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Hip Disease in the Young, Active Patient: Evaluation and Nonarthroplasty Surgical Options

Dr. Sierra is Assistant Professor of Orthopedics, Mayo Clinic College of Medicine, and Senior Associate Consultant, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. Dr. Trousdale is Professor of Orthopedics, Mayo Clinic College of Medicine, and Consultant, Department of Orthopedic Surgery, Mayo Clinic. Dr. Ganz is Emeritus Professor, Inselspital, Bern University Hospital, Bern, Switzerland. Dr. Leunig is Consultant Orthopaedic Surgeon, Schulthess Clinic, Zurich, Switzerland.

Reprint requests: Dr. Trousdale, Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Dr. Sierra or a member of his immediate family serves on a speakers bureau or makes paid presentations for Biomet; is a paid consultant for Biomet; and has received research or institutional support from DePuy, Zimmer, and Stryker. Dr. Trousdale or a member of his immediate family has received royalties from and is a paid consultant of DePuy and Wright Medical Technologies; serves on a speakers bureau or makes paid presentations for DePuy; and has received research or institutional support from DePuy, Stryker, and Zimmer. Dr. Ganz or a member of his immediate family has received research or institutional support from Smith & Nephew and Synthes. Dr. Leunig or a member of his immediate family serves as a consultant to Plus Orthopedics, has received research or institutional support from Zimmer, and holds stock or stock options in Pivot.

As a distinct entity, femoroacetabular impingement has been suggested to be a preosteoarthritic mechanism. The condition occurs when the proximal femur repeatedly comes into contact with the native acetabular rim during normal hip range of motion. Early diagnosis and surgical management are imperative to delay degenerative changes associated with these conditions. Femoroacetabular impingement is most prevalent in young, active patients. Physical examination should include evaluation of gait and foot progression angle, as well as leg length measurement, hip range of motion, and abductor strength. Imaging studies, including plain radiographs and magnetic resonance arthrography, aid in accurate diagnosis. Surgical treatment options include surgical hip dislocation, periacetabular osteotomy, and hip arthroscopy.