Hip Impingement (FAI)

Hip impingement, or femoro-acetabular impingement (FAI), is a condition which usually causes pain and/or a restricted range of movement. It comes in two main forms – Cam and Pincer impingement. Both of these are often associated with a labral tear. This is where a lip of cartilage around the margin of the hip is torn and causes pain. It is believed that the long-term result of FAI is the development of arthritis.

Pain is often felt in the groin crease or in a c-shaped distribution around the hip. Patients often gesture to the location of the pain by clamping their thumb in front of the hip and fingers around the side/back. There may be clunking, clicking (painful or painless) and giving way. Men, in particular, will often have difficulty rotating their hips in a flexed position. This may cause difficulty putting on shoes and socks or cutting toenails. Activities that involve deep flexion will often aggravate the hip. Patients will often complain of pain and discomfort during long drives.

The investigations for this will usually involve an Xray first and, subsequently, an MRI scan (with or without dye injected into the hip). This will give all the information required to make a decision about whether keyhole surgery might be appropriate.

Almost all patients with this condition will benefit from focussed exercises to strengthen the muscles around the hip; in particular, the gluteus medius, minimus and maximus. Core strength and conditioning are vital for normal hip function and this is why activities such as pilates are highly recommended in managing this condition. I do not suggest that patients with FAI focus heavily on flexibility of the hips as there is a finite range of movement that can be achieved and pushing this limit can make the hip more painful and potentially damage the labrum further.

Patients with FAI will often be offered a steroid injection into the hip. This is with the aim of reducing the inflammation in the joint and therefore the pain. When the pain is reduced, it can be easier to work hard on the strengthening exercises.

When surgery is indicated, I will usually refer you on to one of two specialist colleagues in the city who perform hip arthroscopy (keyhole surgery) for ongoing management.