From the Guidelines
Femoroacetabular impingement (FAI) management should prioritize conservative approaches, including physiotherapist-led treatment, before considering surgical intervention, as recommended by the international hip-related pain research network in 2018 1. The goal of FAI management is to alleviate hip-related pain, improve physical activity, and enhance quality of life. According to the study published in the British Journal of Sports Medicine in 2020 1, physiotherapist-led treatment is a recommended approach for young to middle-aged active adults with hip-related pain, including those with FAI syndrome. Key components of conservative management include:
- Activity modification to avoid painful movements
- Physical therapy focusing on core strengthening and hip mobility exercises
- Pain management with NSAIDs, such as ibuprofen or naproxen, for short-term relief during pain flares
- Intra-articular corticosteroid injections for temporary relief in patients with significant inflammation If conservative management fails after 3-6 months, surgical options, such as arthroscopic procedures to reshape the femoral head or trim the acetabular rim, may be considered. Post-surgical rehabilitation is crucial and typically lasts 3-6 months. The specific approach to FAI management should be tailored to the patient's age, activity level, symptom severity, and the specific type of impingement (cam, pincer, or mixed), as highlighted in the study by Kemp et al. in 2020 1.
From the Research
Femoroacetabular Impingement Management
Femoroacetabular impingement (FAI) is a common condition that can cause hip pain and limited mobility. The management of FAI can be conservative or surgical.
- Conservative management includes physical therapy and intra-articular injections, which have been shown to be effective in reducing pain and improving function in the short-term 2.
- Physical therapy has been found to have moderate to large effect sizes in improving pain and function, with common treatments including patient education, activity modification, manual therapy, and strengthening 2.
- Intra-articular injections have also been found to be effective, although with smaller effect sizes compared to physical therapy 2.
Surgical Management
Surgical management of FAI includes open and arthroscopic approaches, which aim to restore normal hip biomechanics and reduce pain.
- Arthroscopic surgery has been found to have comparable long-term pain reduction and improvements in clinical measures of hip function compared to open surgery, with earlier improvement, quicker recovery, and faster return to sports 3.
- Surgical management has been found to offer superior short-term results compared to conservative care only, although further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to FAI 4.
Comparison of Conservative and Surgical Management
Studies have compared the effectiveness of conservative and surgical management of FAI, with mixed results.
- A randomized controlled trial found that both arthroscopic surgery and physical therapy resulted in statistically significant improvements in patient-reported outcomes, although there was no significant difference between the groups at 2 years 5.
- A systematic review and meta-analysis found that supervised physiotherapy programs focusing on active strengthening and core strengthening were more effective than unsupervised, passive, and non-core focused programs 6.
- Another systematic review found that surgical management seemed to offer superior short-term results compared to conservative care only, although further trials are needed to determine the best approach 4.