Cam morphology and the development of femoroacetabular impingement syndrome and hip osteoarthritis

Hip morphology has emerged as an important factor in the development of hip osteoarthritis (OA). Cam morphology is one of the most common hip morphologies, characterized by a bony prominence around the femoral head-neck junction of the hip that alters the normal shape of the femoral head. Cam morphology can contribute to intra-articular joint damage by generating abnormal contact stresses at this junction, initiating femoroacetabular impingement (FAI) syndrome and eventually leading to hip OA. Cam morphology is a causal risk factor for hip OA, but not everybody with this morphology will develop FAI syndrome or OA. The pathogenesis of hip disease is probably driven by the interplay between cam morphology, other coexisting hip morphologies (such as pincer morphology), femoral version, spinopelvic parameters and biomechanical and environmental factors. Early identification of FAI syndrome could enable timely, multidisciplinary intervention and offers the potential to modify the trajectory of disease. Cam morphology can develop during skeletal maturation, particularly in adolescents participating in high-joint-load physical activity, raising important questions about preventative approaches. Management of FAI syndrome includes both surgical and non-surgical approaches. Emerging insights into the pathogenesis and detection of cam morphology are paving the way for more targeted interventions and a deeper understanding of its role in FAI syndrome and hip OA development.