Femoral Acetabular Impingement Book Now

Femoral Acetabular Impingement (FAI)

Femoroacetabular impingement (FAI) is a hip condition that results from inflammation and irritation of the soft tissues within the joint. It occurs when the femoral head (hip ball) presses against the acetabulum (hip socket), often because of abnormal bone development on one or both structures. This irregular shape prevents the bones from fitting together correctly, leading to friction when moving. Over time, this repeated contact can damage the joint, tendons, and nearby cartilage (labrum), resulting in pain, stiffness and restricted mobility.

If not treated, FAI may increase the possibility of chronic hip disorders like osteoarthritis. Thus, early diagnosis and appropriate treatment are important at all phases of hip impingement to prevent long-term complications and preserve joint function.

Symptoms

FAI can develop gradually, usually going unnoticed in its early stages because of the absence of pain. However, as the condition progresses, symptoms typically emerge, affecting daily activities and mobility.

Common FAI symptoms are:

  • Moderate to noticeable hip or groin pain during certain motions or positions of the hip.
  • Pain that radiates to the back, thigh, or buttock.
  • Stiffness and limited hip joint movement.
  • A clicking or catching feeling in the hip.
  • A sensation of joint locking or giving way.
  • Reduced ability to do everyday activities or even participate in sports.
  • Limping while walking or running.

Causes

FAI often stems from structural abnormalities in the hip, which may be present from birth or develop later, particularly during adolescence. Little can be done to avoid impingement when the hipbones are irregularly shaped.

FAI can occur due to three different structural variations:

  • Pincer impingement – Caused by additional bone growth extending over the edge of the acetabulum (hip socket). This can lead to pinching of the labrum, the cartilage that lines the socket.
  • Cam impingement – Occurs when the femoral head is more oval-shaped rather than round, hence preventing smooth rotation within the socket. This creates friction and leads to bony growth on the femoral head, worsening impingement.
  • Combined impingement – This is a combination of both cam and pincer.

If one or both of these abnormalities are present, they can lead to pinching of the hip joint structures, particularly the labrum near the joint edge. Since the labrum acts as a cushion for the hip joint, repeated impingement can damage it over time. This often results in pain, particularly during prolonged sitting or after and during physical activity.

Risk Factors

Whereas femoroacetabular impingement is primarily congenital (present from birth), certain factors may contribute to its development or worsen its effects. These involve:

  • Hip muscle weakness, particularly in the gluteal muscles.
  • Limited range of motion (hypomobility) or excessive flexibility (hypermobility) in the hip joint.
  • Muscular stiffness or tightness within the muscles near the hip.
  • Abnormal walking (gait) pattern.
  • Past hip injuries including fractures.
  • Pelvic posture.
  • Sports participation during adolescence. Certain sports, such as football, have been linked to an increased risk of developing FAI due to repetitive hip motion, particularly leading to cam-type impingement.

Although physically active individuals may experience symptoms earlier because of more hip joint usage, exercise itself does not lead to FAI.

Diagnosis

An early and accurate diagnosis is essential to ensure effective treatment for femoroacetabular impingement. Diagnosis involves a detailed clinical examination and diagnostic imaging to assess the extent and cause of the condition.

Clinical hip examination:

A thorough clinical evaluation mostly begins with:

  • Discussing symptoms, medical history, aggravating factors plus activity levels.
  • Understanding personal objectives so as to tailor treatment.

A physical examination will follow, which may include:

  • Testing range of motion, flexibility and strength of the hip.
  • Assessing for warmth, swelling, or redness in the joint.
  • Checking for grating (crepitus) or clicking sensations during movement.
  • Evaluating walking, jumping, squatting, and running mechanics.
  • Palpating the hip to identify specific areas of pain.

This comprehensive assessment helps confirm a diagnosis. However, imaging is necessary in order to determine the precise cause, such as whether a cam or pincer impingement is present and if a labral tear has occurred.

The diagnostic imaging recommended include:

  • X-ray – Identifies bone and joint structure and assesses joint space and potential degenerative changes. X-ray does not visualise soft tissues like the labrum and cartilage.
  • MRI – Considered the gold standard for diagnosing FAI since it provides detailed images of bone and soft tissue structures surrounding the hip.
  • Ultrasound – Aids in detecting inflammation and impingement in real-time during movement and can also guide injections for pain relief.

Treatment for Femoroacetabular Impingement

FAI responds well to activity modification and physiotherapy. Bone and joint changes cannot be reversed. However, several treatment options can assist in easing pain, restoring mobility, and enhancing overall function. This allows individuals to maintain an active lifestyle.

Aims of physiotherapy for FAI include:

  • Reducing hip discomfort and joint inflammation
  • Improving joint mobility and muscle flexibility
  • Strengthening lower limb muscles
  • Enhancing proprioception, balance, and agility
  • Optimising functional motions and activity levels such as squatting, walking, and climbing stairs

A tailored physiotherapy program may include:

  • Activity adjustment & rest. Adjusting activities so as to avoid aggravating symptoms, such as sitting for long in low chairs or crossing legs when seated.
  • Patient education. Understanding the condition and reasons for symptoms to actively participate in recovery.
  • Pain management. Medication (as prescribed by a GP or pharmacist) may help manage early-stage pain.
  • Manual therapy. Hands-on techniques including joint mobilisations and soft tissue release, to reduce stiffness and improve movement.
  • Range of motion workouts. Targeted stretches to restore normal hip function.
  • Hip strengthening exercises. Strengthening the deep gluteal muscles to improve hip stability.
  • Acupuncture. Aids in alleviating discomfort plus muscle tightness.
  • Proprioception & balance training. Exercises to restore balance and coordination.
  • Movement re-education. Correcting altered walking or running patterns caused by hip pain.
  • Functional & sports-specific training. Preparing the body for a return to daily activities and athletic performance.
  • Pilates. A valuable long-term strategy to maintain strength, flexibility and hip stability.

Additional treatment options:

Corticosteroid injections

Ultrasound-guided corticosteroid injections are an evidence-based and effective treatment for managing constant pain related to FAI. These injections normally provide about three months of relief.

However, injection therapy shouldn’t be administered as a sole treatment. Instead, it creates a chance to maximise the benefits of physiotherapy.

Hyaluronic acid (HA) injections

With the help of ultrasound, hyaluronic acid (HA), a natural substance, can be injected directly into the hip joint. This injection lubricates the joint in order to reduce friction and help alleviate discomfort and swelling. Normally, only one shot is required, but for long-term pain management, an annual HA injection is often recommended.

Platelet-rich plasma (PRP) injections

PRP injections use a person’s own blood to promote a natural healing response with minimal side effects. The procedure involves drawing a small amount of blood and spinning it in a centrifuge to concentrate the platelets. After that, the PRP is injected into the hip joint using ultrasound guidance. One to three shots may be necessary for optimal results depending on the severity, pain levels and chronicity.

Surgery

If diagnostic tests reveal joint damage from FAI and non-surgical treatments have failed to alleviate your pain, surgical intervention may be necessary.

Most FAI issues can be addressed with arthroscopic surgery. The orthopaedic surgeon can perform a hip arthroscopy to repair or remove damaged labrum and articular cartilage portions. Moreover, the procedure allows for impingement correction by trimming the bony edge of the acetabulum or shaving down the additional femoral head bump.

In more severe instances, an open surgical procedure with a bigger incision may be required to address the problem fully.

Bottom Line

Living with femoroacetabular impingement can be challenging, but with proper treatments, you can lead a pain-free and quality life. A combination of physiotherapy, advanced treatments, and, if necessary, surgical options can help you take control of your hip health.

Make an appointment today with our experienced specialists to get a proper diagnosis and a personalized treatment plan.