1 of 12 Top Hip Papers – Defining Femoroacetabular Impingement Syndrome

PAPER 1: The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

In the 10 years prior to this consensus paper, the world saw rapid increases in surgical ‘correction’ of ‘femoroacetabular impingement.’ Many surgeries were occurring in painfree individuals, with the intended purpose to prevent the development of osteoarthritis. This explosion of invasive procedures was of concern, as the relationship between cam and pincer morphologies, pain and development of osteoarthritis was still unclear. Furthermore, the level of evidence for impact on pain and function was only at a low level with high risk of bias and there was no evidence of the impact of such surgeries on altering the course of degenerative joint change. Surgical decisions were often being made on imaging findings alone. Something needed to be done to gain consensus on what constituted a clinically meaningful presentation of femoroacetabular impingement.

Key learnings about defining femoroacetabular impingement:

This expert panel agreed that:

1. The recommended terminology should include the following terms: FAI syndrome, cam morphology, pincer morphology, and the following terms should be avoided: asymptomatic FAI, symptomatic FAI, FAI morphology, deformity, abnormality or lesion.
2. Symptoms, clinical signs and imaging findings must be present to diagnose FAI syndrome.
3. Management includes patient education & load management, physiotherapist-led rehabilitation, pharmaceuticals, and surgery.
4. Preventive measures may have a role in higher risk populations, but surgery in asymptomatic individuals is rarely indicated.