From the Guidelines
Management of femoroacetabular impingement (FAI) in the emergency department should focus on symptom relief and appropriate referral, with initial pain management using NSAIDs such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily, as recommended by recent studies 1. The goal is to alleviate pain and prevent further injury, while also ensuring the patient receives proper follow-up care. Key aspects of management include:
- Pain control with NSAIDs and acetaminophen
- Rest, ice application, and activity modification to avoid exacerbating hip pain
- Use of crutches if weight-bearing is painful
- Referral to an orthopedic specialist within 1-2 weeks for definitive treatment, which may include physical therapy, intra-articular injections, or surgical intervention 1. It is essential to recognize that FAI is a mechanical problem characterized by abnormal contact between the femoral head and acetabular rim, leading to pain and limited range of motion, and if not properly addressed, can result in labral tears and osteoarthritis 1. Emergency physicians should be aware of the importance of early diagnosis and treatment to prevent long-term complications and improve patient outcomes. The patient should be educated on the condition, its potential consequences, and the need for follow-up care to ensure proper management and prevention of further injury. In terms of specific management, the patient should be advised to avoid positions that exacerbate hip pain, particularly flexion and internal rotation, and to follow a rehabilitation program as directed by the orthopedic specialist. Overall, the management of FAI in the emergency department requires a comprehensive approach that prioritizes symptom relief, appropriate referral, and patient education to ensure the best possible outcomes.
From the Research
Management of Femoroacetabular Impingement at the Emergency Department
- The primary goal in managing femoroacetabular impingement (FAI) at the emergency department is to alleviate pain and improve functional mobility 2, 3, 4.
- Initial assessment involves a thorough patient history, physical examination, and radiographic findings to confirm the diagnosis of FAI 2, 5, 6.
- Conservative treatment is typically considered first-line treatment for mild to moderate FAI syndrome, and may include analgesia, physiotherapist-led conservative care, and intra-articular steroid injections 2, 3, 6.
- Intra-articular hip injections, particularly with hyaluronic acid, have been shown to be effective in providing pain relief and improving functional outcomes in patients with FAI 3, 4.
- Arthroscopic hip surgery may be considered for patients with severe FAI or those who have not responded to conservative treatment, aiming to restore pain-free functional range of movement and repair damaged labrum 2, 6.
Diagnostic Considerations
- Plain radiograph of the pelvis is the primary imaging modality for diagnosing FAI, and can be used to measure the alpha angle and the lateral center edge angle to quantify severity 2.
- Cross-sectional imaging with computed tomography and magnetic resonance arthrography may be necessary in selected patients to further evaluate the extent of labral and cartilaginous damage 6.
- A positive FADIR test (flexion, adduction, internal rotation) is a common physical examination finding in patients with FAI, and can support the diagnosis 2.