Hip Sports Injury – Femoro Acetabular Impingement (FAI)

Hip Femoro Acetabular Impingement (FAI)

What is FAI?

In femoral acetabular impingement there is formation of extra bone as a bump at the head/neck junction of the femur (Ball) of the hip joint, it is called a CAM lesion. Extra bone can also form along the rim of the acetabulum (socket) of the hip joint known as a PINCER lesion. They can occur in isolation or as in the majority of cases they are both present together giving a mixed impingement picture of FAI. When the hip moves into certain positions there is conflict between the two and this can cause damage to the labrum and articular cartilage (lining of the joint).

 

 

What are the symptoms?

Most commonly there is restriction of hip movements, that are noticed some time before any severe pain and restriction of activity occurs. There is a deep seated groin pain made worse by activity and exertion, inability to play sport, back pain and disturbed sleep. At times the hip may click, give a feeling of catching, giving way and sometimes a locking sensation.

 

What investigations are needed?

Radiographs in different views.
MR arthrogram is the gold standard investigation, which involves the injection of a small amount of dye into the hip followed by the MRI scan.
A CT Scan with 3 D reconstruction gives additional information.

How can it be managed?

Initially conservative measure are utilised to help with the pain and disability which include:
• Activity level and lifestyle can be modified
• Physical therapy with a individualised exercise programme.
• Simple painkillers, anti–inflammatory medication and supplements can be of help.
• Injection with a steroid and local anaesthetic into the hip joint and or Hyaluronic acid (viscosupplements) an artificial synovial fluid this is carried out under X ray control. These may be of help, as well as confirming the pain is from the hip joint.

When all these interventions fail then hip arthroscopy may be the next option, Mr Aslam Mohammed will discuss this with you in detail.

What does the surgery involve?

Once access has been obtained the hip joint is examined in detail, particularly the labrum to see if it can be preserved, repaired or require debridement. The pincer is assessed and will be removed using a power burr. The cam lesion at the head and neck junction is seen in the peripheral part of the hip joint will be removed and the movement of the femoral head into the acetabulum will be observed to ensure that impingement has been rectified.

Click for details of the procedure of Hip Arthroscopy

 

What are the risks?

Click for details of risks of Hip Arthroscopy

 

What are the outcomes?

Click for details of outcomes of Hip Arthroscopy


CASE EXAMPLE

AF 24 year’s old male patient of Mr Aslam Mohammed’s, who presented with pain in right hip and groin, restricted movements and limitation of activity. He was no longer able to play football.
He had already seen a number of specialists.

1. Repaired labrum with two anchors

2. View at hip arthroscopy showing the labrum has been repaired, the CAM is shown. The CAM is then removed with a burr and the seal around femoral head is checked, as is the range of movement to ensure that there is no impingement.

He was seen at six months post-surgery and had no pain, full range of movement and able to return to playing football with no restrictions.