Hip Disease in the Young, Active Patient: Evaluation and Nonarthroplasty Surgical Options

J Am Acad Orthop Surg, Vol 16, No 12, December 2008 Rafael J. Sierra, MD, Robert T. Trousdale, MD, Reinhold Ganz, MD and Michael Leunig, MD

As a distinct entity, femoroacetabular impingement has been suggested to be a preosteoarthritic mechanism. The condition occurs when the proximal femur repeatedly comes into contact with the native acetabular rim during normal hip range of motion. Early diagnosis and surgical management are imperative to delay degenerative changes associated with these conditions. Femoroacetabular impingement is most prevalent in young, active patients. Physical examination should include evaluation of gait and foot progression angle, as well as leg length measurement, hip range of motion, and abductor strength. Imaging studies, including plain radiographs and magnetic resonance arthrography, aid in accurate diagnosis. Surgical treatment options include surgical hip dislocation, periacetabular osteotomy, and hip arthroscopy.