Femoroacetabular Impingement (FAI)
What Is Femoroacetabular Impingement?
Femoroacetabular impingement (FAI), or hip impingement, is a condition in which the bones of the hip joint are not properly formed, causing abnormal contact between the ball and socket during movement. This abnormal contact leads to pain, reduced range of motion, and can damage the cartilage and labrum (the ring of soft tissue that lines the hip socket). While the condition develops during childhood as the hip bones form, symptoms typically appear during adolescence or young adulthood.
Although sports activity does not cause FAI, people who have the condition and are physically active are likely to experience hip discomfort sooner than those who are less active. Sports that require repeated hip motion—such as soccer, ice skating, gymnastics, dance, and martial arts—are more likely to cause symptoms in people with FAI. The repetitive hip flexion and rotation involved in these activities can accelerate cartilage damage and bring symptoms to the forefront.
There are three types of deformity recognized as femoroacetabular impingement. In a cam impingement, a bump or irregularity forms on the head of the thighbone (femoral head), which grinds against the cartilage in the hip socket during movement. In a pincer impingement, extra bone extends over the rim of the hip socket (acetabulum), creating excessive coverage that pinches the labrum. A combined impingement includes both cam and pincer deformities, which is actually the most common presentation of FAI.
Symptoms of FAI typically include pain in the hip, groin, or outer hip area. Some patients may also experience pain in the lower back. A person with FAI often has reduced or restricted range of motion in the hip, particularly difficulty with hip flexion and internal rotation. Sharp, stabbing pain may be felt in the hip when twisting, turning, squatting, or sitting for prolonged periods. Many patients report discomfort when getting in and out of a car or when sitting in low chairs.
Nonsurgical Treatments
Many patients with FAI can be effectively managed without surgery, especially in the early stages. Our doctors offer a range of nonsurgical treatments to help relieve pain, improve hip function, and slow the progression of joint damage.
Lifestyle Modifications
Modifying or avoiding activities that exacerbate the condition is crucial for managing FAI symptoms. This may include reducing participation in high-impact sports or activities that require extreme hip flexion or rotation. Weight management can also help reduce stress on the hip joint. Patients should avoid positions and movements that trigger pain, such as deep squatting or prolonged sitting in low chairs.
Medications & Injections
Over-the-counter anti-inflammatory pain medications such as ibuprofen or naproxen may help manage pain and reduce inflammation. Patients should talk to their pharmacist before purchasing anti-inflammatories, as these medications may be contraindicated or may interact with other medications and medical conditions. In some cases, corticosteroid injections into the hip joint can provide temporary relief and help confirm the diagnosis.
Physical & Occupational Therapy
Physical therapy is an important component of nonsurgical treatment for FAI. A structured therapy program can help strengthen the muscles around the hip joint, improve flexibility, and optimize hip mechanics. Therapists may teach techniques to avoid impingement positions and provide exercises to maintain hip range of motion within comfortable limits. Core strengthening and hip stabilization exercises can help reduce stress on the joint during daily activities.
Supportive & Assistive Devices
Using assistive devices such as a cane or adjusting seating arrangements to avoid low chairs can help reduce hip stress. Modifications to work and home environments may be recommended to minimize positions that aggravate the condition.
Surgical Treatments
When nonsurgical treatments fail to provide adequate relief and symptoms significantly impact quality of life, surgery may be necessary. The goal of surgery is to reshape the bones to eliminate abnormal contact, repair damaged cartilage and labrum, and prevent further joint deterioration. The right surgical approach depends on the type of impingement, the extent of damage, and your activity goals.
Hip Arthroscopy
Hip arthroscopy is a minimally invasive procedure that can address many cases of FAI. The surgeon makes small incisions and uses a tiny camera and specialized instruments to reshape the bones, remove excess bone growth, and repair torn labral tissue. During the procedure, the surgeon can trim the bump on the femoral head (cam lesion), remove excess bone from the acetabular rim (pincer lesion), and repair or reconstruct the damaged labrum. Hip arthroscopy offers advantages including smaller incisions, less tissue disruption, reduced pain, and faster recovery compared to open surgery.
Open Hip Surgery
In some cases of severe deformity or when arthroscopy is not suitable, an open surgical approach may be necessary. This involves a larger incision to access the hip joint directly, allowing the surgeon to address complex bone abnormalities and perform extensive repairs. While recovery takes longer than with arthroscopic surgery, open surgery may provide better access for comprehensive correction of severe impingement.