Femora Acetabular Impingement (FAI)

Posted by Dr. Lev Kalika on Wednesday, April 4, 2012 · Leave a Comment

Femora Acetabular Impingement (FAI) is a relatively new hip joint diagnosis, which produces pain mostly in active individuals or people with predisposing occupations. The condition itself is not new at all, however current understanding of its pathology came with recent advancement in skeletal imaging.

FAI is common in high level athletes, but also occurs in active individuals.

In this condition bony conflict between anatomical prominences of pelvis and femur occur during hip movement. This contact occurs during hip flexion and is pathological due to its destructive effect to the hip labrum and eventually to the hip cartilage. This condition is a precursor of hip arthritis( arthrosis).

Patients experience symptoms of hip movement stiffness to sharp pain in the groin after sporting activities.

The sports, which usually lead to FAI, are: soccer, hockey, martial arts, ballet and yoga.

This is a list of anatomical predisposing factors:

Congenital hip dysplasia
Prominent femoral head-neck junction
Elliptical femoral head
Femoroacetabular anteversion
Femoroacetabular retroversion
Coxa valga
Coxa Varum
Coxa profunda
Protrusio acetabulum

Other predisposing factors are more functional or traumatic. These range from direct trauma to distant trauma resulting in alteration of biomechanical relationship in the kinetic chain.

The progression of this disease is interesting occurrence. One may ask himself that if all anatomical predisposing factors are congenital why does one develop symptoms in the 3d or 4th decade of life, (professional athletes develop symptoms in the second decade)? The answer is simple. In FAI congenital bone anomalies are varied in combination of it’s severity and overplay with joint and movement dysfunction in other regions of the body. Majority of people with these congenital anatomical defects in the hip area may never experience pain or only develop hip arthritis(arthrosis) in 7 the decade of life. This is because these people simply don’t participate in sports or choose sports, which are not damaging to the hip with congenital imperfections.

Many people with FAI suffer from back pain and herniated disc disease for years prior to developing symptoms of hip pain. Majority of these patients are operated for disc hernia without successful outcomes or only with temporary pain relieve.

FAI DIAGNOSIS

The golden standard of radiological diagnosis for FAI is special CT scan series. This is, however only necessary in case surgical intervention is entertained as there is enormous dose of radiation involved in this special procedure. Otherwise, a combination of X- ray with MRI or diagnostic ultrasound and clinical examination can be specific enough for treatment.

FEMORACETABULAR IMPINGEMENT (FAI) PAIN TREATMENT

FAI pain treatment depends on precise structural and functional diagnosis as well as consideration of compensatory factors, which usually play a significant role in the rehab process. The challenge of conservative treatment of FAI lies in its complexity of presentation, as no FAI patient is similar to another FAI patient as far as rehab is concerned. Also, since hip joint is a major weight bearing joint in the human body it’s gait deviations are engraved in the motor control and the biomechanics of the whole human body.

Femoraceabular ( FAI ) pain treatment also depends on careful elimination of provoking movement and postures. Video gait analysis is the best technological modality to tease out and precisely describe all movement aberrations in pelvis and the rest of lower extremity. These aberrations are not visible to human eye and therefore biomechanical relationship of all the components of lower kinetic chain cannot be properly addressed without it.

Anatomy at the groin; lfcn, lateral femoral cutaneous nerve; asis, anterior superior iliac spine; il, inguinal ligament; fn, femoral nerve; pt, pubic tubercle.

Please explore our gait analysis page.

Even with all the complexity of the FAI pain syndrome, conservative care is successful in experienced hands within 6-8 weeks in initial presentation and up to 6 month of rehab in chronic cases.

SURGICAL INTERVENTION

Surgical intervention should only be reserved to professional athletes or very few patients with greater damage of hip intrarticular tissues. The surgical intervention does not correct the cause of impaired movement but only remove the bone conflicting anatomy. Since data for arthroscopic FAI repairs is relatively new , we can not estimate yet how successful these surgeries are. Especially giving very , very long recovery from this surgery this type of procedure should only be reserved as a last reserve.

Please check out our pages for the running gait lab, the alter-g treadmill, Biofeedback motor control training with real time force plate analysis, and shockwave therapy to see how these technologies can help you.