Dynamic Clinical Assessment of Femoral Acetabular Impingement

OBJECTIVES: There has been a recent interest in the non-arthritic hip and its associated complex pathologies. Passive range of motion and static specialty tests are the corner stone of diagnosis and assessment of treatment. Little information exists on the use of dynamic functional measurements to assess non-arthritic hip function. The aims of this study were: (1) to measure and identify objective and reliable functional parameters to assess dynamic hip function, and (2) to compare functional kinematic and kinetic parameters among healthy controls and subjects with symptomatic diagnosed femoral acetabular impingement (FAI). METHODS: An ongoing cross-sectional study was conducted on male healthy non-arthritic control and symptomatic, diagnosed FAI subjects. Functional kinematic and kinetic data were acquired with dynamic 3D motion analysis during stair ascent, stair descent, and a sit-to-stand maneuver. Joint kinematics were measured in degrees and joint kinetic moments were normalized by body mass (N-m/kg). Surface electromyographic (EMG) activity was measured for hip and trunk musculature. Measurement reliability was quantified with the adjusted coefficient of multiple correlation (CMC), and was calculated for angle, moment and EMG per subject, and averaged across subjects. Control and FAI subjects were compared with differences in kinematic and kinetic waveforms. RESULTS: Data from ten healthy subjects (Age=25±4 years; BMI=24.3±3.6); and six FAI subjects (Age=32±10 years; BMI=25±4) have been recorded. Control and FAI subject CMC values are listed in Table 1. Kinematic and kinetic behavior differed (>1 SD) between control and FAI for multiple joints and planes of motion. Increased internal hip rotation moments were recorded in FAI subjects during both stair ascent and descent tasks, as compared to healthy controls. Increased external rotation moments were recorded in FAI subjects during the sit-to-stand task. Electromyographic data demonstrated notable differences (>1 SD) between healthy and FAI subjects (Figure 1). The stair ascent task elicited increased medial hamstring EMG activity, stair descent produced decreased gluteus medius EMG activity, and early sit-to-stand produced decreased rectus femoris EMG activity in FAI subjects, as compared to healthy controls. CONCLUSION: Overall the kinematic, kinetic and EMG repeatability was very reliable; these measures are sufficiently reliable to objectively assess dynamic function in healthy and pathologic subjects. Kinematic and kinetic data have shown striking differences between the kinematic and kinetic data of control and FAI subjects, particularly the increased external rotation moments and pelvic flexion during sit to stand for subjects with FAI. We hypothesize that increased pelvic flexion with FAI may be a reason why patients develop impingement and symptoms. Likewise, the decreased medial hamstring and rectus femoris activation in FAI subjects may be an attempt to decrease lumbar lordosis, which may be a compensatory behavior to decrease anterior impingement. In addition, we hypothesize that decreased gluteus medius EMG activity in FAI patients is a sign of abductor fatigue. This study provides a foundation to assess specific gait abnormalities associated with FAI, which will advance the understanding of this pathology and direct future treatment regimens.