What is the treatment for Femoral Acetabular Impingement (FAI) syndrome?

From the Guidelines

Treatment for Femoral Acetabular Impingement (FAI) syndrome typically begins with conservative approaches, including activity modification, physical therapy, and pain management, before considering surgical options like arthroscopic surgery to reshape the bone and repair labral tears, as recommended by recent studies 1. The initial treatment approach for FAI syndrome involves a combination of non-surgical methods, including:

• Activity modification to avoid movements that worsen symptoms
• Physical therapy focusing on core strengthening and hip mobility exercises (3-5 sessions per week for 6-12 weeks)
• Pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) Intra-articular corticosteroid injections may provide temporary relief for some patients. If conservative measures fail after 3-6 months, arthroscopic surgery may be recommended to reshape the bone (femoroplasty for cam impingement or acetabuloplasty for pincer impingement) and repair labral tears, as supported by studies like Karthikeyan et al 1. Post-surgical rehabilitation is crucial and typically lasts 3-6 months. FAI syndrome occurs when abnormal bone shapes in the hip joint cause friction during movement, leading to labral tears and cartilage damage. Early intervention is important as untreated FAI can lead to osteoarthritis. The choice between conservative and surgical management depends on symptom severity, activity level, and the patient's specific anatomy, with patient expectations and goals playing a significant role in management success, as highlighted by the first international hip-related pain research network (ihiprn) meeting 1. Some key points to consider in the management of FAI syndrome include:
• Quantifying patient expectations regarding their return to physical activity
• Discussing accurate and balanced information about intervention benefits and harms with patients
• Providing opportunity to develop realistic expectations and make informed decisions
• Regularly re-evaluating the fulfilment of expectations throughout the management process.

From the Research

Treatment Options for Femoral Acetabular Impingement Syndrome

The treatment for Femoral Acetabular Impingement (FAI) syndrome can vary depending on several factors, including the pathomorphology, severity of symptoms, patient's age, and extent of degenerative lesions 2. The primary goal of treatment is to reduce pain, achieve a physiological range of movement, and stabilize the hip, while also delaying the onset of secondary osteoarthritis in the long term.

Nonoperative Management

Nonoperative management of FAI syndrome can be effective in a majority of adolescent patients, with significant improvements in patient-reported outcomes (PROs) persisting at a mean 5-year follow-up 3. This approach typically involves a trial of rest, physical therapy, and activity modification, with the option of intra-articular steroid injections for patients who remain symptomatic.

Surgical Intervention

Surgical treatment of FAI syndrome often involves arthroscopic management, which has become the most common form of surgical management for this condition 4. Arthroscopic treatment typically includes osteoplasty and labral repair, with the goal of improving hip function and reducing pain. The choice of surgical technique and postoperative protocol can vary between surgeons, but studies have shown that patient-reported outcome measures (PROMs) can be similar across different institutions and surgeons 5.

Key Considerations

When considering treatment for FAI syndrome, several key factors should be taken into account, including:

• The type and severity of the impingement (cam or pincer)
• The patient's age and activity level
• The extent of degenerative lesions
• The presence of any underlying hip conditions
• The patient's overall health and medical history

Treatment Modalities

Some of the treatment modalities that may be used to manage FAI syndrome include:

• Conservative management (rest, physical therapy, activity modification)
• Intra-articular steroid injections
• Arthroscopic surgery (osteoplasty, labral repair)
• Open surgical dislocation (in cases where arthroscopic management is not possible or effective)
• Combined mini-open approaches (in cases where both arthroscopic and open techniques are used)

Outcomes and Prognosis

The outcomes and prognosis for FAI syndrome can vary depending on the treatment approach and individual patient factors. Studies have shown that nonoperative management can be effective in a majority of adolescent patients, while arthroscopic treatment can provide significant improvements in PROMs for patients with more severe symptoms or degenerative lesions 3, 5. However, the long-term outcomes and prognosis for FAI syndrome are still being studied, and further research is needed to fully understand the effectiveness of different treatment approaches.