Review of the Literature

“…Over the past decade, the concept of femoroacetabular impingement (FAI) has been refined [26] and this constellation of disorders has been accepted as a common source of hip pain and dysfunction in young, active patients [11]. There is substantial evidence supporting the hypothesis that FAI is a major etiologic factor in the pathophysiology of secondary osteoarthritis of the hip [1,5,6,13,17,18,25,27,[38][39][40].…”

Femoroacetabular Impingement: A Retrospective Case Study With 8-Year Follow-Up

“…1,3,8 These patients are usually physically active and are involved in sports activities such as ballet, martial arts, soccer, ice hockey, and gymnastics-sports that involve movements of extreme ROM, especially repetitive hip hyperflexion, hyperextension, and internal and external rotation. [1][2][3]8 Patients may also have a history of femoral neck fractures, slipped capital femoral epiphysis, or Legg-Calve-Perthes disease, disorders known to be associated with cam-type FAI. 1,2 A typical patient with FAI experiences a gradual onset of intermittent groin pain and or lateral trochanteric pain.…”

“…1,2 A typical patient with FAI experiences a gradual onset of intermittent groin pain and or lateral trochanteric pain. 3,8 Pain can also refer to the lower back, gluteal region, or knee. 1,4 Pain symptoms often gradually worsen owing to progressive degeneration of the labrum and articular cartilage of the hip joint and can be aggravated by athletic activity, lengthy sitting, or walking.…”

“…6 A lack of awareness of FAI has been shown to commonly lead to delays in diagnosis of an estimated 2 to 4 years. 1,3,8 A study published in 2009 by Clohisy et al 8 revealed that the mean time from the onset of symptoms to a definitive diagnosis of FAI was 3.1 years, 1,8 and that patients were evaluated by an average of 4.2 healthcare providers before an accurate diagnosis was established. 1,8 The purpose of this case report is to describe a patient with FAI who was initially misdiagnosed and treated for a hip flexor strain.…”

“…1,3,8 A study published in 2009 by Clohisy et al 8 revealed that the mean time from the onset of symptoms to a definitive diagnosis of FAI was 3.1 years, 1,8 and that patients were evaluated by an average of 4.2 healthcare providers before an accurate diagnosis was established. 1,8 The purpose of this case report is to describe a patient with FAI who was initially misdiagnosed and treated for a hip flexor strain. This case also illustrates the importance of increasing the awareness of FAI, as Doctors of Chiropractic are frequently the primary contact for patients with this condition.…”