Hip Impingement (FAI)

FAI is structural abnormally in the hip that causes hip pain and is a potential risk for the development of degenerative arthritis of the hip. 10-15% of the population has these structural abnormalities, but doesn’t cause problems unless and until the joint is overused and damages the joint. FAI is often diagnosed in patients who participate in athletic activities. FAI is a common pain generator in the young adult community. During the initial phase, pain is intermittent and aggravated by sports, prolonged walking or sitting, such as driving for long periods of time, and even sexual activity.

There are three types of FAI:

• CAM deformity is characterized by an abnormally shaped head of the femur.
• Pincer deformity is characterized by an abnormal oversized acetabulum.
• Mixed FAI is a combination of CAM and Pincer abnormalities.

FAI is the result of an anatomic abnormality of the head of the thigh bone, the socket or both. It is a condition where excess bone forms on one or both bones in the hip joint – the femur and the acetabulum. The excess bone changes the shape and dimensions of the bones which alters normal biomechanics, stresses the joint and accelerates joint deterioration. The deformity pinches and tears the hip labrum and rubs away the cartilage so the bones rub together resulting in pain, disability and can lead to osteoarthritis in the joint if left untreated.

There are many different causes for abnormal hip formation including some pediatric hip diseases and high-impact sports like soccer, basketball, football, and ice hockey during adolescence.

• groin pain with prolonged sitting or standing
• pain in the thigh, back or buttocks
• stiffness
• limping
• restricted range of motion
• locking or giving way
• difficulty performing the activities of daily life

Diagnosis requires both a physical exam and imaging studies. The clinician experts at LALL Orthopedics ⁺ will perform a comprehensive orthopedic examination to identify the cause of your pain including various range of motion and impingement tests. X-rays will provide information about bone shapes related to the CAM and Pincer types. Imaging studies may include CT scans, and MRIs. Diagnostic injections of local anesthetic into the hip joint can provide temporary relief and confirm the diagnosis.

• Conservative management – Nonsurgical management includes modern regenerative medicine options such as platelet-rich plasma (PRP) or Stem-Cell injections, nonsteroidal anti-inflammatory medications, and activity modification to avoid motions that cause pain. Physical therapy is a used to help build strength in the joint, which can help reduce pain, reduce disability, and improve symptoms. A trial of conservative management can be helpful for mild to moderate symptoms. When nonsurgical treatments fail to relieve pain, and imaging studies reveal damage to the joint, hip arthroscopy may be recommended.
• Surgery – Hip arthroscopy is minimally-invasive surgery that is completed as an outpatient, same-day procedure. Surgery may involve repair of the cartilage, labrum and reshaping of the bones. Surgical treatment of FAI has been proven successful within the peer-reviewed literature, in many cases published by the experts at LALL Orthopedics ⁺, outperforming conservative care and physical therapy. Elite athletes who undergo arthroscopic hip surgery for FAI have shown significant functional improvements and a high rate of return to sport at the same or greater competition level compared with preinjury level. Full recovery requires 4-6 months and involves a structured rehabilitation program.
• Hip Preservation – FAI predisposes to premature joint degeneration. Hip preservation is a group of surgical procedures to correct hip damage and restore close to natural hip biomechanics, which in turn protects and maintains joint structures, delays the onset of arthritis, and avoids or delays the need for hip replacement.