Femoroacetabular Impingement (FAI)
What is FAI?
FAI (femoroacetabular impingement) is a mechanical disorder of the hip where the bones do not form normally. The bony abnormalities alter the normal biomechanics, limit normal range of motion and lead to hip instability, labrum injury, and accelerated joint degeneration. FAI is a common cause of hip and groin pain in young, active patients. Most labrum tears are caused by FAI.
The location of the impingement can be described as either the CAM type or Pincer-type or both. CAM type is caused by the abnormal shape of the femoral head and neck, while the Pincer-type is caused an abnormal shape of the acetabulum. Repeated microtrauma causes bone spurs, damage to the labrum, hip joint degeneration and osteoarthritis.
The hip is a ball and socket joint. The socket is the part of the hip bone called the acetabulum, and the head of the femur is the ball. Articular cartilage covers both the ball and the socket and functions to reduce friction for smooth joint movement. The labrum is a ring of very strong tissue that lines the outer edge of the socket and deepens the socket. In a normal, healthy joint the ball fits tightly to the acetabulum. When the bones are abnormally shaped, they can rub against each other and damage the joint.
What are the symptoms of FAI?
Common symptoms include:
- groin pain with activity
- hip, groin and low back pain at rest and with activity
- stiffness in the hip, thigh and groin
- hip pain may extend into the thigh and down the buttocks
- impaired range of motion
Certain movements like getting in and out of a car can cause sharp pain, and at times the pain is a dull ache. By the time symptoms develop there is usually some damage to the hip cartilage (labrum) and with repeated use the damage will progress. Athletes with FAI are often diagnosed when they overuse the joint in extreme ranges of motion during sports. However, some people have the condition and have no symptoms and live a normal life.
How is FAI diagnosed?
During your consultation with Dr. Jonathan Godin, a hip specialist at the world-famous Steadman Clinic, he will review your medical history, symptoms, past injuries and the movements that cause your pain. He will conduct a physical examination checking range of motion and perform specific tests to diagnose hip impingement. A cortisone injection can help to confirm the diagnosis. If the pain goes away, it helps confirm that the source of the pain is due to FAI.
Imaging tests are necessary to definitively diagnose your condition. X-rays will reveal abnormally shaped bones, and an MRI will reveal damage to the soft tissue such a labral tear. In some cases, additional CT imaging studies may be ordered to gain details about the shape and location of abnormal bone.
What are the treatments for FAI?
- Nonsurgical treatment involves activity modification, anti-inflammatory medications and physical therapy. When this fails to relieve pain, and tests reveal damage to the labrum, surgery may be recommended.
- Arthroscopic surgery is the treatment of choice when treating many cases of FAI and related conditions. However, in some severe cases open surgery may be required. Hip surgery is customized for each patient because each patient’s anatomy and condition are different.
- FAI predisposes to premature joint degeneration. Hip replacement surgery is the treatment for advanced arthritis of the hip.
Dr. Jonathan Godin is a board – certified and fellowship – trained Orthopedic surgeon who specializes in the treatment of the shoulders, knees and hips and sports related conditions. He in internationally recognized for his contributions to the field of sports medicine and is a pioneer in the use of novel therapies and cutting-edge procedures. Dr. Godin’s focus is on customized and personalized care to meet the needs of each of his patients. Dr. Godin is located in Vail, Colorado at the renowned Steadman Clinic where national and international patients seek care. Contact the Steadman Clinic to schedule a consultation with Dr. Godin.