Femoroacetabular Impingement Flashcards
What is FAI considered?
primary impingement of the hip joint
What is role of labrum in the hip?
extension of acetabulum to enhance jt stability, suction seal and increases shock absoprtion
What is the premise behind FAI?
misshapen at joint leads to breakdown of intra articular structures
What is a CAM -FAI?
nonspherical femoral head rotating inside acetabulum, likely from slipped capital femoral epiphysis
What is PINCER- FAI?
prominent anterolateral rim of acetabulum likely from overgrowth of anterior rim or retroversion of acetabulum
For either CAM or PINCER what is end result?
femur rubs against acetabulum in early flexion ROM
What is usual PP for FAI?
non specific groin pain that can radiate to medial thigh, C sign (deep inferior hip pain)
intermittent sharp pain, clicking, catching, popping, pain with twisting, pivoting, full flexion
What can FAI be commonly misdiagnosed as?
hip flexor tendinitis
What special tests are important to use for FAI?
FABER, Scour, Log roll, FADIR
What is important to have done before surgery?
intra articular injection to help differentiate between other pathologies
What are important principles for non-op tx of FAI?
avoid irritating positions- avoid squats, limit to 45 degree of HF
maximize mobility of jt -posterior and inferior
core/glute/lumbopelvic strength
What is a post op precaution of a femoroplasty?
avoid spontaneous load as it could cause a femoral neck fracture
What is a post op precaution of a labral repair?
limited weight bearing for 4 weeks
What is a post op precaution of a micro fracture surgery?
longer protection to encourage fribrocartilage healing responses
What are goals of post op phase 1, Week 1-6?
protect surgical site, patient education, normalize gait with AD, minimize pain and inflammation, 75% ROM in all planes
What are precautions for phase 1 of post op recovery?
no pivoting/rotating durin ambulation, avoid sx provocation during ADL/therex, no active SLR/hyperextension, typically 20% WB, Limit ER to 30 degrees
What can’t you do during phase 1 of post op recovery?
no joint play assessment
What is typical treatment for post op phase 1?
isometrics minus hip flexion, bike with minimal resistance, PROM after 7-10 days
What is criteria to advance to stage 2?
pain is well controlled, normal gait with assistive device
What are goals for phase 2, weeks 6-12 post op?
protect hip flexors, restore full ROM, normal gait w/o asst device, no pain and stairs
What is tx for post op phase 2?
closed chain movements/ strengthening, joint mobs if needed in week 6-8, double limb to single limb balance
What is criteria to progress to stage 3?
full ROM, normal gait w/o AS, good pelvic control during SLS
What are goals during phase 3 , weeks 11-13 of post op recovery?
gym program, full ROM, 5/5 strength, pain free ADL, good dynamic balance
What is tx in phase 3?
end range ROM, introduce diagonal patterns for lumbopelvic control, initiate plyos
