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FAI

by Chris Espinoza, MD

Femoroacetabular impingement (FAI) is an increasingly recognized cause of hip pain. It is defined as a mechanical process by which bony abnormalities or overgrowths of the hip combined with hip motion lead to repetitive collisions that damage the soft tissue structures (labrum, articular cartilage) within the hip joint.

The presence of FAI may predispose certain patients to the later development of osteoarthritis in the hip and increase the risk for needing total hip replacement. Many patients with FAI are young and active people participating in recreational or occupational activities requiring repetitive hip flexion such as running, cycling, dancing, etc. Pain may be produced by positions requiring hip flexion such as sitting in a car or rising from a chair. Symptoms may begin following a traumatic event or without a specific injury. Symptoms can include pain, stiffness, clicking, popping, or catching around the hip. Typically, pain is activity-related but over time can occur during daily living or at rest.

Nonsurgical management of FAI includes rest and anti-inflammatory medications like Aleve or Motrin. Activity modification should include the avoidance of positions which provoke symptoms. Physical therapy includes correction of any muscular imbalances followed by a progression to strengthening and eventually a maintenance home program. A steroid injection into the hip joint may serve both therapeutic and diagnostic purposes. When these treatments fail, surgical treatment may be considered.

Surgical management of FAI is performed to treat both the underlying bony deformity and any additional soft tissue injury. Many patients with FAI can be treated with arthroscopic surgery. Arthroscopic techniques to treat FAI have gained rapidly in popularity with the development of improved surgical instrumentation and diagnostic tests. Hip arthroscopy uses small incisions with special cameras and instruments to see and treat the bony and soft tissue abnormalities associated with FAI. Removal of the bony changes on the femoral head (ball) and acetabulum (socket) serves to alleviate any impingement occurring on the soft tissue structures (labrum, articular cartilage) around the hip. Repair or debridement of any damage to the soft tissue structures (labrum, articular cartilage) can also be done arthroscopically.

Occasionally, open surgical dislocation is necessary to treat severe cases of FAI. It allows circumferential access to the femoral head (ball) and acetabulum (socket) of the hip joint. It requires the surgeon to make a large incision to reach the hip. Severe bony deformities requiring alteration of the position of the femoral head (ball) or acetabulum (socket) are best managed with open techniques. The decision between arthroscopic or open surgical treatment can be made based on imaging studies such as radiographs, MRI, and CT scan.

Both surgeries are very successful when performed on the right patient. If you have hip pain and wonder if you may have FAI, please give us a call. We are happy to help get you back to the activities you enjoy the most.