Surgery vs. Conservative Management of Femoroacetabular Impingement (FAI) Syndrome

physical therapy Nov 23, 2020
Femoroacetabular Impingement (FAI) Syndrome
Femoroacetabular Impingement (FAI) Syndrome is where the bones of the hip become irregular and punch. It could be from bony overgrowth on the femoral head (ball) or the acetabulum (socket). There are also many cases of mixed (both). This is typically diagnosed by X-ray, CT scan, or MRI. There is also a special test where you bring the leg up and over towards the opposite shoulder and pain/pinching indicates you may have FAI.
It is believed that FAI occurs because of development abnormalities as a child. Some studies report that you are more likely to have pain from FAI if you are more physically active, while others show how you can live an active, pain-free life even with FAI.
Over the past decade or so, surgical interventions have skyrocketed for the treatment of FAI. This may not be the case for all surgeons, but from my experience there was not much of a push for conservative management. It seems the healthcare industry has been quick to recommend surgery for this type of issue.
What does the evidence say about surgery vs. conservative management of FAI?
Bastos et. al. (2020) reviewed the existing evidence with good methodology to find the following: “There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term.”
This does not mean that overall surgery is not better than conservative management of FAI! Why are we so quick to cut into someone if the evidence does not support it?
We need to take a look at the bigger picture. What happens when we subject someone to anesthesia, surgery, and a long-term recovery? What are the health implications? We could avoid many of these issues with conservative management.
FAI is not a death sentence. Just because you have it, doesn’t mean that you will have pain. For example: If you have hip pain when squatting and you have impingement, the pain may be avoided with modifications. A typical recovery would include modifying squat depth to allow for inflammation to subside while addressing any muscular or joint imbalances. Then, when the pain is down, addressing the reason for pain with squatting. Maybe you lean your trunk too far forward demanding more of the hips. We may need to look at ankle and spinal mobility also to make sure the hips are able to work properly. It could be as simple as learning how to squat better and a few mobility drills to improve your squat depth without compressing your hips.
If you are having hip pain (especially the front of the hip or deep in the socket), you should get it checked out. And by getting it checked out, I don’t mean go get imaging. Have a qualified professional, such as the physical therapists at Beyond Movement PT, assess your hip and movement patterns to determine the best approach to get you better.
Corey Hall, PT, DPT

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