Extra-articular hip impingement: clinical presentation, radiographic findings and surgical treatment outcomes

Femoroacetabular impingement syndrome is classically thought of as either a cam or pincer deformity causing abnormal bony contact resulting in labral pathology. However, alternate patterns of hip impingement can occur, but tend to be less commonly recognized or studied. Collectively termed 'extra-articular impingement', four subgroups of impingement can contribute to non-arthritic hip pain and disability: iliopsoas impingement, subspine impingement, ischiofemoral impingement and trochanteric-pelvic impingement. The purpose of this review article is to highlight the pertinent points to aid in proper clinical and radiographic evaluation to allow appropriate diagnosis. Additionally, a review of potential surgical treatment options and resultant outcomes will also be provided.