Femoracetabular Impingement Syndrome: What's the Best Approach - Surgery or Conservative Treatment?

Femoracetabular Impingement Syndrome (FAI) is a growing concern that can considerably affect the quality of life for many individuals. With more people leading active lifestyles, recognizing the implications of FAI and its treatment choices is essential. In the last year, I attended a webinar about this by Alexis A. Wright, PT, PhD, OCS, FAAOMPT. She stated that newer evidence suggests that conservative management (Physical Therapy) may be equally effective as surgical treatment. Surgery did not demonstrate greater improvement in pain, function, or quality of life when compared to conservative treatment.

What is Femoracetabular Impingement Syndrome?

Femoracetabular Impingement occurs when there is abnormal contact between the femoral head—the ball of the hip joint—and the acetabulum, the hip socket. This contact can lead to pain, limited movement, and eventual osteoarthritis if ignored. The condition has three main types: cam, pincer, and combined impingement.

Understanding the specific type of impingement helps in determining the best treatment approach. For example, individuals with cam impingement may experience extra bone growth on the femoral head, while those with pincer impingement often have an overgrown acetabulum that confines movement.

Symptoms of FAI

People with FAI report a variety of symptoms, which can vary in intensity. Key signs include:

1. Hip or Groin Pain: This pain often worsens with extended periods of sitting or during activities like running. Studies indicate that about 75% of individuals with FAI experience pain in these areas.

   
   

2. Limited Range of Motion: Affected individuals may struggle with tasks that involve hip flexion, such as squatting or twisting. Research shows that range of motion can be reduced by up to 40%.

   
   

3. Clicking or Locking Sensations: Some may notice clicking sounds or sensations in the hip when moving. This can be disruptive and may indicate further joint issues.

   
   

Recognizing these symptoms is critical for individuals seeking effective treatment.

Conservative Treatment Options

Before jumping into surgery, many healthcare professionals recommend starting with conservative treatments. These commonly include:

1. Physical Therapy: Engaging in targeted exercises can help strengthen hip muscles and enhance mobility. For example, studies revealed that around 60% of patients reported significant symptom relief after following a structured physical therapy program for six weeks.

   
   

2. Activity Modification: Evaluating and adjusting daily activities is vital. This may involve reducing high-impact exercises or repetitive movements that aggravate the condition.

   
   

3. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

   
   

While many patients find relief through these conservative methods, some might continue to experience pain that warrants further evaluation for surgical options.

Surgical Treatment Options

When conservative methods fail after a reasonable period and symptoms significantly interfere with daily functions, surgery may be necessary. Common surgical options include:

1. Arthroscopic Surgery: In this minimally invasive procedure, surgeons reshape the bone structures causing impingement. Research shows that approximately 80% of patients experience positive outcomes following this surgery.

   
   

2. Open Surgery: For more complicated cases requiring extensive repair, open surgery may be necessary. This procedure is more invasive but allows better access to the hip joint.

   
   

3. Hip Resurfacing or Replacement: For individuals who develop advanced osteoarthritis as a complication, joint resurfacing or replacement can restore function. Studies suggest that about 90% of patients achieve considerable improvement post-surgery.

   
   

Choosing surgery typically follows a thorough evaluation, considering factors like age, level of activity, and symptom severity.

Making the Right Choice: Surgery vs. Conservative Treatment

Deciding between surgery and continuing conservative care can be tough. Here are key factors to consider:

1. Symptom Severity: If conservative treatments do not relieve symptoms over a few months, surgery may be a sensible next step.

   
   

2. Age and Activity Level: Younger patients or those involved in sports may lean towards surgery to regain full functionality faster.

   
   

3. Health Conditions: Patients facing other health issues might initially prioritize non-invasive options.

   
   

4. Personal Goals: Understanding which activities matter most to you is essential for guiding your treatment decision.

   
   

Ultimately, working closely with a qualified orthopedic specialist helps in making an informed choice.

Snowboarder.

Final Thoughts

Femoracetabular Impingement Syndrome can greatly impact one's lifestyle and activity levels. Deciding whether to pursue surgery or conservative care requires careful consideration of symptoms, personal goals, and overall health. Engaging with healthcare professionals and exploring all options allows those affected by FAI to find a path that best meets their individual needs. By staying informed, individuals can navigate their treatment choices with confidence, aiming for a successful recovery.

Wright pointed out that Physical Therapy should not be the usual clinic approach. The exercises given need to be performed in a weight-bearing position with a triplanar and eccentric focus, high speed, and high endurance that is task-specific and replicates the triplanar pelvifemoral relationship that occurs during activity.

In essence, whether your journey involves surgery or conservative care, understanding the implications and treatment options for FAI is crucial for regaining an active and fulfilling life.

#LiveInspired,

Karen Baltz Gibbs, DPT, CSCS, LMT, CMP, Owner Garage Training & Rehab Gym

Website: www.garagetrainingrehabgym.com