The Risk of Impingement With Sexual Activity in Femoroacetabular Impingement Syndrome Due to Cam Morphology: Shape Matters

BACKGROUND: Sexual difficulties and dysfunction are common in patients with femoroacetabular impingement syndrome (FAIS) secondary to hip pain and stiffness. PURPOSE: To determine the risk of impingement in patients with FAIS during common sexual positions using 3-dimensional computer-simulated collision detection before and after cam correction. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten computed tomography scans of the pelvis and femur from patients with FAIS due to isolated cam morphology were retrospectively reviewed. Three-dimensional osseous models were developed using Mimics software. The cam deformity was then completely corrected. Simulations of hip range of motion for the most common sexual positions for men (n = 15) and women (n = 14) were conducted before and after cam resection. Impingement was determined for each sexual position. Position safety was defined as ≤20% of models demonstrating impingement in a position. Descriptive and simple comparative statistics were calculated. RESULTS: There was no sexual position that was impingement free in all models before cam correction. After cam correction, 11 (37.9%) of 29 total positions were impingement free. There was a significant decrease in impingement from before to after cam correction (40.7% vs 11.4%, respectively, of all female positions [P < .0001]; 26.0% vs 6.7%, respectively, of all male positions [P < .0001]). There was a significant increase in the number of “safe” positions from before to after cam correction (4 vs 11, respectively, of all female positions [P = .008]; 7 vs 15, respectively, of all male positions [P = .001]). CONCLUSION: After cam correction, there was a significant reduction in the impingement rate and a significant increase in the number of “safe” sexual positions. CLINICAL RELEVANCE: Impingement in patients with cam morphology is common during sexual activity. Surgical correction of cam morphology significantly reduces the rate of impingement. Although this laboratory imaging-only study did not account for patient symptoms, this likely translates to significant symptomatic improvement during sexual activity after surgical cam correction.