WHAT IS FAI?

Femoroacetabular Impingement (FAI) is a common orthopedic condition where abnormal bone growth in the hip joint leads to pain and restricted movement, often affecting athletes and active individuals.

ANATOMY OF THE HIP JOINT

The hip joint, a ball-and-socket structure formed where the femur (thigh bone) meets the pelvis, is designed for both stability and a wide range of motion. This joint allows for extensive movement, including flexion, extension, and rotation, essential for everyday activities and athletic movements.

DESCRIPTION OF FAI

Femoroacetabular Impingement (FAI) occurs when extra bone grows along one or both of the bones that form the hip joint, giving the bones an irregular shape and causing them to pinch against each other during movement. This abnormal contact can lead to joint pain and damage to the hip joint, often resulting in limitations in movement and discomfort.

TYPES OF FAI

Cam Impingement

This type occurs when the femoral head is out of round, leading to abnormal contact with the hip socket and causing damage to the cartilage or labrum.

Pincer Impingement

Combined Impingement

CAUSES OF FAI

Femoroacetabular Impingement (FAI) is primarily caused by structural abnormalities in the hip joint, which can be congenital or develop during childhood. In many cases, these abnormalities are exacerbated by high-impact or repetitive motion activities, particularly in athletes, leading to the bones in the hip joint pinching abnormally. Additionally, FAI can develop during the adolescent growth spurt, where intense physical activities can influence the shape and growth of the hip bones, especially in sports that require significant hip movement or rotation.

SYMPTOMS OF FAI

The symptoms of Femoroacetabular Impingement (FAI) typically include:

PAIN IN THE HIP OR GROIN

This is often the primary symptom, especially during activities that involve turning, twisting, or squatting.

STIFFNESS OR LIMITED RANGE OF MOTION

The hip joint may feel stiff, and individuals may experience a reduced range of motion, particularly in movements that bring the knee toward the chest or involve rotating the hip inward.

A LOCKING, CLICKING OR CATCHING SENSATION IN THE HIP JOINT

These sensations can occur during certain movements, indicating that something is impairing the smooth motion of the hip joint.

These symptoms can vary in intensity and may develop gradually, becoming more noticeable over time, especially during or after physical activities.

WHO GETS FAI?

Femoroacetabular Impingement (FAI) is a condition that can affect a wide range of individuals, but certain groups are more commonly impacted due to specific factors related to lifestyle, activities, and physiological development. Here's a closer look at who typically gets FAI:

Athletes and Physically Active Individuals

FAI is particularly prevalent among athletes, especially those engaged in sports that require repetitive hip movements, pivoting, or high-impact activities. Sports like soccer, basketball, tennis, and dance are examples where FAI is more commonly observed.

Adolescents and Young Adults

Young people, particularly those in their teens and twenties, are at a higher risk for developing FAI. This age group is often involved in high-intensity sports and physical activities at a time when their bodies, including the growth plates in their hip joints, are still developing.

Occupations Requiring Repetitive Hip Motion

People whose jobs involve repetitive hip movements or maintaining positions that put strain on the hip joint may also be at an increased risk of developing FAI.

FAI STATISTICS

NUMBER OF PEER REVIEWED ARTICLES PER YEAR

PREVALENCE OF FAI

Population: 30% of the general population presents the anatomy of FAI.

Athletes vs Non-Athletes: 3-8.5x more common in athletes vs non-athletes (Tveit, et al, AJSM 2011).

WHY ATHLETES?

“These findings suggest that a cam-type abnormality in athletes is a consequence of an alteration of the growth plate rather than reactive bone formation.”

“High-level sports activity during growth may be a new and distinct risk factor for a cam-type deformity”

Siebenrock, et al; CORR 2012: Growth Plate Alteration Precedes Cam-type Deformity in Elite Basketball Players

TREATMENT FOR FAI

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SURGICAL TREATMENT

Surgical intervention for FAI typically involves correcting the abnormal bone structures that are causing impingement. This process, often referred to as osteoplasty, involves reshaping the femoral head or the acetabulum (hip socket) to allow for smoother joint movement and to alleviate pain.
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NON-SURGICAL TREATMENT

Non-surgical treatments for FAI focus on managing symptoms and improving joint function without surgery. This approach may include physical therapy to strengthen the hip muscles, pain management through medications, activity modifications to avoid motions that aggravate the hip, and now the use of orthopedic devices like SAFS shorts to align the hip and reduce stress on the joint. Physical therapy often has limited or temporary effects on the symptoms of FAI and does not treat the cause of FAI.
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ARTHROSCOPY

Hip arthroscopy is a minimally invasive surgical procedure used to treat FAI. It involves small incisions and the use of a camera (arthroscope) to view and repair the inside of the hip joint. During the procedure, the surgeon can trim the bone and repair or remove damaged cartilage, offering a less invasive option compared to open surgery, with potentially shorter recovery times.

DOCTOR EXAMINATION FOR FAI

IMPINGEMENT TEST

An FAI Impingement Test involves a doctor flexing the patient's hip and knee towards the chest, then rotating the hip inward towards the midline of the body. If this movement triggers or intensifies hip or groin pain, it suggests the presence of Femoroacetabular Impingement (FAI), indicating an abnormal contact between the hip joint bones.

IMAGING TESTS

An FAI imaging test typically involves using radiographic techniques like X-rays or Magnetic Resonance Imaging (MRI) to visualize the hip joint's structure. These images help identify any abnormalities in the shape of the hip bones or signs of damage to the joint, such as cartilage wear or labral tears, indicative of Femoroacetabular Impingement (FAI).

LONG-TERM OUTCOMES

The long-term outcomes from the three different treatments for Femoroacetabular Impingement (FAI) can vary based on the type of treatment, the severity of the condition, and individual patient factors:

SURGICAL TREATMENT

Long-term outcomes of surgical treatment, particularly osteoplasty or arthroscopic surgery, generally include significant pain relief and improved hip function.

Many patients experience a good recovery with a return to previous levels of activity, including sports.

However, as with any surgery, there's a risk of complications, and some patients might still experience symptoms post-surgery, especially if there was significant cartilage damage.

NON-SURGICAL TREATMENT

Non-surgical treatments, which typically include physical therapy, lifestyle modifications, and pain management, often result in improved symptoms and better management of daily activities.

These treatments are more about managing symptoms than curing FAI, and their effectiveness can depend greatly on patient adherence and the severity of the impingement.

Long-term, patients may still require surgical intervention if symptoms worsen or do not improve significantly with conservative management.

ARTHROSCOPY

Hip arthroscopy for FAI generally has positive long-term outcomes, with many patients experiencing reduced pain and improved joint mobility.

It is less invasive than open surgery, often leading to quicker recovery times and fewer complications.

Long-term success can depend on the extent of the hip damage at the time of surgery and the patient's rehabilitation post-surgery; there's also a risk of needing additional surgeries in the future, especially if FAI is accompanied by more severe joint issues.