The 2016 Warwick Agreement is an international, multidisciplinary consensus statement on femoroacetabular impingement syndrome. 22 experts from 9 countries addressed diagnosis, treatment, prognosis, and outcome measurement. It formally defines what FAI syndrome is — and, critically, what it is not.
The rapid rise in hip arthroscopy rates in the 2000s was driven partly by diagnosing FAI from imaging alone — patients with incidental cam morphology were being labeled and operated on without a consistent clinical framework.
This paper establishes the rule: a large alpha angle on X-ray is a finding, not a diagnosis. The patient needs motion-related pain, a positive impingement test that reproduces their familiar pain, AND imaging evidence of morphology before you can call it FAI syndrome.
When a patient asks about surgery for incidentally found cam morphology with no symptoms, the answer is almost always no. The panel was explicit: no evidence shows prophylactic surgery alters the risk of developing FAI syndrome or osteoarthritis.
For the boards, know the asymmetry in osteoarthritis risk: cam morphology is linked to hip OA in all prospective cohort studies; pincer morphology is not. Know the three recommended PRO tools: iHOT, HAGOS, and HOS. Know that image-guided local anesthetic injection can help confirm the hip joint as the pain source when the diagnosis is uncertain.
The 2016 Warwick Agreement is an international, multidisciplinary consensus statement on femoroacetabular impingement syndrome. 22 experts from 9 countries addressed diagnosis, treatment, prognosis, and outcome measurement. It formally defines what FAI syndrome is — and, critically, what it is not.
The rapid rise in hip arthroscopy rates in the 2000s was driven partly by diagnosing FAI from imaging alone — patients with incidental cam morphology were being labeled and operated on without a consistent clinical framework.
This paper establishes the rule: a large alpha angle on X-ray is a finding, not a diagnosis. The patient needs motion-related pain, a positive impingement test that reproduces their familiar pain, AND imaging evidence of morphology before you can call it FAI syndrome.
When a patient asks about surgery for incidentally found cam morphology with no symptoms, the answer is almost always no. The panel was explicit: no evidence shows prophylactic surgery alters the risk of developing FAI syndrome or osteoarthritis.
For the boards, know the asymmetry in osteoarthritis risk: cam morphology is linked to hip OA in all prospective cohort studies; pincer morphology is not. Know the three recommended PRO tools: iHOT, HAGOS, and HOS. Know that image-guided local anesthetic injection can help confirm the hip joint as the pain source when the diagnosis is uncertain.