Femoroacetabular Impingement Treatment Guidelines

What is a femoroacetabular impingement (FAI)?

Femoroacetabular impingement (FAI) is a condition where abnormal contact between the femoral head and the hip socket (acetabular rim) causes damage to the acetabular labrum and articular cartilage. This condition can result in hip or groin pain and reduced mobility in the ball-and-socket joint and is a known contributor to early-onset osteoarthritis. FAI is classified into three types: cam impingement, caused by an irregularly shaped femoral head with excess bone; pincer impingement, resulting from excessive acetabular rim coverage; and combined or mixed impingement, which involves both abnormalities.

Common symptoms include anterior hip pain or groin pain that worsens with activities such as running, prolonged walking, or deep hip flexion. Physical exams often reveal limited internal rotation of the hip joint. Imaging tests like X-rays or MRIs are crucial for diagnosing FAI, identifying structural abnormalities, and guiding treatment options.

Treatment of femoroacetabular impingement

Femoroacetabular impingement is managed through a combination of non-operative and surgical interventions, tailored to the severity of symptoms, the extent of damage to the hip joint, and the patient’s activity level.

Non-operative management

Non-operative management is the first-line approach for treating FAI, especially in mild or asymptomatic cases. It focuses on alleviating hip pain and preventing progression through conservative strategies. Activity modification reduces stress on the hip joint by avoiding movements that worsen symptoms, such as deep hip flexion or high-impact activities. Physical therapy plays a crucial role by improving hip mobility, strengthening stabilizing muscles, and addressing compensatory movement patterns.

Targeted exercises protect joint mechanics and minimize hip impingement. Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are commonly prescribed to manage pain and reduce inflammation. While these methods are often effective for early-stage FAI, their benefits may diminish in patients with severe symptoms, significant structural abnormalities, or highly active lifestyles, who may require surgical treatment.

Operative management

Surgical intervention is recommended when non-operative treatments fail to provide relief after six months or when imaging confirms structural issues, such as cam deformities, pincer lesions, or damage to the labrum and articular cartilage. The primary goals of surgery are to restore proper mechanics of the ball-and-socket joint, repair damaged soft tissue, and relieve hip pain.

• Hip arthroscopy: A minimally invasive procedure that addresses intra- and extra-articular pathologies. This includes reshaping cam deformities, trimming excess acetabular rim bone, and repairing the labrum to restore joint stability. Studies like Griffin et al. (2018) demonstrate that hip arthroscopy significantly improves functional outcomes, although complications such as neuropraxia or labral re-injury can occur.
• Open surgical dislocation: This technique provides 360° visualization of the hip joint, enabling precise correction of complex deformities. While effective for severe FAI, it is more invasive and associated with longer recovery times and higher risks, including blood loss and soft tissue damage.
• Combined mini-open arthroscopy: This approach combines the advantages of arthroscopic and open techniques, addressing both bony and soft tissue abnormalities without requiring a trochanteric osteotomy. It reduces some risks of open surgery but carries slightly higher complication rates compared to pure arthroscopy.

Post-surgical rehabilitation

Rehabilitation is a vital component of treatment, focusing on restoring function, reducing the risk of recurrence, and supporting long-term joint health.

• Initial phase: Gradual reintroduction of weight-bearing activities and gentle exercises to regain mobility while managing pain.
• Strengthening phase: Progressive strengthening of hip stabilizers and core muscles to improve joint support and mechanics.
• Advanced phase: Functional training tailored to the patient’s daily activities or athletic goals to ensure a full return to activity.

Recovery timelines typically range from 3 to 7 months, depending on the severity of the condition, the type of surgical treatment performed, and individual progress during rehabilitation. By integrating surgical and non-surgical approaches, along with structured rehabilitation, patients can achieve significant improvements in hip function and quality of life.

How to use our Femoroacetabular Impingement Treatment Guidelines Handout

Carepatron’s Femoroacetabular Impingement Treatment Guidelines Handout is a practical resource designed to assist healthcare professionals in educating patients about FAI. This tool simplifies complex medical concepts, making it easier for patients to understand their hip condition, available treatment options, and the recovery process.

Step 1: Access and download the handout

Download the handout from Carepatron’s resource library. Click "Use template" to access an editable version in the Carepatron app or choose "Download" for a PDF copy. Keep this resource readily available for consultations to ensure a smooth discussion about FAI treatment and management.

Step 2: Review the handout

Take time to familiarize yourself with the content to confidently guide patients through their diagnosis and treatment. The handout provides:

• FAI types: Explains cam, pincer, and combined impingements, highlighting their effects on the femoral head, hip socket, and surrounding soft tissue.
• Treatment options: Covers non-operative strategies like physical therapy and NSAIDs, as well as surgical procedures such as arthroscopic hip surgery and open dislocation techniques.
• Recovery guidance: Details post-surgical rehabilitation steps, including strategies for managing hip or groin pain, strengthening the ball-and-socket joint, and restoring mobility.

Step 3: Introduce and educate patients

During consultations, use the handout to explain femoroacetabular impingement and guide patients through their care plan. Emphasize the importance of activity modification and physical therapy in relieving symptoms and preventing further damage. Discuss the role of NSAIDs and injections in managing hip pain and inflammation.

Highlight the benefits of arthroscopic hip surgery for treating cam impingement, labral tears, and damage to articular cartilage. Finally, outline post-surgical recovery steps, focusing on mobility restoration, soft tissue strengthening, and long-term joint health.

Step 4: Provide the handout to patients

Ensure your patients leave with a copy of the handout for reference. This empowers them to better understand their condition, reinforces their care plan, and aids in managing expectations during recovery.

Benefits of using this handout

Our free handout offers a comprehensive guide for managing femoroacetabular impingement, ensuring patients receive the most effective care. Here are some of the benefits of using it in your practice:

• Standardized care practices: Ensures consistent and effective treatment for hip impingement across clinical settings.
• Early detection and intervention: Guides the recognition of early FAI symptoms, like restricted motion and hip or groin pain, to prevent joint damage.
• Evidence-based interventions: Provides accurate information about proven treatments, such as hip arthroscopy for reshaping excess bone and repairing soft tissue.
• Improved care coordination: Enhances communication between healthcare providers to create integrated and effective care plans.
• Optimized quality of life: Helps patients manage hip pain, restore mobility, and return to an active lifestyle through tailored interventions and rehabilitation.

References

Griffin, D. R., Dickenson, E. J., Wall, P. D. H., Achana, F., Donovan, J. L., Griffin, J., Hobson, R., Hutchinson, C. E., Jepson, M., Parsons, N. R., Petrou, S., Realpe, A., Smith, J., Foster, N. E., & FASHIoN Study Group. (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial. The Lancet, 391(10136), 2225–2235.https://doi.org/10.1016/S0140-6736(18)31202-9

Maupin, J. J., Steinmetz, G., & Thakral, R. (2019). Management of femoroacetabular impingement syndrome: Current insights. Orthopedic Research and Reviews, 11, 99–108. https://doi.org/10.2147/ORR.S138454