The Latest on FAI (hip impingement)

FAI, or Femoroacetabular impingement, has come to light in the sports medicine world in the last one and a half decades. Researchers initially began discussing hip impingement in the 1930s, but it wasn’t until 2001 that femoroacetabular impingement was described in detail and a new surgery was laid out. The number of people diagnosed and treated in recent years has greatly increased—most likely as a result of this new research. So in order to help manage and create quality care for these patients, a panel was formed in early 2016 to create an international, multidisciplinary consensus statement on FAI.


The panel consisted of 22 members from 9 different countries and 5 disciplines including sports medicine, physical therapists, orthopedic surgeons, and radiologists. Their job was to reach a high level of agreement on the answers to 6 questions, and I’ll address the most relevant of these questions to you as the patient, client, or athlete.


The first question was “What is FAI syndrome?” The consensus panel defined it a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging finds. The key point here is that to have “FAI syndrome”, the patient has to have symptoms, positive clinical findings (what is discovered when the doctor or physical therapists examines and evaluates your hip), and relevant radiology (x-ray) findings. Not just one of these things, all of them. Also, we are moving away from calling FAI “symptomatic” or “asymptomatic”—either the person has FAI syndrome (all 3 factors), or they just have the boney changes you see on the x-rays (called CAM or Pincer morphology). 


The second question was “How should FAI syndrome be diagnosed?” And again, this brings us back to our three-part requirement to define a condition as FAI syndrome: symptoms, clinical findings, and radiology findings. The most obvious symptom is pain, most commonly in the groin or hip region. Other symptoms include clicking, catching, locking, or stiffness. Clinical findings are limited range of motion and positive hip impingement testing; radiograph (x-ray) findings will show a Pincer or CAM boney change at the hip joint. 


Another question was “What is the appropriate treatment of FAI syndrome?” There is no good evidence to support any single treatment option, so it is important that all options are considered for each person as an individual. These include conservative care, rehabilitation, and surgery. Conservative care is a broad term that covers patient education, activity/lifestyle modifications, oral OTC meds, steroid injections, and “watchful waiting”. Watchful waiting is just being aware of if and when your symptoms worsen.  Rehabilitation refers to physical therapy, with the specific goals of improving hip stability and range of motion, neuromuscular control, and normalizing movement patterns. A surgical intervention would aim to correct the CAM or Pincer boney changes of the hip joint. 


So what are the results of each of these treatments? Again, it is extremely variable from person to person. However, to try to create general guidance, the consensus panel answered the question “What is the prognosis of FAI syndrome?” They agreed that treatment in general results in symptoms improvement, but without treatment FAI symptoms will most likely worsen over time. 


This consensus statement is important because it puts us all on the same page in terms of defining, diagnosing, treating, and understanding femoroacetabular impingement syndrome. As a patient or athlete, this is valuable information to you because it gives you the latest information from the top experts so that you can have a better understanding of your condition.