Hip Arthroscopy and Femoroacetabular Impingement Management

Hip arthroscopy has evolved into a minimally invasive cornerstone for the assessment and treatment of intra-articular hip disorders, most notably femoroacetabular impingement (FAI). FAI is characterised by abnormal contact between the femoral head–neck junction and the acetabular rim, leading to damage of the cartilage and acetabular labrum, pain and functional limitations. Three principal impingement subtypes are recognised: cam morphology, in which a non-spherical femoral head abuts the acetabular edge; pincer morphology, defined by excessive acetabular coverage; and mixed forms combining both deformities. Patients typically present with activity-related groin pain and restricted range of motion, often exacerbated by flexion and internal rotation. Diagnostic work-up relies on a combination of clinical examination, plain radiography and advanced imaging modalities such as magnetic resonance arthrography, which delineate labral tears and cartilage defects.

Arthroscopic management targets restoration of hip biomechanics through recontouring of bony prominences, acetabular rim trimming, labral repair or reconstruction, and treatment of concomitant cartilage lesions. Non-operative measures, including physiotherapy programmes to strengthen peri-articular musculature and modify movement patterns, remain first-line in mild cases. Surgical indications encompass persistent pain despite conservative care, mechanical symptoms and radiological evidence of morphological abnormalities. Outcomes are influenced by patient age, cartilage health at the time of intervention and surgeon experience, with higher-volume practitioners achieving lower re-operation rates. In appropriately selected individuals, arthroscopic correction of FAI can alleviate pain, improve function and potentially delay the onset of hip osteoarthritis, underscoring its global relevance.

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Hip Arthroscopy and Femoroacetabular Impingement Management publication trend

The graph below shows the total number of articles in hip arthroscopy and femoroacetabular impingement management across all publications each year (not limited to Nature Index journals).

Technical terms

Femoroacetabular impingement: A pathomechanical condition where abnormal contact between the femoral head–neck junction and the acetabular rim leads to labral and cartilage damage.

Hip arthroscopy: A minimally invasive surgical technique using small portals and an arthroscope to diagnose and treat intra-articular hip pathology.

Cam morphology: A bony deformity of the femoral head–neck junction characterised by loss of sphericity, often quantified by an increased alpha angle.

Bony range of motion (BROM): The maximum theoretical movement of the hip joint based solely on skeletal geometry, as computed from three-dimensional imaging.

Functional range of motion (FROM): The actual measurable movement of the hip joint in a clinical or cadaveric setting, encompassing both bony and soft-tissue constraints.

References

1. Muscle Fat and Volume Differences in People With Hip‐Related Pain Compared With Controls: A Machine Learning Approach. Journal of Cachexia Sarcopenia and Muscle (2024).
2. Simulation of hip bony range of motion (BROM) corresponds to the observed functional range of motion (FROM) for pure flexion, internal rotation in deep flexion, and external rotation in minimal flexion-extension – A cadaver study. Computers in Biology and Medicine (2024).
3. Cam morphology is strongly and consistently associated with development of radiographic hip osteoarthritis throughout 4 follow-up visits within 10 years. Osteoarthritis and Cartilage (2023).