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After Surgery for Femoroacetabular Impingement

Athletes At All Levels Can Return to Sports After Surgery for Femoroacetabular Impingement

Femoroacetabular impingement, otherwise known as FAI has become a household name in the world of sports and athletics. That's because this problem is becoming recognized as present in many more people than ever before. Is it really a new problem? Probably not -- we are just getting better at identifying it when it's there.

What exactly is femoroacetabular impingement (FAI)? And why does it affect athletes? Femoroacetabular impingement (FAI) is a pinching of the soft tissues close to, next to, or around the hip. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

One of the main areas affected is the labrum, a rim of fibrous cartilage around the hip socket. The labrum is designed to give the hip a bit more depth and stability. But even a small amount of asymmetry of the hip socket and/or femoral head in the hip socket can cause impingement with hip motion.

For example, a slightly oval shape instead of a perfectly round head of the femur or a slightly off-angle of the socket can result in painful pinching of the labrum or other soft tissues of the hip.

Sometimes it's a case of a hip socket that's deeper than normal. Over time, this pinching or impingement of the labrum can cause fraying and tearing of the edges and/or osteoarthritic changes at the impingement site.

The athlete experiences hip and/or groin pain along with decreased hip motion. The condition may look like a chronic muscle strain or groin injury but an X-ray, CT scan, or arthroscopic examination confirms femoroacetabular impingement as the true cause of the problem.

What causes FAI? Studies in children show that many of these abnormalities of hip shape, angle, or depth are present at birth. The average person would never know he or she had any of these slight anatomical changes if it weren't for the repetitive motions of the high-level athlete. But pinch or compress those soft tissues often enough creating mini-traumas to the hip joint and a painful response will develop.

What can be done about it? Conservative (nonoperative) care with antiinflammatories and Physical Therapy may be recommended at first. If this approach is not helping, then surgery may be needed to restore normal hip motion. If there is a labral tear, surgery is usually done arthroscopically to repair (whenever possible) the damage. The surgeon trims the acetabular rim and then reattaches the torn labrum. This procedure is called labral refixation.

Each layer of tissue is sewn back together and reattached as closely as possible to its original position along the acetabular rim. When repair is not possible, then debridement (shaving or removing) the torn tissue or pieces of tissue may be necessary.

In a recent study from the Hospital for Special Surgery in New York City, this type of arthroscopic surgery was performed on 47 athletes with painful femoroacetabular impingement (FAI). Results were reported for 33 of those athletes at the end of one year and again two years after surgery.

More than three-fourths (79 per cent) of the group went back to their previous sport. Most of those athletes (92 per cent) participated successfully at their highest level of competition. That was the reported result one year after arthroscopic surgery. Two years after surgery, 73 per cent of the group was still going strong.

Athletes from all types (and competitive levels: high school, college, professional) of sports were included in this study. The largest number of patients were ice hockey players followed by soccer and baseball players. But swimmers, horseback equestrians, football, track, tennis, lacrosse, and crew members were also part of the treatment group.

Other studies have been done reporting the results of surgery for femoroacetabular impingement. What makes this study so special? The mixed type of sports and varied levels of participation.

The authors showed that arthroscopic surgery for femoroacetabular impingement (FAI) can be effective for all athletes at an intense level of participation regardless of sport type or level of competition (from amateur to professional). It isn't just the highly paid, highly motivated professional athletes who can benefit from this surgery.

Reference: Shane J. Nho, MD, MS, et al. Outcomes After the Arthroscopic Treatment of Femoracetabular Impingement in a Mixed Group of High-Level Athletes. In The American Journal of Sports Medicine. July 2011. Vol. 39. Supplement 4. Pp. S14-S19.