From the Guidelines
Treatment for femoroacetabular impingement syndrome (FAI) should begin with conservative measures, including physiotherapist-led treatment, as recommended by the international hip-related pain research network 1. The goal of treatment is to alleviate pain, improve function, and prevent progression to osteoarthritis. Conservative treatment includes:
- Activity modification to avoid painful movements
- Physical therapy focusing on core strengthening and hip mobility exercises (3-4 sessions weekly for 6-8 weeks)
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain relief
- Intra-articular corticosteroid injections may provide temporary relief for some patients
If conservative treatment fails after 3-6 months, surgical intervention may be considered, with arthroscopic surgery being the most common approach 1. This procedure reshapes the bone to eliminate impingement, repairs labral tears, and addresses cartilage damage. The specific surgical technique depends on the type of impingement (cam, pincer, or mixed). Post-surgical rehabilitation is crucial and typically involves protected weight-bearing for 2-4 weeks followed by progressive physical therapy for 3-6 months. Key considerations in treatment include:
- Early intervention to prevent progression to osteoarthritis
- Individualized treatment plans based on patient-specific factors, such as age, activity level, and severity of symptoms
- A multidisciplinary approach, including physiotherapy, pain management, and surgical intervention as needed.
From the Research
Treatment Options for Femeroacetabular Impingement Syndrome
The treatment for femeroacetabular impingement syndrome (FAIS) can be divided into non-operative and operative management.
- Non-operative management includes supervised physical therapy programs that focus on active strengthening and core strengthening, which have been shown to be more effective than unsupervised, passive, and non-core-focused programs 2.
- Operative management, on the other hand, involves hip arthroscopy, which has become a common treatment option for FAIS, with excellent outcomes reported in several studies 3, 4, 5.
Non-Operative Management
Non-operative management is often considered the first-line treatment for mild to moderate FAIS syndrome.
- This approach includes physical therapy exercises that aim to improve hip strength, mobility, and motor control 3, 2.
- Intra-articular hyaluronic acid and platelet-rich plasma (PRP) injections have also been shown to be promising adjunct treatment options 2.
Operative Management
Operative management is typically considered for patients with severe FAIS syndrome or those who have not responded to non-operative management.
- Hip arthroscopy is the most common surgical treatment option for FAIS, and it has been shown to demonstrate improved short-term outcomes over physical therapy in young active patients 2.
- However, the decision to undergo surgery should be made on a case-by-case basis, taking into account factors such as the patient's age, timing to return to sport, longevity of treatment, hip morphology, and degree of cartilage degeneration 2.
Comparison of Treatment Outcomes
Several studies have compared the outcomes of non-operative and operative management for FAIS.
- A randomized controlled trial found that both arthroscopic hip surgery and physical therapy resulted in significant improvements in patient-reported outcomes, but there was no significant difference between the two groups at 2-year follow-up 6.
- Another study found that hip arthroscopy demonstrated improved short-term outcomes over physical therapy in young active patients, but the long-term outcomes were similar 2.