Femoroacetabular Impingement (FAI) is a condition arising due an abnormal shape of the bones of the hip joint causing them, to rub against each other. As a result, pinching and friction occurs at the point of contact of femur and the hip socket, creating damage to the hip joint.
In a normal hip, the head of the femur moves smoothly within the hip socket, enabling movement without pain. In FAI, the femur pinches against the cartilage of the hip socket preventing smooth movement and causing pain.
Some non -surgical treatment options include rest, activity modification, anti-inflammatory medications, physical therapy, and steroid injections and intra-articular analgesics into the hip joint. These conservative options will probably not change the underlying abnormal biomechanics of the hip, causing the FAI, but may offer pain relief and improved mobility.
When conservative approach fail to provide relief to the patient hip arthroscopy is considered. Hip arthroscopy is a surgical procedure in which an arthroscope is inserted into the hip joint to check for any damage and to repair it as well. Arthroscope is a small, fiber-optic instrument consisting of lens, light source, and a video camera. The camera projects the image of the inside of the hip joint on a large screen monitor which allows the surgeon to look for the damage, type of injury, and repair the problem as needed.
Hip arthroscopy is performed under regional or general anesthesia depending on your surgeon’s and your preference.
In arthroscopic repair of FAI, your surgeon may perform the following procedures:
- Chondroplasty: Chondroplasty is surgical repair of the torn cartilage or a torn labrum
- Microfracture: The microfracture procedure involves making small holes in the bare bone of missing cartilage to stimulate the growth of new cartilage
- Labral/Cartilage Debridement: Debridement is the process of removing the torn or frayed labrum or cartilage to promote healing
- FAI decompression: Decompressive surgery is done to remove pressure areas causing the impingement
- Osteoplasty: Osteoplasty is surgical repair or alteration of the shape of bone
At first, your surgeon will make 2 or 3 small incisions of 1/4th an inch, in length, around the hip joint. Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work. The larger image on the television monitor allows the surgeon to visualize the joint directly to determine the extent of damage so that it can be surgically treated. Through other incisions surgical instruments will be inserted to treat the problem. For FAI surgery, a special instrument called a shaver is used to cut away or debride any frayed cartilage. If the labrum is torn, your surgeon will reattach the labrum using sutures. Any bony bumps causing the impingement will also be shaved away and smoothed. Your surgeon may drill holes in bone with no cartilage. This technique is called microfracture and stimulates the formation of new cartilage. After the surgery, the arthroscope is removed and incisions will be closed with sutures.
Surgery may be successful in relieving the symptoms associated with hip impingement. If an impingement is not corrected future damage to the hip joint may occur.