The evolution of the femoroacetabular impingement depends on the severity and level of physical activity the patient has. Too much exercise, especially with impact may be an aggravating factor. There are also patients with higher susceptibility to develop degenerative changes in the hip due to genetic reasons.

The ideal indication for surgery arises when there are symptoms and the cartilage is not yet far degraded.  

Open surgery by lateral approach called "safe surgical dislocation of the hip" (see section "Surgical hip dislocation") allows full access to the joint without changing arterial perfusion of the femoral head. In its most basic form, allows to: a) perform a osteoplasty of the femoral head, in order to restore its sphericity; b) remove excess marginal coverage of the acetabular cavity increasing joint mobility; c) correct the neck-head impingement with the acetabular labrum and repair the ruptures within. 

The arthroscopic surgery (see section "Arthroscopy of the hip") of the hip has been increasingly used to treat these conditions, particularly when the posteroinferior sector of the joint is not involved. The access is made through 2 or 3 small lateral and anterior incisions with partial opening of the capsule exposing the peripheral and central compartment of the joint using traction of the member with an appropriate device. The procedures carried out are similar to open surgery.

The functional outcome in the medium term is very similar for both techniques, and the short-term recovery faster with arthroscopy.These surgeries are complex and should be carried out in reference medical centers and by surgeons who specialize in hip preservation.

If degenerative changes are too much advanced the best option is hip replacement with a prosthesis (see sections "What solution if you are unable to preserve your hip?" e "Prosthetic reconstructive surgery").

conflito-femuro-acetabular-fig.1 Delamination (detachment) of the cartilage in the hip bone of an athlete caused by a "cam" mechanism. Despite the severity of the lesion we still consider to be a hip candidate for preserving surgery 

acetabular cartilage lesion and labral deformity caused by the "cam"

Arthroscopic view of the acetabular cartilage lesion and labral deformity caused by the "cam"

Arthroscopy of a "cam" deformity

Arthroscopy of a "cam" deformity of great dimensions penetrating the acetabulum

motion is normal without compression of the cartilage

After removing the "cam" lesion motion is normal without compression of the cartilage

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