FAI results from incongruity of the femoral head and acetabulum and is one of the leading causes of precocious osteoarthritis of the hip joint. Two types of FAI have been described based on the predominance of anatomic abnormalities affecting either femoral head or acetabulum. In
cam type, the nonspherical shape of the femoral head secondary to excessive bone formation at the junction of head and neck results in abutment against the acetabular rim. In
pincer type, because of deep acetabulum (coxa profunda), acetabular protrusio, or acetabular retroversion, acetabular “over-coverage” of the femoral head limits the range of motion in the hip joint and leads to abnormal stresses on acetabular rim. In both types of FAI, the abnormal mechanism results in damage of the acetabular labrum, thus promoting secondary osteoarthritis. The diagnosis of FAI is based on (a) the patient’s clinical history of chronic pain; (b) physical examination revealing reduced range of motion in the hip
joint, particularly flexion and internal rotation; and (c) imaging findings on conventional radiography, CT, and MRI. In cam type, conventional radiography demonstrates excessive bone formation at the femoral head/neck junction with loss of normal anatomic “waist” at this site (
Fig. 5.25A), occasionally resembling the smooth hand grip of some pistols (“pistol grip deformity” or a “cam effect”) (
Fig. 5.25B); an os acetabulum, which more likely represents an osseous metaplasia of the cartilaginous labrum or a fragment of damaged acetabular rim; and a radiolucent lesion at the head/neck junction, formerly called
synovial herniation pit, and now designated as fibroosseous lesion. CT shows these abnormalities even better (
Fig. 5.26). MR arthrography (MRa), particularly the radial reformatted images, in addition to the findings listed previously, clearly demonstrates abnormalities of the fibrocartilaginous labrum at the anterosuperior portion of the acetabulum (
Fig. 5.27; see also
Fig. 2.91). In pincer type, particularly in case of acetabular retroversion, conventional radiograph shows “crossover” sign, when more lateral projection of anterior acetabulum, which normally should project medially to the posterior acetabulum, “crosses” the
posterior acetabular outline (
Fig. 5.28). MRI demonstrates acetabular version and depth of the femoral head coverage (
Fig. 5.29). To determine the sphericity of the femoral head and the prominence of the anterior femoral head/neck junction, the alpha angle is calculated on the oblique axial CT or oblique axial MR images (
Fig. 5.30). Radial reformatted MR images are of particular value in this respect because they allow optimal visualization of the anterosuperior region of the femoral head/neck junction, where the most significant changes in the alpha angle occur (see
Fig. 5.27). The normal alpha angle should not exceed 50 degrees. The larger the alpha angle, the more pronounced is nonspherical shape of the femoral head, and the greater is predisposition for anterior FAI.