From the Guidelines
Management of femoroacetabular impingement (FAI) in the Emergency Department should focus on symptomatic relief with rest, activity modification, and analgesics such as NSAIDs, while arranging orthopedic follow-up within 1-2 weeks for definitive management. Initial treatment includes rest and activity modification to avoid painful movements, particularly those involving hip flexion and internal rotation. Analgesics such as NSAIDs (ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily) can be used for pain and inflammation, as supported by general medical knowledge and not specifically addressed in the provided studies 1. Ice application for 15-20 minutes several times daily can help reduce inflammation. For moderate to severe pain, a short course of oral opioids may be considered, such as hydrocodone/acetaminophen 5/325mg every 6 hours for 3-5 days.
Key considerations in managing FAI include:
- Avoiding activities that exacerbate symptoms
- Using imaging studies like plain radiographs to rule out fractures or other acute pathology
- Arranging advanced imaging such as MRI on an outpatient basis
- Educating patients about FAI as a mechanical problem that can lead to labral tears and osteoarthritis if not properly addressed
- Considering long-term management options such as physical therapy, activity modification, or surgical intervention, as determined during follow-up care. The provided studies 1 discuss various surgical options for managing chondral injuries of the hip, including osteochondral allograft transplantation, but these are not directly applicable to initial ED management.
From the Research
Management of Femoroacetabular Impingement at the ED
- The management of femoroacetabular impingement (FAI) can be conservative or surgical, depending on the severity of the condition and the patient's symptoms 2, 3.
- Conservative treatment is typically considered first-line treatment for mild to moderate FAI syndrome and may include rest, physical therapy, and activity modification 4.
- Surgical treatment is indicated in symptomatic patients after failed conservative management, with the goal of restoring normal hip biomechanics and reducing pain 3, 5.
- Arthroscopic management of FAI has become widely utilized in recent years and has shown comparable long-term pain reduction and improvements in clinical measures of hip function to open surgery 3.
Nonoperative Management
- A nonoperative approach should be the first-line treatment for young active patients with symptomatic FAI syndrome, with significant improvements in outcome scores at a mean follow-up of 2 years 4.
- Exercise therapy has been shown to be effective in improving hip function, strength, and morphology in patients with FAI syndrome, with half of patients benefiting from exercise therapy in the short term 6.
- The responsiveness to exercise therapy is associated with improvements in hip abductor strength and dynamic pelvic control, whereas the presence of severe cam morphology is associated with a poor therapy outcome 6.
Surgical Management
- The most common surgical treatment option for FAI is done arthroscopically, with the goal of correcting the femoral head-neck relationship to the acetabulum and treating concomitant hip pathology 2, 3.
- Open surgery is also an option, particularly in cases with complex deformities or significant arthritic changes, and has shown comparable long-term outcomes to arthroscopic surgery 3, 5.
- The choice of surgical approach depends on the individual patient's condition and the surgeon's preference, with the goal of achieving optimal outcomes and minimizing complications 3, 5.