Femoroacetabular Impingement (FAI) Overview
Femoroacetabular impingement (FAI) is a condition related to the way that the ball (head of the femur) and socket (acetabulum) of the hip fit together. When the ball and socket do not fit well together, repetitive motion of the hip socket can lead to degeneration and cartilage wear within the joint. Dr. Jeff Padalecki, hip specialist serving the greater Austin, Texas communities, specializes in FAI of the hip – both pincer impingement and CAM impingement.
FAI is a major contributing cause of early degenerative joint disease of the hip in young, active patients. It often causes damage to articular cartilage, which is the smooth surface of the ball and socket of the hip that protects the joint and allows it to move smoothly. FAI can also cause a separation or tear of the labral cartilage which is a soft tissue bumper that surrounds the socket. The labrum of the hip helps distribute joint fluid within the hip and is important for hip stability.
There are two main types of FAI – Pincer and CAM. The majority of patients will present with both which is also termed “Mixed Impingement”:
- Pincer Impingement: The socket (acetabulum) is too deep and has too much coverage in front which results in “pinching” of the labrum during hip flexion.
- CAM Impingement: The femoral head and neck connection is aspherical or not perfectly round. This loss of roundness contributes to abnormal contact between the ball and socket during hip flexion which causes excessive grinding against the cartilage inside the joint and tearing of the labrum.
Femoroacetabular Impingement (FAI) Symptoms
The typical symptoms of femoroacetabular impingement include hip pain primarily toward the inside of the hip and a loss of hip motion. Movements such as turning, twisting and squatting may cause sharp stabbing pain.
Femoroacetabular Impingement (FAI) Diagnostic Testing
Dr. Padalecki will discuss your symptoms and conduct a procedure called an impingement test, where he brings your knee up towards your chest and then rotates it inward towards your opposite shoulder. If this recreates your hip pain, the test result is positive for impingement. Dr. Padalecki will also most likely use digital imaging techniques to confirm the diagnosis. X-rays determine if the bones are misshapen, but an MRI (magnetic resonance imaging) will find damage to the labrum and articular cartilage within the hip. Sometimes, an injection into the hip joint can confirm the diagnosis and rule out other potential sources of hip pain.
Femoroacetabular Impingement (FAI) Treatment
Patients with FAI are potentially at risk for future joint damage. Seeking treatment as soon as symptoms appear has been shown to yield better long-term results, whether non-invasive or surgical.
Treatment varies depending on the severity of the diagnosis and the associated symptoms. Dr. Padalecki may recommend changing your daily routine and avoiding activities that cause symptoms if at all possible. The use of a combination of physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and rest will also help alleviate pain and stiffness.
In more chronic cases, surgery can be a viable option to relieve the symptoms that impact everyday activities. Dr. Padalecki utilizes an arthroscopic procedure to repair damage to the labrum and articular cartilage, which could include trimming the bony rim of the socket in cases of pincer impingement, or shaving down the bump on the ball for cases of CAM impingement.
Dr. Padalecki will provide a specific physical therapy program following hip surgery at your first post-op visit. It’s important to follow these exercises both with a therapist and at home in order to establish normal range of motion. The goal of physical therapy is full mobility with eventual resumption of normal activities.
For more information on femoroacetabular impingement (FAI), or to learn more about arthroscopic hip surgery, please contact Dr. Jeff Padalecki, hip specialist in Austin, Texas.