In order to correct Femoralacetabular Impingement (FAI), the bony rim of the acetabulum is trimmed and the bump on the femoral head is shaved down. Other issues such as damage to the labrum or articular cartilage will be addressed (repaired or cleaned out) as well. Non-surgical treatment methods typically fail to control symptoms, leaving hip arthroscopy as the best treatment option. An open procedure, called an osteopathy, may be necessary for more severe cases of impingement.
Procedure Options
- Closed (Hip arthroscopy)
- Open (Femoral Acetabular Osteopathy)
*Either procedure restores the femoral neck clearance and free range of motion (ROM) of the hip.
Hip Arthroscopy Procedure
- Put to sleep with anesthesia
- Hip is positioned in traction
- Marks will be made on skin to identify anatomical structures and incision placements
- 2-4 small incisions (portals) are made
- Surgical tools are inserted through portals
- Sterile fluid is injected into joint to give the surgeon a clear view and control bleeding
- Images from arthroscope are sent to screen allowing the surgeon to see inside of the hip joint
- Damaged labrum is removed or repaired. Bony malformations may be decompressed (shaved down) removing the bony prominence
- Surgical tools are removed
- Portals are closed (surgical strips for small incisions, sutures for larger) and covered with sterile bandages
- Taken to recovery room for a 1-2 hours before being discharged
- Crutches will be necessary for a period of time depending on procedure
- Pain medications and non-steroidal anti-inflammatory drugs (NSAIDs) will be prescribed
- Several sessions of Physical Therapy for restoration of strength and range of motion.
Goal
- Hip preservation. Reduce the patient’s pain and prevent any further damage to the cartilage by repairing the current damage and preserving the natural hip structures.
Pros
- Less pain/stiffness
- Minimally Invasive
- Quicker recovery period
- Less scarring
- Ideal for athletes and those under the age of 55
- Most often an outpatient procedure
Who qualifies?
- Those too young for total hip replacements
- Patients who have only minimal arthritis
- Patients with evidence of advanced arthritis are NOT candidates for either FAI surgery.
Contraindications
- Pre-existing arthritis
- Obesity
- Infection
- Regional Pain Syndromes
Complications
- Traction can stretch nerves causes temporary numbness
- Infection
- Blood clots in legs (Deep Vein Thrombosis)
- Anesthesia complications
Outcomes
- Surgery is currently the best treatment option
- If the case was severe or surgery was put off for a long period of time, it is possible for problems to develop in the future.
- Can begin weaning off crutches after 2 weeks.
- Return to normal physical activity in 3-6 months
Femoral Acetabular Osteopathy
- Open surgical procedure where the prominent area of bone from the femoral neck is removed.
- More appropriate for severe cases
