Osseous abnormalities and early osteoarthritis: the role of hip impingement

Clin Orthop Relat Res. 2004 Dec:(429):170-7.


The purpose of this study was to establish that anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol-grip deformity, was a common etiology of hip disorders. This impingement results in a spectrum of injury ranging from anterior hip pain, labral tears, damage to the acetabular articular cartilage and idiopathic arthritis. This was accomplished through three separate but closely related studies: (1) an arthroscopic labral tear study of 38 patients who had hip arthroscopy for a labral tear (2) a hip cheilectomy study of 10 patients who had a cheilectomy for anterior femoroacetabular impingement and (3) an idiopathic arthritis study of 200 consecutive patients having THA. In all three studies, a common etiology was identified. Repetitive anterior femoroacetabular impingement resulted in anterior groin pain, labral tears, chondral damage and eventually arthritis. This impingement was caused by a pistol-grip deformity of the proximal femur in 97% of the cases in the arthroscopic labral study and 100% of the cases in the idiopathic arthritis study. The identification of anterior hip impingement as a cause of labral tears and idiopathic arthritis may allow surgeons to correct it early in its natural history and delay or prevent end-stage arthritis.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Acetabulum / abnormalities*
  • Acetabulum / diagnostic imaging
  • Adolescent
  • Adult
  • Aged
  • Arthroscopy / methods
  • Cartilage, Articular / pathology
  • Cartilage, Articular / surgery
  • Disease Progression
  • Female
  • Femur Neck / abnormalities*
  • Femur Neck / diagnostic imaging
  • Follow-Up Studies
  • Hip Injuries / diagnostic imaging
  • Hip Injuries / physiopathology
  • Hip Injuries / surgery*
  • Humans
  • Injury Severity Score
  • Joint Deformities, Acquired / diagnostic imaging
  • Joint Deformities, Acquired / surgery*
  • Legg-Calve-Perthes Disease / diagnosis
  • Legg-Calve-Perthes Disease / surgery
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / pathology
  • Osteoarthritis, Hip / surgery*
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Tomography, X-Ray Computed
  • Treatment Outcome