Everything You Should Know About Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI) is also called hip impingement. It gets its name from the affected joint — your hip, which is where the head of your thigh bone, the femur, forms a ball and socket joint with a part of the pelvis called the acetabulum. This painful condition can affect your mobility and eventually lead to osteoarthritis.

Chris Boone, MD, an orthopedic surgeon in Bellevue, Washington, is an expert at diagnosing and treating hip pain. Here, our team explains everything you need to know about FAI. 

What causes femoroacetabular impingement? 

Hip impingement occurs when something interferes with the smooth motion of the ball (the femoral head) within the socket (the acetabulum) of your hip joint. Sometimes with FAI, bone spurs, or growths, develop in the joint, causing abnormal contact between the hip bones.

Shape abnormalities of the hip also can impede its smooth motion. Conditions such as Legg-Calve-Perthes disease can cause shape abnormalities, More subtle shape abnormalities may also form early in life, such as little bumps that form on the ball’s surface called cam lesions, an overgrowth of the socket that covers too much of the ball, or an abnormal twist in your thigh bone, called femoral retrotorsion.

Impeding the smooth motion in the joint causes repetitive trauma that damages the cartilage of the socket. For this reason, hip impingement is believed to be one of the major causes of osteoarthritis of the hip, especially when it occurs in people under age 40.

What are the symptoms of FAI?

You can have FAI for many years without knowing it, because it’s not painful in the early stages. Symptoms initially include pain in your groin and a decreased range of motion of your hip. At first, you might only feel pain when the motion of your hip nears its limits, but as the condition worsens, you may start to feel pain during normal activities like walking uphill. 

When you begin having pain at night or when walking on level ground, it means the cartilage cushioning the ball is breaking down — this is called osteoarthritis. If your FAI goes untreated, your symptoms only worsen over time. 

How is FAI diagnosed?

Your doctor performs a physical examination and may order one or more imaging tests, such as an X-ray or MRI. It might be necessary to perform an arthroscopy; that is, insert a long, narrow tube with an attached camera into the joint. This is usually done when your hip pain persists despite nonsurgical treatments.

How is FAI treated? 

Dr. Boone focuses first on hip preservation. This includes treatments designed to maintain a healthy hip and delay more invasive options. These treatments might include modifying your activities, strengthening your hip muscles, and taking anti-inflammatory pain medications. It could also include weight loss and joint injections to relieve inflammation and promote healing. 

Should hip preservation methods fail, arthroscopy might be necessary. After inserting the arthroscope into the joint to visualize the problems, Dr. Boone can insert surgical tools through the same incision to try to correct the problems. FAI frequently requires this “hip scope.”

If all else fails or if the damage to the joint is extensive, a hip replacement may be necessary. Dr. Boone has extensive experience doing these kinds of surgeries. He uses robotic-assisted devices to allow for precision in the removal of damaged tissues and the placement of the prosthesis within the joint. Younger patients may be candidates for a bone preserving procedure called hip resurfacing. This is where a cap is placed on the femoral head and a metal socket is inserted. Patients with hip resurfacing procedures are able to return to almost all of their desired activities. 

The key to maintaining a healthy hip is in the early detection of problems and utilizing hip preservation treatments to avoid the need for surgery. Contact Dr. Boone when you first begin to feel hip pain. Doing so may mean avoiding more invasive treatments. No matter how far your FAI has progressed, Dr. Boone can create a treatment plan that is right for you. 

If you have FAI or think you might, contact our office today to begin the healing process. You can even book an appointment online.

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