Hip - Femoroacetabular Impingement
Description
FAI is not true arthritis by definition. However, FAI is overgrowth of bone on either the “ball” (aka – CAM lesion) or “socket” (aka – Pincer lesion). A CAM lesion results is extra bone formation or a bump on the femur (thigh bone) and can impinge on the socket with motion. A Pincer lesion is extra bone formation on the acetabulum (pelvis). When the leg is brought to extreme ranges of motion, it will impinge on the Pincer. A patient with FAI can have an isolated CAM or an isolated Pincer, but most often will have a combination of both types of FAI, causing impingement and ultimately degeneration of the joint cartilage and soft tissue surrounding the joint (labrum).
What are the causes?
FAI is usually a combination of anatomical anomalies and abnormal stresses, typically from sports activities.
What are the symptoms?
FAI causes pain (particularly in the groin), decreased motion and strength. Clicking may also be felt in the hip if the soft tissue around the socket (labrum) is torn in conjunction with the FAI.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. Pain with provocative maneuvers will increase pain, leading to the diagnosis of FAI. X-rays will demonstrate extra bone formation on the femur, the acetabulum, or both. Your surgeon may order additional diagnostic tests to evaluate all hip structures (CT/”CAT” scan) to better evaluate the fracture or MRI to evaluate the muscles, tendons and ligaments.
Non-operative
Historically, non-operative treatment consisted of rest, anti-inflammatory medication and activity modification. Patients were often advised to “wait until the arthritis got bad enough” before having hip replacement. Current non-operative treatment may include the above treatments with a specific physical therapy program dedicated toward treating FAI.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the hip. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Operative treatment of non-arthritic FAI consists of a minimally-invasive hip arthroscopy to treat the underlying pathology. Arthroscopic removal of extra bone on both the femur (aka – osteoplasty) and acetabulum (aka – rim trimming) is performed, as well as repair of any other pathology in and around the hip joint. Labral repair is commonly performed in conjunction with osteoplasty and rim trimming. Hip arthroscopy may delay the onset of hip arthritis. Over time, patients with FAI ultimately continue to progress to arthritis.
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