From the Guidelines
Management of Femoroacetabular Impingement (FAI) should prioritize conservative measures, including physiotherapist-led treatment, as the initial approach for young to middle-aged active adults with hip-related pain, as recommended by the international hip-related pain research network 1. The goal of management is to alleviate symptoms, improve function, and prevent progression to osteoarthritis. Conservative management options include:
- Activity modification to avoid exacerbating activities
- Physical therapy focusing on core strengthening and hip mobility
- Pain management with NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily)
- Intra-articular corticosteroid injections for temporary relief in patients with significant inflammation If conservative management fails after 3-6 months, surgical intervention may be considered. The choice between conservative and surgical management depends on symptom severity, degree of impingement, presence of cartilage damage, patient age, activity level, and comorbidities, with a focus on improving quality of life and reducing morbidity and mortality 1. Surgical options include arthroscopic surgery, which is the most common approach, involving reshaping of the femoral head (cam lesion), acetabular rim trimming (pincer lesion), and labral repair when necessary. Open surgical dislocation is reserved for complex cases requiring extensive reconstruction. Post-surgical rehabilitation is crucial, typically lasting 3-6 months with gradual return to activities, to ensure optimal outcomes and minimize complications 1. Diagnostic imaging, including anteroposterior (AP) pelvis and lateral femoral head–neck radiographs, and MRI/magnetic resonance arthrogram (MRA) or CT scan when indicated, should be used in conjunction with clinical signs and symptoms to guide management decisions 1. Key considerations in management include:
- Early intervention to prevent progression to osteoarthritis
- Individualized treatment plans based on patient factors and symptom severity
- Multidisciplinary approach, including physiotherapy, pain management, and surgical intervention when necessary
- Regular follow-up and monitoring to adjust treatment plans as needed.
From the Research
Management Options for Femoroacetabular Impingement (FAI)
The management of FAI can be broadly categorized into conservative and surgical approaches.
- Conservative management includes physical therapy, intra-articular injections, patient education, activity modification, manual therapy, and strengthening 2.
- Surgical management involves arthroscopic or open surgery to correct the deformity causing impingement 3, 4.
Conservative Management
Conservative management is often the first line of treatment for FAI, aiming to reduce pain and improve function.
- A systematic review and meta-analysis found that conservative interventions, including physical therapy and intra-articular injections, are effective in reducing pain and improving function in the short term 2.
- Another study found that an initial 3-month trial of conservative treatment can lead to significant improvements in clinical outcomes, with 54.6% of patients able to perform normal daily activities without surgery 4.
Surgical Management
Surgical management is considered when conservative treatment fails to improve symptoms.
- A systematic review found that surgical treatment, particularly arthroscopic treatment, can offer superior short-term results compared to conservative care alone 3.
- However, the decision to undergo surgery depends on various factors, including the severity of symptoms, patient age, and extent of degenerative lesions 5.
Postoperative Rehabilitation
After surgical management, a structured physical therapy program is essential for rehabilitation.
- A contemporary review recommends a four-phase postoperative physical therapy protocol, aiming to protect the surgically repaired tissues, reduce pain and inflammation, and regain functional independence 6.
- The protocol includes goals, restrictions, precautions, and rehabilitation techniques for each phase, ultimately aiming to return the patient to their previous level of physical activity.