Hip Preservation: The Diagnosis and Management of FAI, Femoral Torsion Abnormalities and Hip Dysplasia (2025 Annual Meeting)-Hip Preservation: The Diagnosis and Management of FAI, Femoral Torsion Abnormalities and Hip Dysplasia

Video Transcription

Video Summary

This comprehensive discussion on hip preservation encompasses hip pain evaluation, femoroacetabular impingement (FAI) syndrome, femoral torsion, and hip dysplasia, presented by experts from top institutions.<br /><br />Hip pain evaluation in young athletes starts with distinguishing intra-articular versus extra-articular causes via detailed history, physical exam—including gait, range of motion, and special tests—and multimodal imaging (X-ray, MRI, CT). MRI is crucial for labral and cartilage assessment, while CT precisely measures femoral version and acetabular morphology.<br /><br />FAI involves abnormal contact between a non-spherical femoral head and acetabular overcoverage causing labral tears and cartilage damage leading to arthritis. Imaging protocols include standing AP pelvis, Dunn views, radial MRI, and low-dose CT for complex cases. Arthroscopic treatment is effective with labral repair preferred over debridement, careful rim trimming to avoid instability, and precise CAM resection aided by intraoperative navigation. Labral reconstruction is valuable in failed repairs with diseased labrum.<br /><br />Femoral torsion abnormalities significantly impact hip mechanics. Excessive femoral anteversion (>35°) causes posterior impingement and limited external rotation, sometimes addressed with derotational subtrochanteric osteotomy combined with arthroscopy. Deficient anteversion or retroversion (<10°) leads to anterior impingement and may require more complex surgical approaches including osteotomy and open surgical dislocation.<br /><br />Hip dysplasia, characterized by acetabular undercoverage, predisposes to labral strain and early arthritis. Diagnosis requires both radiographic parameters such as lateral center-edge angle, Tönnis angle, FEAR index, and clinical instability signs. Periacetabular osteotomy (PAO) restores coverage, normalizes joint mechanics, and can slow arthritis progression. Combined hip arthroscopy and PAO allow labral repair and optimized correction. Precise measurement, including pelvic tilt correction, and individualized surgical planning are emphasized.<br /><br />Case discussions illustrate challenging presentations involving femoral anteversion abnormalities and global acetabular retroversion, highlighting the need for tailored treatment balancing conservative measures, arthroscopy, osteotomy, or combined procedures to optimize outcomes.<br /><br />Overall, hip preservation demands careful assessment of bony and soft tissue abnormalities with multimodal imaging and a spectrum of surgical options personalized to deformity patterns and patient factors to improve function and delay arthritis.

Asset Caption

Spencer M. Stein, M.D. | Thomas Youm, M.D. | Andrea M. Spiker, M.D., FAANA | Diren Arsoy, M.D., M.Sc.

Keywords

hip preservation

hip pain evaluation

femoroacetabular impingement

FAI syndrome

femoral torsion

hip dysplasia

labral repair

arthroscopic treatment

periacetabular osteotomy

femoral anteversion

imaging techniques

hip arthroscopy