About FAI (Femoroacetabular Impingement)

FAI (femoroacetabular impingement) is a common source of hip pain affecting athletes, "weekend warriors" and young and middle-aged adults alike. It begins in the childhood growth years, when the bones of the hip fail to develop normally. Although exercise does not cause FAI (femoroacetabular impingement, symptoms may be worsened by exercise, particularly activities that require high-impact hip flexion. Soccer, gymnastics, hockey and ice skating are a few of the sports associated with this condition; however, the condition can occur in non-athletes as well.

In order to understand FAI (femoroacetabular impingement), it is important to understand how the hip functions. The hip joint consists of these important structures:

• Head of the femur (femoral head, or ball)


• Acetabulum (hip socket)


• Labrum- composed of cartilage; sits on the edge of the acetabulum and extends almost all the way around the socket


• Capsule- thick fibrous tissue that surrounds the hip joint

Impingement (FAI) occurs when there is an abnormal shape to the bone on either the socket or the ball side of the joint. For example, the ball can have an extra boney "bump" or the socket can be too deep. In either case, the labrum is pinched (impinged upon) between the abnormal areas of bone, resulting in damage to the labrum or to the underlying cartilage within the socket. This results in the pain that is typical of this condition.

Symptoms

The primary symptom of FAI (femoroacetabular impingement) is groin pain, although the pain may also locate to the outer edge of the hip. The "C' sign is demonstrated when a patient cups their fingers and thumb in a C formation and grips the side of their hip. Patients may complain that the pain is sharp or dull. Patients may also complain of a sensation of instability in their hip, as if their leg is going to "give way". Catching, locking and popping are also common sensations experienced by patients with FAI (femoroacetabular impingement).

Diagnosis

Diagnosis of this condition should be made by an orthopedic specialist, who will initially obtain a thorough history focused on the hip pain. A physical exam will also be done in which the specialist maneuvers the affected hip in an attempt to localize the pain. In the anterior impingement test, the patient lies on their back. The hip is flexed and the knee is brought to the midline of the body while the hip is internally rotated. This simple maneuver often recreates the groin pain experienced by patients with FAI (femoroacetabular impingement) and is a reliable sign that impingement may be an issue. Of course, specialists will not rely solely on the anterior impingement test to diagnose patients-- x-rays are required, which may show abnormal hip bone formation and possible arthritis, and an MRI can often reveal soft tissue damage not visible on x-rays.

Treatment

FAI can sometimes be treated conservatively. Conservative treatment consists of activity modification, physical therapy and anti-inflammatory medications. Hip joint injections, in which a corticosteroid is injected into the hip joint to relieve pain and inflammation, are sometimes performed when oral anti-inflammatories, physical therapy and rest are ineffective in relieving pain.

Should all of these measures (including joint injections) fail, arthroscopic surgery may be required. In this type of surgery, incisions (portals) less than 翻 an inch in size are created around the hip joint. Through one portal, a camera is inserted. Instruments no larger than a pen or pencil are inserted through the other portals. Using these instruments, the surgeon can shave down any bony spurs (bumps), reshape the acetabulum if it is too deep and/or repair any labral injuries with sutures. Arthroscopic surgery is minimally invasive. Physical therapy begins almost immediately, and most athletes can return to their sport of choice within 3 to 5 months.

Choosing a Surgeon

If you have hip pain, whether you are an athlete or simply an active adult, you will want to choose a qualified orthopedic surgeon to evaluate your hip pain. A determination will need to be made regarding the cause of your hip pain, as well as the best treatment for it.

Holland Bone and Joint Center offers state-of-the-art diagnostic and treatment options to patients suffering hip pain, whether the pain is caused by FAI (femoroacetabular impingement) or another condition. Should arthroscopic surgery be needed, the Center provides professional and personalized pre and postoperative care to people from all walks of life, including world-class athletes.