Houston Methodist. Leading Medicine

Hip FAQ

Question:

My father is an athletic trainer and has always helped me with my various athletic injuries. But a hip problem that turned out to be something called femoroacetabular impingement (or FAI as my doctor calls it) is new to him. Is this really a new or rare problem that I have? Can you give me a quick run down on it?

Answer:

FAI is probably the most common cause of early cartilage and labral damage in the hip of young athletes complaining of hip pain. But it's not really new -- it's just that the condition has been given a name that your father may not have heard used. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. There is new information to suggest that recognizing, understanding, and addressing dynamic and static mechanical factors associated with FAI is a key to successful treatment results. Dynamic factors include the loss of normal structure and joint mechanics that cause the pinching. But other associated dynamic mechanical factors are being highlighted for the surgeon's consideration. These include the extra-articular (outside the joint) factors associated with impingement. This can include anatomic changes such as femoral retroversion, femoral varus, trochanteric impingement, and impingement of the anterior inferior iliac spine. Static factors (the way the hip is formed) cause increased abnormal stress and uneven load between the femoral head and the hip socket during standing activities. These include hip dysplasia, femoral anteversion, and femoral valgus. In many cases, there are combined patterns with both dynamic and static effects contributing to injury patterns with FAI. Many orthopedic conditions can be treated conservatively (without surgery) and that is often the first step with femoroacetabular impingement (FAI). A physical therapist helps the patient regain soft-tissue mobility, hip muscle strength, neuromuscular control, and postural balance. If your painful symptoms are not relieved by this approach or if the X-rays show progressive degeneration of the hip, then surgery may be required. Surgery can be done with an open incision or with the less invasive arthroscopic approach. The surgeon's choice depends on the patient's age, type and severity of impingement, and amount of damage to the hip cartilage. The main objectives of surgery are to relieve pain, improve function (including return to daily and/or sports activities), and prevent hip arthritis. With correct treatment early on, up to 90 per cent of athletes affected by FAI can return-to-sports successfully. The important ingredient to successful surgical treatment is careful attention to all aspects of the deformity. This includes recognizing static and dynamic mechanical factors (often present at the same time) and addressing them during the surgical procedure. Asheesh Bedi, MD, and Bryan T. Kelly, MD. Current Concepts Review. Femoroacetabular Impingement. In The Journal of Bone and Joint Surgery. January 2, 2013. Vol. 94A. No. 1. Pp. 82-92.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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