Best Practices: Hip Femoroacetabular Impingement

AJR Am J Roentgenol. 2021 Mar;216(3):585-598. doi: 10.2214/AJR.20.22783. Epub 2021 Jan 21.

Abstract

OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.

Keywords: MR arthrography; MRI; femoroacetabular impingement; imaging workup; radiography.

Publication types

  • Systematic Review

MeSH terms

  • Acetabulum / diagnostic imaging
  • Adult
  • Arthrography / methods*
  • Diagnosis, Differential
  • Evidence-Based Medicine
  • Female
  • Femoracetabular Impingement / complications
  • Femoracetabular Impingement / diagnostic imaging*
  • Femoracetabular Impingement / surgery
  • Femur Head / diagnostic imaging
  • Femur Neck / diagnostic imaging*
  • Hip Dislocation, Congenital / diagnostic imaging
  • Hip Joint / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Organ Sparing Treatments / methods
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / etiology
  • Practice Guidelines as Topic*
  • Tomography, X-Ray Computed / methods
  • Torsion Abnormality / diagnostic imaging
  • Traction / methods
  • Young Adult