Femoroacetabular Impingement

Pain starts in the groin and can radiate along the thigh down to the knee, sometimes becoming debilitating. This pain is described as deep or sharp. It is most often felt when the person is seated, but can also occur during exercise (typically during a match or intense training) or just afterwards. Movements involving rotation or flexion of the hip, such as turning or squatting, can also cause acute pain.

The joint also tends to lose mobility (particularly in flexion and internal rotation) or become stiff. Large hip movements are poorly tolerated, occasionally with “cracking” inside the joint.

Often, the person affected reports having suffered from a lack of mobility during their adolescence.

The frequency and intensity of the pain tend to get worse during physical activity, particularly when it involves the hip moving in flexion (for example skiing or skating) or rotating (tennis or basketball). Typically patients report pain when getting into or out of the car.
 

The medical condition often seems to be caused by a congenital bone deformity associated with overuse of the joint caused by playing a sport that places particular stress on the hip joint. Initially, the loss of mobility in the hip leads to the person unconsciously performing compensatory movements and therefore overloading of the joint. It seems that the condition therefore develops gradually through repeated microtraumas inside the hip, but it could equally be caused by trauma (an impact).

Young adults who do sports that require forced flexion of the hip such as the following are most at risk:

The butterfly style of keeping practiced by ice hockey goaltenders that entails an exaggerated internal flexion-rotation movement of the hips to cover the entire goal line is a representative example.

Young adults who display the signs commonly associated with FAI should be included in an early screening program to prevent any incurable damage.
 

The prognosis for femoroacetabular impingement is good when the condition is correctly diagnosed and identified. The primary treatment, or the conservative approach, entails resting the joint, adapting or stopping the sporting activity, taking anti-inflammatories, physiotherapy, and/or muscle strengthening. If symptoms last longer than two months, surgery is generally considered.

In principle, femoroacetabular impingement can be treated using minimally invasive surgery (arthroscopy*A surgical technique that can be used for a range of operations and entails making only a few small incisions and using a small camera. Considered to be minimally invasive, this technique has few complications and enables patients to return to sport quickly.), or classic surgery. Classic surgery is currently normally limited to situations that involve morphological deformities that require complex surgical procedures. In recent years, arthroscopy has become much more widely performed. Various studies have shown that this method has two advantages: it comes with few complications, and enables the patient to return to sport quickly.

It is a good idea to include muscle strengthening exercises in your physical training plan if you play a sport that places a lot of strain on the hip joint.

Early screening for FAI is also recommended for people, in particular young sports players, whose morphology makes them more likely to develop FAI and who report a loss of hip mobility with chronic pain in the groin area.
 

A loss of hip mobility and range of movement in the hip accompanied by pain that originates in the groin area and may radiate down to the knee are all signs that could be caused by FAI. In particular, young sports players experiencing these symptoms should be screened for the condition as early medical care contributes to a good prognosis. The condition is currently underdiagnosed.

FAI not only causes a reduction in physical performance due to limited hip mobility and range of movement, it can also cause cartilage damage that is potentially incurable if early and appropriate medical care is not provided.

There has been growing awareness for several years of the potential role of FAI in the development of hip osteoarthritis (coxarthrosis), which had previously been assumed to be a natural consequence of aging. According to certain estimates, FAI could explain over 60% of cases of hip osteoarthritis and other deformities of the hip.

Moreover, the progression of FAI into hip osteoarthritis could be accelerated by playing a sport that places a lot of strain on this joint on a regular basis.
 

The clinical assessment will include:

• an analysis of the patient's medical history,
• a full physical examination of the pelvic region in a standing position and while walking,
• an observation of the range of movement of the hip joint,
• a neurological assessment of the lower limbs (muscle strength, any circulatory issues, etc.),
• simple tests such as raising the dominant leg against resistance.

After this, an X-ray will be done to confirm the diagnosis. This diagnosis will be made by a sports physician or a hip surgeon. Other examinations may also be needed. The patient's medical history, clinical assessment, health, age and the results of the examinations performed will all be taken into account when deciding whether surgery is necessary. Operations for this condition last between one and three hours, and a hospital stay of around two days will be required.

Anti-inflammatories are normally prescribed after the operation, and rehabilitation should start as soon as possible (patients should start to walk using walking sticks to ensure that the joint that has been operated on only bears part of the load).
 

1. What is femoroacetabular impingement (FAI)?
AFC is a condition in which a bone defect in the hip causes friction between the acetabulum and the head of the femur, resulting in pain and loss of mobility.

2. What are the main symptoms of femoroacetabular impingement?
The most common symptoms include deep pain in the groin area, stiffness in the hip and limited mobility, particularly when flexing or rotating the joint. Pain can also extend to the thigh and knee.

3. What treatments are available for FAI?
Conservative treatment includes rest, physiotherapy and the use of anti-inflammatories. If symptoms persist, surgery, usually arthroscopic, may be required.
 

4. Which sports are most likely to cause femoro-acetabular impingement?
Sports involving repeated flexion and rotation of the hip are most at risk. These include ice hockey, football, tennis, dance and martial arts. High-level athletes and amateurs in these disciplines are particularly at risk.