Femoral acetabular impingement (FAI) is a condition that affects the hip joint. It occurs when the bones of the hip joint have an asymmetrical fit, leading to friction and damage to the joint. FAI can cause pain, stiffness, and reduced mobility and can lead to the development of osteoarthritis and other serious joint issues if left untreated.
Several treatment options are available for managing FAI, ranging from non-surgical approaches to surgical intervention. Non-surgical treatments may include physical therapy, activity modification, and pain management medications.
Surgical treatments may involve repairing or reshaping the hip joint bones or removing damaged tissue. The treatment choice will depend on the severity of the condition, the patient’s age and overall health, and other factors, and surgery should always be viewed as a last resort.
In this article, we’ll review the different treatment options for FAI, which ones you should try first, and which ones may not be as helpful as they once seemed.
Key Takeaways
- FAI is a condition that affects the hip joint and can cause pain, stiffness, and reduced mobility.
- Treatment options for FAI range from non-surgical approaches to surgical intervention, and treatment choice will depend on several factors.
- With appropriate treatment and care, many patients with FAI can manage their symptoms and maintain good joint health.
- People can live long and healthy athletic lives without having to undergo surgery in most cases.
Understanding Femoral Acetabular Impingement
Femoroacetabular impingement is a common hip condition that affects the ball-and-socket joint. It occurs when abnormal contact between the femoral head and the acetabulum leads to joint friction and damage. This condition is characterized by extra bone growth along one or both of the bones that form the hip joint, resulting in an irregular shape of the bones.
There are three types of FAI: cam, pincer, and combined.
Cam lesions occur when the femoral head is not perfectly round, leading to abnormal contact with the acetabulum. X-ray shows this as an extra bone growth or bump on the top of the hip.
Pincer lesions occur when the acetabulum has too much coverage of the femoral head, causing impingement during hip movement. While not always the case, Pincer lesions are more common in females.
A combined impingement is where there is a combination of both the Cam and Pincer Lesion.
FAI can occur in people of all ages, but it is most commonly seen in young adults and athletes. It can lead to hip pain, stiffness, and limited range of motion. Left untreated can cause labral tears, cartilage damage, and even osteoarthritis.
In summary, FAI is a condition that affects the hip joint, leading to abnormal contact between the femoral head and the acetabulum. It can cause hip pain, stiffness, and limited range of motion, leading to labral tears, cartilage damage, and osteoarthritis if left untreated. Understanding the anatomy of the hip joint and the types of lesions that can occur is crucial in understanding this condition.
Symptoms and Risk Factors
FAI is a condition that affects the hip joint, causing pain and stiffness. The symptoms of FAI can vary, but the most common symptom is pain in the groin or hip area. This pain may be sharp or dull and may worsen with activity, especially activities that involve bending or twisting the hip joint, such as running, jumping, or squatting.
Other symptoms of FAI may include stiffness in the hip joint, which can make it difficult to move the joint through its full range of motion. Some people with FAI may also experience pain in the buttock, lower back, thigh, or knee, and a clicking or popping sensation in the hip joint.
Several risk factors can increase a person’s likelihood of developing FAI. These include:
- Structural abnormalities in the hip joint, such as a misshapen femoral head or acetabulum
- Repetitive activities that involve bending or twisting the hip joint, such as certain sports or occupations
- Genetic factors that affect the shape and structure of the hip joint
- Hormonal imbalances that can affect bone growth and development
Not everyone with these risk factors will develop FAI, and some people without any known risk factors may still develop the condition.
Diagnosis of Femoral Acetabular Impingement
Diagnosing FAI requires a thorough physical examination and imaging tests. FAI is a hip condition characterized by abnormal contact between the acetabulum and femoral head-neck junction.
The first step in diagnosing FAI is to complete a thorough subjective examination. The patient will provide all of the key times of pain, relieving factors, and specific aggravating movements. With the clues from the patient report, the next step is the physical exam.
During the physical exam, assess the patient’s range of motion, look for any signs of swelling or tenderness, and perform an impingement test. An impingement test, such as Scour’s or FADDIR test, involves moving the hip joint in various directions while under pressure to determine if there is any pain or discomfort.
Imaging tests are also used to diagnose FAI. Radiographs, also known as X-rays, are commonly used to identify any bony abnormalities in the hip joint. A computed tomography (CT) scan may also provide a more detailed view of the bones and joints in the hip.
Magnetic resonance imaging (MRI) scans can visualize soft tissues, such as the labrum, which can be damaged due to FAI. Magnetic resonance arthrography (MRA) is a specialized MRI that can provide even more detailed images of the hip joint.
A combination of physical examination and imaging tests is used to diagnose FAI. A proper diagnosis is important to identify the type of FAI and determine the best treatment options.
Non-Surgical Treatment Options
In many cases, non-surgical treatment options can effectively manage FAI. These options are usually recommended as the initial course of treatment before considering surgery.
Active Rest and Activity Modification
Active rest and activity modification can help to reduce inflammation and pain in the hip joint. Avoiding complete rest is crucial as that can cause weakness and less blood flow to the area, which is important for healing.
Patients are advised to avoid activities that worsen their symptoms, such as high-impact sports, running, and jumping. The activity modification allows for the hip to reduce muscle tightness and prevent repetitive aggravation.
Physical Therapy
Physical therapy is a common and, in most cases, an effective non-surgical treatment option for FAI. This is especially successful in mild cases. Physical therapy can help to improve hip joint mobility, strengthen the muscles around the hip joint, and correct any muscle imbalances.
It’s common to find a weakness in two primary patterns with FAI. First, the hip most affected by FAI is weaker than the non-effected hop. However, on the hip with FAI, there is also a weakness in the muscles on the posterior side compared to the front of the hip. The chronic muscle imbalance further exacerbates friction and joint irritation in the front of the hip.
A physical therapist will work with the patient to develop an individualized exercise program targeting their needs. More details on specific strengthening exercises can be found later in this article.
Anti-Inflammatory Medications
Anti-inflammatory medications such as ibuprofen and naproxen can help to reduce pain and inflammation in the hip joint. However, it is important to note that these medications should be used with caution and under the guidance of a healthcare professional.
In reality, we want a little inflammation to allow the body’s natural healing process to work on the joint. Inflammation is our body’s natural repair response and often gets a bad reputation for always being bad.
Go light on the anti-inflammatories unless you need them for pain relief, and we typically only have patients use them for short periods. For example, take the recommended amount for the first 3 days after a flare-up and then try to wean off and let the body work its own magic.
Pain Relief
Other pain relief options are available for FAI, including ice packs, heat therapy, and massage. These options can help to reduce pain in the short term. These methods don’t have long-term effects but are important pain relief measures in the acute pain phases.
Surgical Treatment Strategies
When conservative treatments fail to manage FAI, surgical intervention may be necessary. Surgery is usually recommended for patients who experience persistent pain and functional limitations despite exhausting every other conservative option. Surgery is always a last resort because once you have surgery there is no, “undo button.”
Surgical treatment for FAI involves the removal of bone spurs or excess bone from the femoral head or acetabulum and may also require fixing any labral tear or pathology that is present. Surgery aims to restore the hip joint’s normal anatomy, reduce impingement, and prevent further damage to the joint.
Arthroscopic Surgery
Arthroscopic surgery is the most common form of surgical management for FAI. This minimally invasive procedure involves making small incisions around the hip joint and using a camera and surgical instruments to remove bone spurs and reshape the bones.
Arthroscopic management of FAI effectively reduces pain and improves function in patients with FAI. However, inadequate bony resection during arthroscopic surgery is a frequent source of revision surgery.
Also, the problem that we find with bone spur removal of any type is that it’s common for the bone spur to grow back. Growing more bone is the body’s own protective mechanism against further damage.
Open Surgical Dislocation
Open surgical dislocation is a more invasive surgical approach that involves making a larger incision and dislocating the hip joint to gain better access to the femoral head and acetabulum.
This approach allows for more extensive bony resection and is often used for patients with more severe forms of FAI. This type of surgery is less common and we rarely see these in the clinic anymore.
Mini-Open Approach
The mini-open approach is a hybrid of arthroscopic and open surgical dislocation techniques. This approach involves making a small incision to access the hip joint and using arthroscopic and open techniques to remove bone spurs and reshape the bones. This is a great way for surgeons to also repair any labral damage, and correct any other issues such as ligamentous scarring.
Bony Resection
Bony resection removes excess bone from the femoral head or acetabulum. This can be done using arthroscopic, open surgical dislocation, or mini-open approaches. Bony resection aims to restore the hip joint’s normal anatomy and reduce impingement.
Acetabular Rim Resection
Acetabular rim resection involves removing a portion of the acetabular rim to increase the depth of the socket and improve coverage of the femoral head. This procedure is often used in patients with pincer-type FAI.
Hip Replacement
In severe cases of FAI, hip replacement surgery may be necessary, particularly if the patient is older or the symptoms have been ongoing for many years. This involves replacing the damaged hip joint with an artificial joint.
Overall, surgical treatment for FAI can effectively reduce pain and improve function in patients who have failed non-surgical treatments. The choice of surgical approach depends on the severity and type of FAI, the patient’s age, activity level, and overall health.
Understanding Labral Pathology
Femoroacetabular impingement can lead to labral pathology, which is damage or injury to the labrum, a ring of cartilage that surrounds the hip joint. The labrum helps stabilize the hip joint and cushion the bones.
Labral tears are common and can occur due to repetitive movements or trauma to the hip joint. Labral tears can be classified as either traumatic or degenerative, depending on the cause of the injury. Traumatic labral tears are caused by a sudden injury, such as a fall or a car accident. Degenerative labral tears occur gradually over time due to wear and tear on the hip joint.
The symptoms of labral pathology can vary depending on the severity of the injury. Some common symptoms include hip pain, stiffness, and a clicking or popping sensation in the hip joint. In some cases, labral pathology can also lead to hip instability and a feeling of the hip “giving way.”
Treatment for labral pathology depends on the severity of the injury. It can range from conservative measures such as rest, physical therapy, and anti-inflammatory medications to more invasive treatments such as arthroscopic surgery. Surgery may sometimes be necessary to repair or remove the damaged labrum.
Role of Cartilage in FAI
Cartilage plays a crucial role in FAI. The Acetabulum and Femoral head are covered with articular cartilage, which creates a smooth, low-friction surface that allows the bones to glide easily across each other during movement. In FAI, the abnormal contact between the Acetabulum and Femoral head can cause damage to the articular cartilage, leading to pain, stiffness, and limited range of motion.
Acetabular cartilage delamination is a common complication of FAI. Delamination occurs when the articular cartilage separates from the underlying bone, causing pain and instability in the hip joint. This can further damage the cartilage and bone and may require surgical intervention.
Treatment options for cartilage damage in FAI include conservative management, such as physical therapy, anti-inflammatory medications, and surgical intervention. Cartilage repair or regeneration techniques, such as microfracture or autologous chondrocyte implantation, may be used to restore damaged cartilage.
It is important to note that the success of cartilage repair techniques in FAI depends on the extent and location of the cartilage damage, as well as the age and overall health of the patient. In some cases, total hip replacement may be necessary to address severe cartilage damage and restore function to the hip joint.
Overall, the role of cartilage in FAI is significant, and damage to the articular cartilage can significantly impact the patient’s quality of life. Early diagnosis and treatment of FAI can help prevent further damage to the cartilage and improve patient outcomes.
Rehabilitation and Post-Treatment Care
After undergoing treatment for FAI, rehabilitation is essential to the recovery process. The goal of rehabilitation is to restore the patient’s range of motion, strength, and hip joint function. A physical therapy program should be tailored to the patient’s needs and goals and is dependent on each person’s unique presentation.
Physical therapists can develop a customized exercise program that targets the specific muscles and joints affected by FAI. These exercises may include:
- Strengthening exercises for the hip, such as hip abductor and adductor exercises, and exercises to strengthen the glutes and core muscles.
- Stretching exercises to improve flexibility and range of motion in the hip joint.
- Low-impact exercises such as swimming or cycling to maintain cardiovascular fitness while minimizing stress on the hip joint.
Physicians may also recommend non-surgical management strategies for FAI. These may include:
- Rest and activity modification to reduce pain and inflammation.
- Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation.
- Corticosteroid injections reduce pain and inflammation in the hip joint.
After surgery, patients may need to use crutches or a walker to keep weight off the affected hip joint. They may also need to wear a brace or immobilizer for a period of time to protect the hip joint while it heals.
In addition to physical therapy and non-surgical management strategies, patients with FAI should also take steps to prevent future injury. This may include maintaining a healthy weight, avoiding high-impact activities that place stress on the hip joint, and practicing good posture and body mechanics.
Associated Conditions with FAI
It is important to note that FAI can be associated with other conditions that may exacerbate the symptoms or complicate the treatment.
One such condition is hip impingement, a general term used to describe any condition in which the bones in the hip joint rub against each other or muscle compression in the front of the hip causes pain and discomfort. FAI is a type of hip impingement, but there are other types as well, such as Ischiofemoral impingement and Hip Flexor impingement.
Hip dysplasia is another condition that can be associated with FAI. It is a condition in which the hip joint does not develop properly, leading to instability and increased wear and tear on the joint. Patients with hip dysplasia may be more prone to developing FAI, and the two conditions can often coexist.
Slipped capital femoral epiphysis (SCFE) is a condition that affects the hip joint in children and adolescents. It occurs when the growth plate at the top of the thighbone slips out of place, causing pain and instability in the hip joint. SCFE can lead to FAI if left untreated, as the abnormal positioning of the thighbone can cause damage to the hip joint.
Perthes disease is another condition that affects the hip joint in children. It occurs when the blood supply to the top of the thighbone is disrupted, leading to bone death and deformity. Perthes disease can cause FAI if the deformity of the thighbone is severe enough to cause impingement.
Finally, knee pain can also be associated with FAI. Patients with FAI may compensate for the hip pain by altering their gait, which can increase stress on the knee joint. This can lead to knee pain and other conditions like patellofemoral pain syndrome.
Overall, it is important to consider these associated conditions when diagnosing and treating FAI, as they can significantly impact the patient’s symptoms and treatment outcomes.
Frequently Asked Questions
Conclusion
Femoroacetabular impingement (FAI) is a condition that can cause hip pain and lead to secondary osteoarthritis. The understanding of FAI’s pathophysiology, management options, and outcomes has evolved since its description by Ganz in 2003.
Nonoperative management of FAI syndrome is evolving and includes patient education, activity modifications, oral anti-inflammatories, physical therapy, and intra-articular musculoskeletal injection therapies. However, the literature has insufficient evidence comparing the various treatment options.
Surgical management of FAI has shown promising results in pain relief and functional improvement. However, the decision to proceed with surgery should be made only after thoroughly evaluating the patient’s symptoms, imaging findings, and functional limitations.
It is important to note that each patient is unique, and treatment should be tailored to their specific needs. A multidisciplinary approach involving orthopedic surgeons, physical therapists, and pain management specialists can help optimize outcomes.
In conclusion, managing FAI requires a comprehensive understanding of the condition and its treatment options. Nonoperative management can be effective, but surgical intervention may sometimes be necessary. A tailored approach to treatment involving a multidisciplinary team can help achieve optimal outcomes for patients with FAI.
