Femoroacetabular Impingement (FAI) is a condition where the bones of the hip joint abnormally rub against each other, leading to pain and restricted movement. This occurs when the femoral head (the ball of the thigh bone) and the acetabulum (the hip socket) do not fit together perfectly, creating friction. This article explores FAI, guiding you through understanding the condition and its management strategies.
Understanding Femoroacetabular Impingement
Femoroacetabular Impingement (FAI) is a structural issue where extra bone grows along the femoral head or acetabulum, causing painful pinching or rubbing within the hip joint. This prevents smooth movement. There are three common types of FAI: cam impingement (extra bone on the femoral head), pincer impingement (extra bone on the hip socket), and mixed impingement (a combination of both).
Individuals with FAI often experience hip or groin pain, especially during movements like bending, twisting, or squatting. Other symptoms include stiffness, a limping gait, and sensations of clicking or catching. Diagnosis involves a physical examination and imaging, such as X-rays for bony abnormalities and MRI or CT scans for soft tissues like the labrum and cartilage. Without intervention, this abnormal contact can damage cartilage, lead to labral tears, and potentially increase the risk of osteoarthritis.
Non-Surgical Management Options
Initial FAI management often begins with conservative, non-surgical approaches aimed at alleviating symptoms and improving hip function without altering the joint’s structure. Activity modification is a primary step, involving avoidance of movements and positions that provoke impingement, such as deep hip flexion, prolonged sitting, or repetitive twisting. This helps reduce friction and stress on the hip joint.
Physical therapy is a central component of non-surgical treatment, focusing on a structured rehabilitation program. This therapy emphasizes improving hip stability, neuromuscular control, core strength, and overall hip mechanics and range of motion.
Pain management strategies include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Corticosteroid injections directly into the hip joint can also provide temporary pain relief and serve as a diagnostic tool. These non-surgical methods aim to reduce discomfort and improve hip function, potentially delaying or preventing surgery.
Surgical Treatment Approaches
When conservative, non-surgical management fails to adequately relieve symptoms, and imaging confirms FAI with associated damage like a labral tear, surgical intervention may be considered. Hip arthroscopy is the most common surgical procedure for FAI, offering a minimally invasive approach. This procedure involves small incisions, through which a small camera (arthroscope) and specialized instruments are inserted into the hip joint.
During arthroscopy, the surgeon reshapes abnormal bone growths on the femoral head or neck (osteochondroplasty) and trims excess bone from the acetabulum (rim trimming) to restore a more normal hip joint shape. If a labral tear is present, it can be repaired or, in some cases, reconstructed. Cartilage damage within the joint may also be addressed, sometimes through techniques like microfracture.
The primary goals of FAI surgery are to correct the underlying structural abnormalities, reduce hip pain, improve the joint’s range of motion and overall function, and potentially prevent further damage that could lead to osteoarthritis. Hip arthroscopy is often performed as an outpatient procedure, allowing patients to return home the same day. While arthroscopy is the prevalent method, open hip surgery, involving a larger incision and temporary hip dislocation, may be necessary for more complex cases or significant deformities.
Post-Treatment Recovery and Rehabilitation
Recovery and rehabilitation are integral to achieving positive outcomes following FAI treatment, whether managed non-surgically or surgically. For individuals undergoing surgery, a structured physical therapy program is immediately initiated to guide the healing process. The initial post-operative phase focuses on pain management, protecting the surgical site, and limiting weight-bearing with crutches. Patients may also use a hip brace and a continuous passive motion machine to aid recovery and prevent stiffness.
As healing progresses, physical therapy intensifies to improve strength, stability, and mobility. The rehabilitation program focuses on restoring the hip’s stability, neuromuscular control, and core strength, gradually increasing the range of motion through specific exercises. A full return to unrestricted activity, including sports, can be expected within four to twelve months, depending on individual progress and activity level.
For those managing FAI non-surgically, ongoing commitment to physical therapy and activity modification is important to maintain symptom relief and function. Adherence to prescribed rehabilitation protocols is paramount in both scenarios, as it directly influences the long-term success and overall outcome of FAI treatment.