7.01.109 Surgical Treatment of Femoroacetabular Impingement
Original MPC Approval: 08/12/2009
Last Review: 09/19/2011
Last Revision: 09/19/2011
Femoroacetabular impingement (FAI) is a structural abnormality in the hip joint that results in articulation abnormality of the femoral head and the acetabular rim. During flexion, altered mechanics result in compression of the labrum and / or articular cartilage in the acetabulum, with tearing and inflammation. Degenerative joint disease develops with inflammation, hip and groin pain, and decreased range of motion on flexion and internal rotation. Two different types of impingement, known as cam impingement, and pincer impingement, have been identified. In cam impingement, there is an asymmetric or nonspherical contour of the femoral head or neck that abuts against the acetabulum, resulting in cartilage damage and detachment from the subchondral bone. Pincer impingement is an overcoverage of the acetabulum that pinches and injures the labrum. The two types of impingement may occur singly or together. Impingement with damage to the labrum and / or acetabulum is felt to be a contributing factor to development of osteoarthritis of the hip, and that a significant percentage of patients with primary hip osteoarthritis may have been caused by FAI. The disease mainly appears to affect young to middle-aged adults, particularly those who engage in strenuous athletic activity.
Treatment of FAI is usually initiated with conservative therapies, including reduced activity and non-steroidal anti-inflammatory drugs. Physical therapy is usually not done because it aggravates the condition. Surgery is considered for patients that do not improve with conservative management.
The surgical technique for correcting the structural defects was first performed using an open technique that involved complete disarticulation of the hip joint. More recently, an arthroscopic technique is used wherein the femoral head is distracted from the joint to the point where the surgeon can inspect the articular surfaces thoroughly, and perform the necessary resection of overhanging acetabulum, trim torn labrum, and / or debride the cam area of the femoral head.
The following were among the resources reviewed and considered in developing this policy. By reviewing and considering the resources, CareFirst does not in any way endorse the contents thereof nor assume any liability or responsibility in connection therewith. The opinions and conclusions of the authors of these resources are their own, and may or may not be in agreement with those of CareFirst.
Bardokos, N.V., Vasconcelos, J.C., Villar, R.N. (2008). Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement. Journal of Bone and Joint Surgery British90, 1570-5
Beaulé, P.E., LeDuff, M.J., Zaragoza, E. (2007). Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. Journal of Bone and Joint Surgery American89, 773-9.
Beck, M., Leunig, M., Parvizi, J. et al (2004). Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clinical Orthopaedics and Related Research 418, 67-73.
Blue Cross and Blue Shield Association (April, 2009; updated 2010, May). Surgical Treatment of Femoroacetabular Impingement (Medical Policy 7.01.118). Chicago, IL: Author.
Botser, I., Smith, T., Nasser, R., Domb, B. (2011, February). Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 27(2):270-8.
Byrd, J.W., Jones, K.S. (2009). Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clinical Orthopaedics and Related Research467, 739-46.
Hayes Medical Technology Brief (2008; updated 2011, March). Arthroscopic Hip Surgery for Femoroacetabular Impingement (FAI). July 18, 2008. Lansdale, PA: Hayes, Inc.
Larson, C.M., Giveans, M.R. (2008). Arthroscopic management of femoroacetabular impingment: early outcomes measures. Arthroscopy 24, 540-6.
Matsuda, D., Carlisle, J., Arthurs, S., et al (2011, February). Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 27(2):252-69.
Murphy, S., Tannast, M., Kim, Y.J. et al (2004). Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clinical Orthopaedics and Related Research 429. 178-81.
Peters, C.L., Erickson, J.A. (2006) Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. Journal of Bone and Joint Surgery American 88, 1735-41.
Philippon, M.J., Briggs, K.K., Yen, Y.M. et al (2009). OUtcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. Journal of Bone and Joint Surgery British 91, 16-23.
Sampson, T.G. (2005). Arthroscopic treatment of femoroacetabular impingement. Techniques in Orthopaedics 20, 56-62.
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