Consultant – Orthopaedic Surgeon
Speciality interests include:
Lower extremity: trauma, sports surgery, knee, patella dislocation, tendon problems, foot and ankle surgery, and the management of degenerative joint disease in younger patients.
Visiting on Sep 21-22, 2019Request an Appointment
Femoroacetabular impingement (FAI) is a condition that results from the abnormal contact between the femoral head and the acetabulum (see picture), which leads to a mechanical conflict. It is a mechanism that clinically leads to pain and has been associated with several intra-articular injuries.
What can cause the impingement?
The hip is a ball-and-socket joint, and its movements require bearing of the femoral head in the acetabulum. Impingement arises when the harmony of this movement is altered, which results in the mechanical interlocking of the last degrees of the femoral head movements, which in turn makes this structure strike the outside (lateral) edge of the acetabulum, causing regional micro-traumas. Usually, the impact is caused by anatomical changes in the head-neck junction and/or the acetabulum. However, it can also occur in normal hips that are subjected to great physical demands associated with repeated flexion. So, although involvement in sport was once thought to only expose those with these anatomical changes present at birth (congenital), recent literature has shown increasing evidence that acquired changes from sports demands over time may be a contributing factor. FAI has been observed to be more prevalent in athletic populations, and more specifically in sports which require end-range movements of hip flexion, adduction, and internal rotation.
What are the symptoms of FAI?
Patients with FAI will often present with groin pain, pain with prolonged sitting or walking, and pain during athletic activities requiring end-range motion, such as deep squatting. Several clues in the clinical history include sharp or deep intermittent hip pain with insidious onset, long-term, and progressive worsening. FAI is common in young adults, practising a sport that involves hip flexion. Pain may be constant, intermittent, or at rest, and may interfere with sleep, either preventing it or causing awakening.
How to set the diagnosis?
Pain in the hip region may be a manifestation of several regional problems. Considering the number of injuries that can occur at the hip, specifically in athletes, several important differential diagnoses must be evaluated and ruled out. The diagnosis is based on detailed history, the typical clinical findings and images. Diagnostic imaging is necessary to confirm the presence and severity of the deformity and is used to predict symptomatic impingement.
What are the treatment options?
When considering the treatment options for patients diagnosed with FAI and possible hip labrum complications, it is important to note the age, level of sport/activity, and physical findings. Both conservative and surgical treatment aims to restore normal hip function while decreasing pain, and thus enabling the individual or athlete to return to their previous level of activity or sport. It is generally agreed that a trial of conservative care is initiated first and regardless whether a patient with FAI is involved in a non-surgical or operative plan, rehabilitation is the cornerstone of treatment.
Patients with FAI syndrome have altered hip muscle strength, range of motion (ROM), endurance, proprioception and gait biomechanics, and patients with these symptoms are potential patients for treatment through physiotherapy. The goal of physiotherapy is to do a comprehensive assessment, to give education to the patient, to advise lifestyle modification, to decrease the pain and to give an exercise-based program. Exercise is an effective treatment for many types of musculoskeletal pain. It is important to also focus on the lower limb strengthening, core stability and postural balance exercises to allow participation in sport.