Femoroacetabular impingement

Femoroacetabular impingement

Hip ​Condition

Femoroacetabular impingement

Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.

Anatomy

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, low friction surface that helps the bones glide easily across each other during movement.

The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket, creating a tight seal and helping to provide stability to the joint.

Description

In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum. This extra bone causes abnormal contact between the hip bones, and prevents them from moving smoothly during activity. Over time, this can result in tears of the labrum and breakdown of articular cartilage (osteoarthritis).

Types of FAI

There are three types of FAI: pincer, cam, and combined impingement.

  • This type of impingement occurs because extra bone extends out over the normal rim of the acetabulum.
  • In cam impingement the femoral head is not round and cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum.
  • Combined impingement just means that both the pincer and cam types are present.
Symptoms

The most common symptoms of FAI include:

  • Pain
  • Stiffness
  • Limping

 
Pain often occurs in the groin area, although it may occur toward the outside of the hip. Turning, twisting, and squatting may cause a sharp, stabbing pain. Sometimes, the pain is just a dull ache.

Treatment
  • Nonsurgical Treatment
  • Activity changes.
  • Non-steroidal anti-inflammatory medications.
  • Physical therapy.
Surgical treatment

If tests show joint damage caused by FAI and your pain is not relieved by nonsurgical treatment, your doctor may recommend surgery.

Many FAI problems can be treated with arthroscopic surgery. Arthroscopic procedures are done with small incisions and thin instruments. The surgeon uses a small camera, called an arthroscope, to view inside the hip.

During arthroscopy, your doctor can repair or clean out any damage to the labrum and articular cartilage. He or she can correct the FAI by trimming the bony rim of the acetabulum and also shaving down the bump on the femoral head.

Some severe cases may require an open operation with a larger incision to accomplish this.

Long-Term Outcomes

Surgery can successfully reduce symptoms caused by impingement. Correcting the impingement can prevent future damage to the hip joint. However, not all of the damage can be completely fixed by surgery, especially if treatment has been put off and the damage is severe. It is possible that more problems may develop in the future.

While there is a small chance that surgery might not help, it is currently the best way to treat painful FAI.