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Femoracetabular impingement

Ó. Marín-Peña pp. 274 Springer 2012 ISBN: 978-3642227684

Originally published in Spanish in 2010 entitled Choque Femoracetabular, this is a brave effort to bring together a large amount information from a quickly changing field.

Femoroacetabular Impingement (FAI) is rapidly becoming a common diagnosis, and many sports and arthroplasty surgeons will need to get to grips with it.

Editor Óliver Marín-Peña is based in Madrid, and has brought together experts from the Spanish-speaking orthopaedic community, as well as from the rest of the world.

There is a short but useful summary of the evolution of the concept of FAI as a cause of osteoarthritis and a good chapter on the mechanics of FAI.

The editor’s chapter on physical examination is a little short, and fails to discuss some of the challenges, such as ‘sciatica’ in a patient with groin, sacroiliac joint and low back pain, or the patient with lateral hip pain and groin pain, and there is no mention of diagnostic injection – a technique which many, including me, find most useful.

There are three excellent chapters on imaging, beginning with careful interpretation of plain X-ray, then MRI and CT, with appropriate emphasis on radial MR to demonstrate cam deformities. However, there is a regrettable failure to consider femoral version, and only a short chapter on new and evolving techniques for examining cartilage, which is an area which is moving so rapidly it is difficult for even a short textbook to keep up.

Ten chapters cover various aspects of treatment of ‘pure’ FAI, including open treatment via hip dislocation, and mini-open (which, in my opinion, is a very useful tool for the arthroscopist on the learning curve), and variations of arthroscopic technique. Unfortunately, most of these are general ‘how I do it’ sections/discourses which necessarily repeat some material, rather than each chapter concentrating on a specific point, such as, for example, the iliopsoas tendon, cartilage repair, or labral repair and reconstruction.

Three chapters consider FAI and dysplasia. The first is simply on distinguishing FAI from dysplasia – an important step sometimes missed by arthroscopists – but it could be more comprehensive, and, for example, highlight the problem of ‘short horizontal roof’ dysplasia often seen combined with cam deformities in young men. The second, entitled ‘Advances in PAO Surgery: The Minimally Invasive Approach’ is an exciting glimpse into one possible future of pelvic osteotomy, but, alas, is not preceded by chapters entitled: ‘Pelvic Osteotomy: What Every Surgeon Should Know’ and ‘Pelvic Osteotomy: Basic Techniques and Results’. The third chapter discusses rim trimming versus pelvic osteotomy in the retroverted acetabulum. I’m not sure these chapters will encourage surgeons to learn osteotomy (and there is a shortage of pelvic osteotomists) but if they discourage arthroscopy of hips that would benefit more from a pelvic osteotomy they will have been useful.

Three chapters look at arthroplasty in the young patient, but all assume that arthritis is established, and arthroplasty is thus the only option. I would have very much appreciated a chapter on how much arthritis is too much, helping to guide a discussion with a young patient with significant arthritis about the options of arthroscopy versus joint replacement versus pelvic osteotomy. The first chapter in this section surveys options in the young patient, and is somewhat circumspect about resurfacing, but this seems to be the minority opinion, as the next two look at resurfacing in FAI (and recommend performing a femoroplasty en passant) and resurfacing in dysplasia (and while this chapter probabably does not actually belong in a book on FAI, it is an interesting read for the arthroplasty surgeon).

The penultimate section looks, very briefly, at rehabilitation of surgery for FAI, and (you guessed) resurfacing. The final chapter attempts to survey the numerous hip outcome scores available circa 2008, and concludes that none is ideal for FAI.

This book is a brave effort to bring together a large amount of information from a very rapidly changing field into one place, but, is not entirely successful. Most of the text would have been written in 2008 for initial publication in Spanish in 2010, and it is thus lacking in new areas, such as new theories on the aetiology of FAI and arthroscopic treatment of the gluteal tendons, pertrochanteric space and hamstring tendons, which, while not ‘FAI’ are generally treated by the FAI surgeon.

Despite some failings, this book is a useful introduction. I hope Dr Marín-Peña already has the second edition in progress, and I hope it will grow and become more helpful to experienced FAI surgeons facing challenges such as ‘the X-ray is perfect, but the hip still hurts….

Jason Brockwell

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