From the Research
The initial treatment for a patient with cam-type femoroacetabular impingement (FAI) is conservative, non-surgical management. This approach is based on the most recent and highest quality study available, which suggests that conservative treatment can lead to significant improvement in symptoms and function for many patients 1. The conservative management typically begins with activity modification to avoid movements that exacerbate symptoms, particularly those involving hip flexion and internal rotation. Patients should temporarily reduce high-impact activities and sports that aggravate their symptoms.
Some key points to consider in the conservative management of CAM deformity include:
- Physical therapy is a cornerstone of treatment, focusing on core strengthening, hip stabilization, and improving range of motion without impingement.
- Anti-inflammatory medications such as NSAIDs (e.g., ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) can help manage pain and inflammation for short periods, typically 1-2 weeks.
- For persistent pain, intra-articular corticosteroid injections may provide temporary relief and can be diagnostic.
- This conservative approach is recommended for at least 3-6 months before considering surgical options.
It's worth noting that the presence of a cam deformity represents a significant risk factor for the development of hip pain, and an elevated alpha angle at the 1:30 clock position and decreased internal rotation are associated with an increased risk of developing hip pain 2. However, not all patients with a cam deformity develop hip pain, and further research is needed to better define those at greater risk of developing degenerative symptoms.
In some cases, physical therapy may not be successful, particularly when femoral anteversion is less than 16° and α-angle is greater than 65°, and surgery may be necessary to address the underlying bony deformity 1. The rationale behind the conservative approach is to reduce inflammation around the impingement site and strengthen supporting musculature to improve biomechanics, potentially decreasing the abnormal contact between the femoral head and acetabulum that causes pain and cartilage damage. While conservative treatment cannot correct the underlying bony deformity, many patients experience significant symptom improvement without requiring surgery.