FAI – Konzept und Ätiopathogenese

ZusammenfassungBeim femoroazetabulären Impingement (FAI) handelt es sich um ein neues, zunehmend an Akzeptanz gewinnendes mechanisches Konzept zur Entstehung der Koxarthrose. Dabei können sowohl die Deformität der Hüfte als auch ihre Nutzung zu Schäden führen. Man unterscheidet azetabuläre (Pincer-) und femorale (Cam-)Deformitäten, welche zu charakteristischen Veränderungen des Pfannenrandes führen. Ein Cam-FAI wird v. a. bei aktiven 20- bis 30-jährigen Männern mit weit nach zentral reichenden Knorpelschäden, jedoch meist nur geringen Labrumschäden gesehen, während das Pincer-FAI bei 30- bis 40-jährigen Frauen, mit ausgeprägten Labrumläsionen mit nur randständiger Degeneration des azetabulären Knorpels gefunden wird. Impaktaktivitäten bei Arbeit oder Sport können bereits geringradige FAI-Deformitäten symptomatisch werden lassen. Obwohl für einige FAI-Deformitäten die Ursachen bekannt sind, fehlt für die Mehrzahl der Fälle die Kenntnis der exakten Ursache. Ein besseres Verständnis der Ätiologie des FAI sowie deren Rolle in der Entstehung der Koxarthrose könnte es ermöglichen, die Prävalenz der sog. „primären“ Koxarthrose und deren Folgen zu verringern.AbstractFemoroacetabular impingement (FAI), a recently proposed mechanical concept regarding the development of osteoarthritis (OA) of the hip, is gaining increased acceptance. Both osseous deformity and use of the hip may result in hip damage. Osseous deformities are seen on the acetabular (pincer) or the femoral (cam) side of the hip, leading to characteristic alterations of the acetabular rim. Cam FAI is found in 20–30-year-old athletic men, revealing deep cartilage avulsions from the acetabular rim while the labrum is frequently intact. In pincer FAI, found in 30–40-year-old women, the labrum is frequently significantly destroyed with only minor damage to the acetabular rim. Professional or athletic impact activities can trigger even mild FAI deformities to become symptomatic. For some FAI deformities, the etiologies are known, but for most of them the exact causes are unknown. An improved understanding of the etiology of FAI and its role in the development of hip OA might lead to a reduction in the prevalence of so-called primary OA of the hip.

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