Femoroacetabular Impingement and Early Hip Arthritis

Femoroacetabular impingement (FAI) is a condition characterized by the abnormal shape of the ball-and-socket hip joint. FAI is associated with hip-joint arthritis, and there are a number of different treatment options.

Physical therapist manipulating patient's leg
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FAI Defined

With FAI, the alteration in the shape of the ball-and-socket hip joint causes restricted movement. Sometimes, bone spurs can form around the hip joint. You can also have damaged cartilage in the hip and labral tears of the hip with FAI.

When the hip is bent or turned, the bone spurs can cause the characteristic impingement of FAI, which produces the symptoms. FAI is often associated with hip-joint pain. Typically the pain is felt in the groin, and it can also affect the front of the hip or in the buttocks. 

FAI and Hip Arthritis

FAI is considered a possible risk factor for hip-joint arthritis. Having FAI increases the chance that you will ultimately need to have a total hip replacement surgery, particularly if you have a cam lesion—a bone spur on the ball of the ball-and-socket hip joint. 

The progression to hip arthritis with pincer lesions—a bone spur on the socket of the ball-and-socket hip joint—is less clear, although a pincer lesion is also considered to be a risk factor for developing arthritis.

Ultimately it is clear that FAI is not the only risk for developing hip arthritis—other important factors include genetics and previous injuries.

Treatment

The optimal treatment of FAI is unclear at this time. In general, treatment for FAI is not recommended when the condition isn't causing symptoms, such as when it is only seen incidentally on an x-ray or MRI.

Most surgeons recommend trying non-surgical treatments to relieve symptoms before considering surgical treatment of FAI. Non-surgical treatments may include rest, activity modifications, anti-inflammatory medications, or cortisone injections.

An osteoplasty is a surgical procedure in which bone spurs are removed. This procedure has shown very good results in relieving pain and improving motion when FAI associated hip pain hasn't improved with more conservative treatments. The long-term effects of these surgical procedures are yet to be determined, however.

Bottom Line

The significance of FAI in arthritis, as well as the optimal treatment approach for this condition, are subjects of great debate. Young to middle-aged individuals who have cam lesions of FAI are at a higher risk for developing significant hip joint arthritis and ultimately requiring a total hip replacement. Currently, the best treatment approach in these cases isn't well established.

An osteoplasty can help improve symptoms of FAI, but it hasn't been shown to provide a long-term benefit or prevent the progression of arthritis.

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