Femoroacetabular impingement (FAI) results from localized compression in the joint due to an anatomical mis-match between the head of the femur and the acetabulum. This decreased clearance between the femoral neck and the hip socket results in development of bone spurs, cartilage breakdown, pain, and decreased joint mobility. Symptoms of impingement typically occur in young to middle-aged active adults prior to the onset of advanced osteoarthritis but may be present in younger patients with developmental hip disorders. The objective of surgical treatment of FAI is to improve symptoms and reduce future damage to the joint.
Open or arthroscopic treatment of femoroacetabular impingement is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Surgical treatment of femoroacetabular impingement in all other situations is considered investigational.
Open or arthroscopic treatment of femoroacetabular impingement is considered medically appropriate if ALL of the following criteria are met:
Skeletal maturity with documented closure of growth plates
Moderate-to-severe hip pain that is worsened by flexion activities (e.g., squatting or prolonged sitting) that significantly limits activities)
Unresponsive to conservative therapy for at least 3 months (including activity modifications, restriction of athletic pursuits and avoidance of symptomatic motion)
Positive impingement sign on clinical examination (pain elicited with 90 degrees of flexion and internal rotation and adduction of the femur)
Morphology indicative of cam or pincer-type FAI, (e.g., pistol-grip deformity, femoral head-neck offset with an alpha angle greater than 50 degrees, a positive wall sign, acetabular retroversion [over coverage with crossover sign]), coxa profunda or protrusion, or damage of the acetabular rim
High probability of a causal association between the FAI morphology and damage (e.g., a pistol-grip deformity with a tear of the acetabular labrum and articular cartilage damage in the anterosuperior quadrant)
No evidence of advanced osteoarthritis, defined as TÖNNIS grade II or III, or joint space of less than 2 mm
No evidence of severe chondral damage (Outerbridge grade IV)
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TÖNNIS Classification of Osteoarthritis by Radiographic Changes
No signs of osteoarthritis
Mild: Increased sclerosis, slight narrowing of the joint space, no or slight loss of head sphericity
Moderate: Small cysts, moderate narrowing of the joint space, moderate loss of head sphericity
Severe: Large cysts, severe narrowing or obliteration of the joint space, severe head deformity
There is a lack of evidence to evaluate the effect of surgical treatment in other conditions to improve acute and chronic pain or health outcomes.
BlueCross BlueShield Association. Evidence Positioning System. (4:2018). Surgical treatment of femoroacetabular impingement. (7.01.118). Retrieved October 17, 2017 from http://www.evidencepositioningsystem.com BlueWeb. (51 articles and/or guidelines reviewed)
Degen, R. M., Fields, K. G., Wentzel, C. S., Bartscherer, B., Ranawat, A. S., Coleman, S. H., et al. (2016). Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players. The Physician and Sportsmedicine, 44 (4), 385-390. Abstract retrieved December 1, 2016 from PubMed database.
Harris, J., Erickson, B., Bush-Joseph, C., & Nho, S. (2013). Treatment of femoroacetabular impingement: a systematic review. Current Reviews in Musculoskeletal Medicine, (2013), 6, 207-218. (Level 2 evidence)
Khan, M., Habib, A., de Sa, D., Larson, C. M., Kelly, B. T., Bhandari, M., et al. (2016). Arthroscopy up to date: Hip femoroacetabular impingement. Arthroscopy, 32 (1), 177-189. Abstract retrieved February 4, 2016 from PubMed database.
Kuhns, B. D., Frank, R. M., & Pulido, L. (2015). Open and arthroscopic surgical treatment of femoroacetabular impingement. Frontiers in Surgery, 2 (63), 1-16. (Level 5 evidence – Independent study)
National Institute for Health and Clinical Excellence. (2011, September). Open femoro-acetabular surgery for hip impingement syndrome. Retrieved October 3, 2011 from http://www.nice.org.
National Institute for Health and Clinical Excellence. (2011, September). Arthroscopic femoro-acetabular surgery for hip impingement syndrome. Retrieved October 3, 2011 from http://www.nice.org.
Nwachukwu, B., Rebolledo, B., McCormick, F., Rosas, S., Harris, J., & Kelly, B. (2016). Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium-to long-term outcomes. American Journal of Sports Medicine, 44 (4), 1062-1068. Abstract retrieved October 18, 2017 from PubMed database.
Sansone, M., Ahlden, M., Jonasson, P., Thomee, C., Sward, L., Ohlin, A., et al. (2016). Outcome after hip arthroscopy for femoroacetabular impingement in 289 patients with minimum 2-year follow-up. Scandinavian Journal of Medicine & Science in Sports, 2016 Jan 21. Doi: 10.111/sms.12641. [Epub ahead of print]. Abstract retrieved February 4, 2016 from PubMed database.
Winifred S. Hayes, Inc. Medical Technology Directory. (2017, May; last updated search May 2018). Arthroscopic hip surgery for femoroacetabular impingement. Retrieved September 25, 2018 from www.Hayesinc.com (65 articles and/or guidelines reviewed)
Zhang, D., Chen, L., & Wang, G. (2016). Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement. Medicine, 95 (41), e5122. (Level 2 evidence)
ORIGINAL EFFECTIVE DATE: 2/12/2012
MOST RECENT REVIEW DATE: 12/13/2018
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