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More Important Information on Femoroacetabular Impingement

Posted on: 10/14/2010
Dr. J. W. Byrd, a prominent orthopedic surgeon at the Nashville Sports Medicine Foundation presents part two of a two-part series on femoroacetabular impingement (FAI) in athletes. This article focuses on treatment and what to expect after treatment.

Femoroacetabular impingement (FAI) occurs in the hip joint. 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.

Although we know a lot about the causes of this condition, what to do about it remains in question. Can it be prevented is the first question. Should we even try to prevent it is the next question.

Some athletes have abnormally shaped hips but don't ever develop symptoms. It has been suggested that we need to figure out who is at risk for pain and other problems from FAI before launching into a prevention program for everyone.

On the other hand, if some easy screening tests were done to find athletes at risk, then perhaps a careful wait-and-watch program would be helpful. Or maybe some simple changes in activity would be all that is needed. Preventing substantial changes in the hip and the need for surgery would be a worthy goal.

Conservative (nonoperative) care really requires early recognition. So, it's a "catch-22" kind of situation. There's no evidence that screening and prevention help but without catching the problem early, conservative care quickly gets replaced by a more invasive approach with surgery.

What kind of treatment is available right now? On the conservative side, there's not a lot to offer. Athletes are told to avoid full squats (especially during weight training) because this position really compresses the hip joint.

Every effort is made to maintain joint motion but the abnormal shape of the hip makes this difficult as well. At the very least, athletes are encouraged to keep up with their core strength training to help them compensate for lost motion.

When the athlete is unable to get relief from pain with a conservative approach, surgery is often advised. Surgery is also recommended when imaging studies show damage to the joint. Dr. Byrd presents a detailed description of the kinds of arthroscopic surgical procedures that can be done to treat femoroacetabular impingement.

With the arthroscope inserted into the joint, the surgeon takes a careful look around to see what's going on inside the hip. If there are any loose fragments or frayed edges of the cartilage, these are removed or shaved off. This procedure is called a debridement. Every effort is made to preserve this rim of cartilage around the hip socket called the labrum.

The surgeon can use high-speed surgical tools to remove bone and reshape the head of the femur and the acetabulum (hip socket). Any other damage to the hip socket or surrounding structures is repaired. With drawings and photos taken inside the hip during arthroscopic surgery, Dr. Byrd shows how each type of impingement can be surgically corrected.

The postoperative recovery period may include a specific rehabilitation program. It depends on what the surgeon did. A simple debridement requires less postoperative caution than reshaping and repair procedure. The concern is for regaining hip motion, maintaining joint stability, and preventing complications.

The more complex procedures will require the athlete to keep weight off the hip and avoid twisting motions for at least a month. This can be accomplished by using crutches. The athlete is gradually allowed to return to light activities at first. Avoiding twisting motions is enforced for a full three months. It will be six months or more before the athlete is allowed to return to full sports participation.

What can the patient expect after it's all said and done? Will the remodeled hip hold up? Will it be possible to resume an athletic career? Let's take these questions one at a time. What to expect: the joint will never be "normal" after surgery. But the changes made will allow many athletes to return to the sports they love.

Studies done so far show that up to 90 per cent of athletes with femoroacetabular impingement repaired surgically get back to their previous level of sports participation. With longer follow-up, other studies have shown that this number dwindles over time.

There is some evidence that arthroscopic surgery yields better results than open surgery. More study is needed to confirm this is true and perhaps identify which athletes would do better with arthroscopic versus open surgery.

J. W. Thomas Byrd, MD. Femoroacetabular Impingement in Athletes, Part II: Treatment and Outcomes. In Sports Health. September/October 2010. Vol. 2. No. 5. Pp. 403-409.

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