Femoroacetabular Impingement (FAI) Diagnosis - What to do next?

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What to do once I’ve been diagnosed with hip impingement?

In part 1 of this blog, we discussed what FAI (or hip impingement) is, and how a diagnosis is made. The article may have rung some alarm bells for you, or perhaps you have been diagnosed as having hip impingement. The burning question now is, how can I fix it?

There are 2 different pathways involved when it comes to the management of true hip impingement- surgical or non-surgical. At times- they may coexist. As physiotherapists, we clearly are involved in the non-surgical approach, but it is important to shed light on both options.

What does physio involve?

The first thing that your physio will usually address is looking at the factors and movements that are aggravating the pain- and providing education and direction on how to correct these. We never want to take you away from your sport or hobby (unfortunately it may have to happen for some time), so we will discuss management strategies instead. A big focus is placed on building up your strength and control through your glute (butt) muscles and carrying this over to movements you typically complete during your sporting activity. If required, we will also combine this with manual techniques, with an aim of reducing any soft tissue restrictions and improving the hip joint’s mobility. 1

What does the surgery involve?

With the bony changes that are found with hip impingement- surgical management aims to improve the congruency of the ball and socket aspect of the hip joint. This will typically be done with arthroscopic (‘key-hole’) surgery, unless the imaging findings are quite unusual compared to ‘typical’ FAI. Depending on type of lesion found (part 1), the surgeon will remove the area of concern, in order to stop that area causing the bone impingement. If there is damage to the lining of the socket, this will also be repaired. Hip arthroscopy is typically a day procedure, and most surgeons with have specific physiotherapy protocols to follow during the rehab timeframe. 2

Is one better than the other?

In a recent consensus statement from international experts, it was agreed that rehab and surgical management can both be suitable management options. 3 An interesting point is that from late 2016, arthroscopic surgery for hip impingement symptoms was removed from the Medicare Benefits Scheme, potentially indicating that the government could not justify the cost for the number of surgeries that were being undertaken at the time. As FAI is quite a ‘new’ condition, there still lacks a massive amount of evidence that shows one option is better than other. With this in mind, we would typically commence a period of conservative rehab management, before exploring invasive surgical options.

IF YOU’RE STRUGGLING WITH HIP PAIN SIMPLY CONTACT THE CLINIC ON 5174 7250 or BOOK ONLINE with myself or one of our expert Physio's below. We can't wait to help get you back to your best!

AUTHOR: JARRYD CROXFORD - Physiotherapist

1 Mansell, N. S., Rhon, D. I., Meyer, J., Slevin, J. M., & Marchant, B. G. (2018). Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. The American Journal of Sports Medicine46(6), 1306-1314.

2 Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research417, 112-120.

3 Griffin, D. R., Dickenson, E. J., O'donnell, J., Awan, T., Beck, M., Clohisy, J. C., ... & Hölmich, P. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine50(19), 1169-1176.