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What is Femoracebatular Impingement (FAI)?

Femoroacetabular Impingment (FAI) is when the femoral neck (ball) and the acetabulum (socket) do not fit together or work together well.  These parts of your hip should work seamlessly together, but when a patient has FAI, it can create soft tissue damage in your labrum and possibly cause arthritis.

How prevalent is the need for hip arthroscopy?

That is a very tough question to answer.  There are many people that have the bony abnormalities and even labral tears and exhibit no symptoms.  However, the medical research is showing that the surgery to repair FAI in symptomatic patients has increased drastically.  One article stated that in the U.S. hip arthroscopy had ballooned by 365% between 2004 and 2009.  

Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29(4):661–665. 

What type of doctor should I see if I think I may have FAI?

Ideally, you should choose an orthopedic doctor who is fellowship trained in Hip Preservation.  There are many orthopedists who do this type of surgery. If they are not fellowship trained, you should, at least choose an orthopedist, who is considered a "high volume" surgeon.  According to an article in the Journal of Hip Preservation Surgery, an average of 162 cases per year with the range being between 75-400 is a good bet.  The best chance to get this problem fixed happens with that first surgery.

Austin W Chen, Matthew J Steffes, Joseph R Laseter, David R Maldonado, Victor Ortiz-Declet, Itay Perets, Benjamin G Domb; The education and training of future hip preservation surgeons: aggregate recommendations of high-volume surgeons, Journal of Hip Preservation Surgery, Volume 5, Issue 3, 1 August 2018, Pages 307–311,

What are some ways to treat FAI?

Doctors and most insurance companies would like you to complete a period of "conservative treatment" which includes modifying your physical activity levels, a trial of medicines which are considered NSAIDs (anti-inflammatories), physical therapy and/or a cortisone injection into the joint. This time period can be between 3 and 6 months.  Additionally, if the pain and limitation is not resolving, you may be a candidate for arthroscopic hip surgery as determined by your doctor.

If my particular situation requires hip surgery, what should I expect?

Although hip arthroscopy is considered to be "minimally invasive", it can still be a challenging procedure to recover from.  It typically can include a period of restricted weight bearing and range of motion limitations.  Most patients will use crutches for several weeks.  Some may wear a brace to prevent flexion and extension of the hip for several weeks and others may not.  The expectation after surgery should be addressed by your surgeon and can depend on your health and strength going into the surgery as well as the extent of the repairs.

Where can I find research about FAI?

There is so much information on the internet and some of it is not reliable.  If you see a scientific journal or a website with a .org extension, most times the information will be research based and peer reviewed.  There are commercial websites that also unilaterally indicate that arthroscopic surgery is never effective and can be addressed by their protocol or product. That should be a red flag for you. Please talk with your surgeon, however, about your specific case and the prognosis before solely relying on journal articles to make decisions about treatment.

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