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Authors
Abstract(s)
Introdução: O conflito femoro-acetabular representa uma patologia ortopédica, que
embora tenha sido abordada primordialmente no início do século passado, só começou a
ser explorada mais intensamente na comunidade científica nas últimas duas décadas. Hoje
acredita-se ser uma das causas principais para o desenvolvimento de coxartrose da anca.
O objetivo deste trabalho é fazer uma revisão ao atual estado da arte relativo ao conflito
femoro-acetabular em tópicos que englobam o seu conceito, epidemiologia, etiologia,
patofisiologia, apresentação clínica, exame físico, meios complementares de diagnóstico,
tratamento, prognóstico e reabilitação. Pretende-se igualmente identificar as áreas que
ainda carecem de consenso, assim como as principais tendências futuras na abordagem do
conflito femoro-acetabular.
Metodologia: Este trabalho consiste na revisão da literatura, recorrendo à pesquisa de
artigos científicos sobre o tema na base de dados PubMed, no período compreendido entre
1 de janeiro de 2015 e o presente, procedendo-se posteriormente à seleção e análise dos
mesmos.
Desenvolvimento: O conflito femoro-acetabular caracteriza-se pelo contacto patológico
repetitivo entre o fémur proximal e o acetábulo devido ao progressivo desenvolvimento de
anomalias morfológicas ao nível destas estruturas anatómicas. O conflito é mais evidente
durante atividades físicas vigorosas que envolvem a realização de amplitudes extremas de
movimento da articulação da anca. A sua prevalência é mais elevada em jovens adultos,
nomeadamente nos que praticam desportos de alta competição. O principal sintoma é a
dor localizada à região da anca e virilha, sendo exacerbada pelos movimentos de flexão,
adução e rotação interna da articulação. O diagnóstico preciso desta patologia só é possível
de alcançar com um bom nível de segurança através da interligação dos achados da
anamnese e exame físico, confirmados recorrendo a exames imagiológicos. O tratamento
não cirúrgico é essencialmente importante no controlo sintomático, envolvendo a
aplicação de alterações no estilo de vida, medicamentos anti-inflamatórios e fisioterapia.
O tratamento cirúrgico demonstra bons resultados a curto e médio prazo ao nível da
preservação da articulação, resolução sintomática e retorno dos doentes ao desempenho
das atividades de vida diária sem limitações. Este engloba duas abordagens principais, a
cirurgia aberta com luxação da anca e a artroscopia da anca.
Conclusão: O crescimento das novas tecnologias tem potenciado uma rápida evolução do
conhecimento ao nível do conflito femoro-acetabular, refletido num grande
desenvolvimento das técnicas aplicadas no seu diagnóstico e tratamento. Ainda assim,
perante estadios avançados da doença com coxartrose concomitante, a cirurgia conservadora revela-se pouco eficaz no debelar deste conflito, sendo necessária uma
artroplastia total da anca. Embora seja já uma patologia amplamente estudada, é
importante como meta futura o desenvolvimento de estudos randomizados controlados
que permitam avaliar o sucesso das metodologias cirúrgicas a longo prazo, nomeadamente
no que diz respeito à capacidade de alterar a história natural da doença e prevenir o
aparecimento de coxartrose.
Introduction: Femoroacetabular impingement represents an orthopedic pathology, which, although it was primarily addressed in the beginning of the last century, has only begun to be explored more intensely in the scientific community in the last two decades. Today it is believed to be one of the main causes for the development of hip osteoarthritis. The purpose of this work is to review the current state of the art about femoroacetabular impingement in topics that encompass its concept, epidemiology, etiology, pathophysiology, clinical presentation, physical examination, complementary diagnosis methods, treatment, prognosis and rehabilitation. It is also intended to identify the areas that still need consensus, as well as the main trends in the future approach of femoroacetabular impingement. Methodology: This work consists of a review of the literature, using scientific articles on the subject searched in the PubMed database, in the period between january 1, 2015 and the present, proceeding, subsequently to their selection and analysis. Development: Femoroacetabular impingement stands out for its repetitive pathological contact between the proximal femur and the acetabulum due to the progressive development of morphological anomalies at the level of these anatomical structures. The conflict is most evident during vigorous physical activities that involve performing extreme ranges of hip motion. Its prevalence is higher in young adults, namely in those who practice high competition sports. The main symptom is pain located in the hip and groin region, which is exacerbated by the movements of flexion, adduction and internal rotation of the joint. The accurate diagnosis of this pathology is only possible with a good level of safety through the interconnection of the anamnesis findings and physical exam, confirmed using imaging exams. Non-surgical treatment is essentially important for symptomatic control, involving the application of lifestyle changes, anti-inflammatory medications and physical therapy. Surgical treatment shows good results in the short and medium-terms, in terms of joint preservation, symptomatic resolution and patients' return to the performance of activities of daily living without limitations. This encompasses the two main approaches, an open surgical dislocation of the hip and an hip arthroscopy. Conclusion: The growth of new technologies has potentialized a fast evolution of knowledge at the femoroacetabular impingement level, reflected in a great development of the techniques applied in its diagnosis and treatment. Even so, in the advanced stages of the disease with concomitant osteoarthrosis, conservative surgery proves to be ineffective in resolving this conflict, requiring total hip arthroplasty. Although it is already a widely studied pathology, it is important as a future goal the development of randomized controlled trials that allow to evaluate the success of long-term surgical methodologies, namely with regard to the ability to change the natural history of the disease and prevent the onset of osteoarthrosis.
Introduction: Femoroacetabular impingement represents an orthopedic pathology, which, although it was primarily addressed in the beginning of the last century, has only begun to be explored more intensely in the scientific community in the last two decades. Today it is believed to be one of the main causes for the development of hip osteoarthritis. The purpose of this work is to review the current state of the art about femoroacetabular impingement in topics that encompass its concept, epidemiology, etiology, pathophysiology, clinical presentation, physical examination, complementary diagnosis methods, treatment, prognosis and rehabilitation. It is also intended to identify the areas that still need consensus, as well as the main trends in the future approach of femoroacetabular impingement. Methodology: This work consists of a review of the literature, using scientific articles on the subject searched in the PubMed database, in the period between january 1, 2015 and the present, proceeding, subsequently to their selection and analysis. Development: Femoroacetabular impingement stands out for its repetitive pathological contact between the proximal femur and the acetabulum due to the progressive development of morphological anomalies at the level of these anatomical structures. The conflict is most evident during vigorous physical activities that involve performing extreme ranges of hip motion. Its prevalence is higher in young adults, namely in those who practice high competition sports. The main symptom is pain located in the hip and groin region, which is exacerbated by the movements of flexion, adduction and internal rotation of the joint. The accurate diagnosis of this pathology is only possible with a good level of safety through the interconnection of the anamnesis findings and physical exam, confirmed using imaging exams. Non-surgical treatment is essentially important for symptomatic control, involving the application of lifestyle changes, anti-inflammatory medications and physical therapy. Surgical treatment shows good results in the short and medium-terms, in terms of joint preservation, symptomatic resolution and patients' return to the performance of activities of daily living without limitations. This encompasses the two main approaches, an open surgical dislocation of the hip and an hip arthroscopy. Conclusion: The growth of new technologies has potentialized a fast evolution of knowledge at the femoroacetabular impingement level, reflected in a great development of the techniques applied in its diagnosis and treatment. Even so, in the advanced stages of the disease with concomitant osteoarthrosis, conservative surgery proves to be ineffective in resolving this conflict, requiring total hip arthroplasty. Although it is already a widely studied pathology, it is important as a future goal the development of randomized controlled trials that allow to evaluate the success of long-term surgical methodologies, namely with regard to the ability to change the natural history of the disease and prevent the onset of osteoarthrosis.
Description
Keywords
Artroscopia da Anca Cirurgia Aberta Com Luxação da Anca Conflito Femoro-Acetabular Morfologia Tipo “Cam” Morfologia Tipo “Pinça”