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Femoroacetabular impingement (FAI) is a condition affecting the hip joint, which is a ball and socket joint. The socket is formed by the acetabulum and the ball is the top of the femur. A cartilage called the labrum covers the acetabulum. This allows a smoother joint surface and decreases friction between joint surfaces. It also improves joint stability.
With FAI, bone spurs develop around the acetabulum and head of the femur. FAI can also develop when the femoral head is not positioned properly in the socket. It is unknown if femoroacetabular impingement is a condition that develops at birth or happens gradually over growth periods. Environmental factors such as sporting activities may also contribute to the development of FAI.
There are two types of impingement, Pincer and Cam. Pincer impingement occurs when there is too much growth of the outer edge of the acetabulum (socket) causing too much coverage over the ball of the hip joint. The labrum is pinched between the acetabulum and femur as the hip is flexed. Cam impingement occurs when there is excessive boney growth of the head of the femur. The boney growth of the femur can impinge upon the labrum as the hip is flexed. Sometimes impingement can be caused by a combination of Cam and Pincer impingement.
Some studies have shown that ‘Cam’ deformities are more common in males, while ‘Pincer’ deformities are more common in females.
FAI can cause pain and stiffness in the groin and front of your thigh. There may also be a loss of range of motion of the hip joint. Pain is normally brought on by activities requiring repetitive hip flexion and as the condition progresses, pain can be brought on with prolonged sitting, walking uphill and sitting cross legged. The condition can gradually develop into osteoarthritis when the cartilage begins to tear away.
Treatment of FAI often begins with activity modification, anti-inflammatory medication and physiotherapy. Physiotherapy treatment focuses on improving movement and alignment of the hip joint. This can be achieved using a combination of soft tissue work and joint mobilisation, which can assist in allowing the head of femur to sit in a better position in the acetabulum. This helps decrease loading through the hip joint and impingement of the labrum. A physiotherapist can also help in identifying abnormal biomechanics and weaknesses that may have contributed to the injury, and provide a graduated strengthening program to address these factors.
If FAI does not respond to the conservative measures mentioned above, an x-ray or MRI scan may be appropriate to assess the severity of the impingement and whether there are any labral tears. Following this, a hip specialist may perform surgery to correct the Cam or Pincer lesion, preventing impingement and therefore allowing greater range of movement. This can also help improve the hip joint by preserving the cartilage of the joint. Recovery from this surgery normally takes 3 months.