From the Guidelines
Management of femoroacetabular impingement (FAI) in the emergency department should focus on symptom control and appropriate disposition, with an emphasis on ruling out more serious conditions and providing symptomatic relief. The primary goal is to alleviate pain and inflammation, and to prevent further injury. According to the most recent and highest quality study, physiotherapist-led treatment is recommended for young to middle-aged active adults with hip-related pain, including FAI syndrome 1.
Key Components of Management
- Begin with NSAIDs such as ibuprofen 400-800mg every 6-8 hours or naproxen 500mg twice daily for pain and inflammation
- Acetaminophen 1000mg every 6 hours can be added for additional pain relief
- Rest, ice application for 15-20 minutes several times daily, and activity modification to avoid painful movements are essential
- Consider a short course of muscle relaxants like cyclobenzaprine 5-10mg at bedtime for associated muscle spasms
- Patients should be discharged with crutches if weight-bearing is painful, with instructions to follow up with orthopedics or sports medicine within 1-2 weeks
Importance of Early Detection and Management
Early detection and management of FAI syndrome are crucial to prevent further damage and degeneration of the joint. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain is essential for progression of the field and to provide recommendations for clinical practice 1.
Role of the Emergency Department
The ED's role is primarily to rule out more serious conditions like fracture or septic arthritis, provide symptomatic relief, and ensure appropriate outpatient follow-up for definitive management, which may eventually include physical therapy, injections, or surgical intervention. Joint-preserving surgical options, such as hip arthroscopy, may be considered for management of chondral injuries of the hip 1.
From the Research
Femoroacetabular Impingement Management in the ED
- Femoroacetabular impingement (FAI) is a chronic hip condition caused by femoral head and acetabular malformations resulting in abnormal contact across the joint, often leading to labral, cartilaginous, and tissue damage that predispose this patient population to early osteoarthritis (OA) 2.
- The primary imaging modality for diagnosing FAI is a plain radiograph of the pelvis, which can be used to measure the alpha angle and the lateral center edge angle used to quantify severity 2.
- Conservative treatment is typically considered first-line treatment for mild to moderate FAI syndrome; however, the outcomes following postoperative surgical intervention have demonstrated excellent results 2, 3, 4, 5.
Treatment Options
- Surgical treatment options for FAI include arthroscopic resection of the cam/pincer morphology and treatment of concomitant soft tissue pathologies such as labral tears, cartilage lesions or ligamentum teres tears 2, 4, 5.
- Physiotherapist-led management involves exercises aimed to optimise movement patterns of the hip and pelvis to prevent impingement from occurring, activity modification and analgesia 3, 4.
- Joint provider recommendations from a physical therapist and a surgeon can influence patients' decisions to pursue physical therapy 6.
Outcomes
- Hip arthroscopy has been found to provide greater improvement in patient-reported outcomes in the short-term compared to physiotherapy, however it is unknown whether this is sustained in the long-term or affects the future development of hip osteoarthritis 3, 4.
- Advanced articular cartilage disease generally is associated with poorer outcomes 5.
- Careful patient selection is important in predicting the success of the surgical management of symptomatic FAI 5.