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Femoroacetabular Impingement (FAI)

Younger patients (teens, twenties, thirties) with FAI report a history of groin pain and/or a painful catching or popping of the hip. This pain often occurs in athletes or dancers. The symptoms may have a gradual onset or be from an acute injury. Patients may describe the pain as intermittent or as constant. The pain is usually a deep hip pain or groin pain. After a physical examination and imaging, your physician can start to rule out other conditions. If your symptoms don’t improve with rest and NSAIDS, Femoroacetabular Impingement may be the diagnosis.

What Is FAI?

FAI is caused by abnormal repetitive contact between the proximal femur and the acetabular rim. The abnormal contact is due to extra bone, either on the acetabulum (pincer) or the femur (cam). Left untreated, FAI can result in groin pain, hip labral tears or degeneration, cartilage degeneration and progressive secondary osteoarthritis. Other diagnoses that can co-exist with FAI are sports hernias, SI joint pain, and greater trochanter bursitis/IT band syndrome.

How Is FAI Diagnosed?

A physical exam will include an impingment test – this is most important pertinent positive. This is positive when flexion and internal rotation of the hip reproduces the deep hip/groin pain. Based on the physical exam, x-rays, MR arthogram or CT scan may be required. These imaging studies will show the FAI findings, but often radiologists are not looking for FAI findings and may not report them routinely.

  • Palpation  (Symphysis, Greater Trochanter, SI Joint, Lumbar Spine)
  • Neurologic exam
  • Straight leg raise
  • Apprehension test
  • Muscle testing  (Iliopsoas, Quads, Abductors, Adductors)
  • Hip range of motion - FAI patients may lack hip internal rotation 

What Is The Differential Diagnosis For Hip Pain In This 

  • Stress fractures 
  • Lubar radiculopathy 
  • Muscle strains
  • Coxa saltans (snapping hip)
  • Avulsion fractures
  • SCFE (Slipped Capital Femoral Epiphysis)
  • Avascular necrosis
  • Osteoarthritis
  • Bursitis
  • Dysplasia 

What Are The Treatment Options For FAI?

Conservative Treatment Options are Recommended First:

  • Physical therapy
  • NSAIDS
  • Activity modification 
  • Injections
  • Weight loss, if needed

If other treatments fail, surgical options are: 

  • Open, for extreme FAI deformity, dysplasia, posterior lesions 
  • Arthroscopic 

Hip Arthroscopy Can: 

  • Debride or repair labrum 
  • Remove cam 
  • Chondroplasty (remove loose cartilage flaps)
  • Microfracture (promote fibrocartilage growth if bare bone)
  • Lengthen IT band 
  • Lengthen Illiopsoas

For successful hip arthroscopy outcomes, patient selection is important. In some cases, it may be too late for arthroscopic surgery if there is moderate arthritis. Patients need to have realistic expectations and understand there is a long rehab with this surgery.

FAI, Hip Arthroscopy And CNOS

CNOS, PC has the area’s most experienced Orthopaedic Surgeon in Hip Arthroscopy to treat FAI, Dr. Benjamin Bissell. A board certified Orthopaedic Surgeon, with fellowship training in Sports Medicine, Dr. Bissell has performed hundreds of arthroscopic procedures. He is a graduate of the University of Nebraska-Omaha College of Medicine, and completed his orthopaedic sports medicine/ shoulder fellowship at the University of Michigan. Dr. Bissell sees patients for a range of sports medicine injuries and general orthopaedics, including shoulder, knee and hip conditions.

CNOS - Improving Health 

We know you have a choice when it comes to choosing a specialized healthcare facility. At CNOS, our mission is improving health. We focus on the prevention, diagnosis and treatment of bones, joints, muscles, nerves and the brain. Our multidisciplinary approach to quality care includes integrating medical and surgical specialities, rehabilitation, and full diagnostic capabilities. The CNOS team is dedicated to providing you with the expertise you need to live a better, longer, improved life.