Femoroacetabular Impingement and Early Hip Arthritis

Femoroacetabular impingement (FAI) is a condition characterized by the abnormal shape of the ball-and-socket hip joint. The importance of FAI in the development of hip-joint arthritis, and the treatment that is best suited for the condition, is a subject of great debate.

FAI Defined

FAI is a condition that occurs when there is an abnormal shape of the ball-and-socket hip joint causing restricted movement. We all have a slightly different shape to our bones, and some people have a more abnormal shape of the ball and/or socket of the hip. In these individuals, bone spurs can form around the hip joint. When the hip is bent or turned, these bone spurs can come into contact, causing the characteristic impingement of FAI.

People who have FAI often have hip-joint pain. Typically the pain is felt in the groin, although people with FAI may also have pain in the front of the hip or in the buttocks. In addition to bone spurs around the joint, individuals with FAI also can have damaged cartilage in the hip and labral tears of the hip.

FAI and Hip Arthritis

In recent years, more surgeons have speculated that FAI is a risk factor for developing hip-joint arthritis. It is clear that people who have FAI do have a higher chance of ultimately requiring total hip replacement surgery, particularly if they have a cam lesion (bone spur is on the ball of the ball-and-socket hip joint). The progression of hip arthritis in individuals with pincer lesions (bone spur on the socket of the ball-and-socket hip joint) is less clear, although it is also felt to be a risk factor for developing arthritis. Ultimately it is clear that while not the only risk for developing hip arthritis (other important factors include genetics, previous injuries

Treatment

The optimal treatment of FAI is unclear at this time. There has been great interest in surgical procedures to remove the bone spurs, called an osteoplasty, although the long-term effects of these surgical procedures are yet to be determined. On a positive note, these surgical procedures have shown very good results in relieving pain and improving motion in individuals with FAI causing hip pain who have failed more conservative treatments. 

In general, no treatment of FAI is recommended for individuals who don't have symptoms (FAI is only seen on an x-ray or MRI). In addition, most surgeons recommend trying non-surgical treatments before proceeding with surgical intervention to address FAI. These non-surgical treatments may include rest, activity modifications, anti-inflammatory medications, or cortisone injections.

Bottom Line

As mentioned earlier, the subject of the importance of FAI in developing arthritis and the best treatment for this condition are subjects of great debate. The bottom line is that no one really knows the answers, and while some surgeons have strong opinions on the subject, there is little long-term data to clearly demonstrate the answers to these questions. The clearest data shows that young to middle-aged individuals who have cam lesions of FAI are at much high risk for developing significant hip joint arthritis and ultimately requiring a total hip replacement.

The surgical procedure to remove bone spurs, an osteoplasty, can be very helpful in improving symptoms of individuals with FAI, but there is nothing to demonstrate that this will provide a long-term benefit or prevent the progression of arthritis.