Femoroacetabular impingement (FAI), or hip impingement, is a condition where the hip joint structure is abnormal, causing friction and damage. This occurs because extra bone grows on the ball (femoral head) or the socket (acetabulum), or both, resulting in an irregular shape. This extra bony growth, called a cam or pincer lesion, causes the femoral head and socket to rub against each other prematurely as the hip moves. This friction can damage the soft tissues within the joint, specifically the labrum—the ring of cartilage lining the socket—and the articular cartilage. Treatment involves a structured approach, starting with non-invasive methods and progressing to surgical correction when necessary.
Initial Conservative Management
The first line of defense against FAI pain involves non-invasive, conservative strategies. This includes activity modification, focusing on avoiding positions that provoke impingement symptoms, such as deep hip flexion, twisting, and pivoting movements. Patients should avoid activities like deep squats or prolonged sitting in low chairs to reduce compressive forces on the anterior hip joint.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, help manage acute pain and inflammation. These medications are used on a short-term basis to alleviate symptoms during flare-ups. The most important component of conservative care is a structured physical therapy (PT) program tailored to the individual.
Physical therapy focuses on improving dynamic stability of the hip and pelvis, as aggressive stretching can sometimes worsen impingement. The primary goals are to strengthen the surrounding musculature, particularly the gluteal and core muscles, to better control hip movement and reduce joint loading. A trial of conservative management, often lasting three to six months, can successfully alleviate symptoms for many patients, potentially delaying or avoiding surgery.
Targeted Pain Management Injections
If pain persists despite consistent conservative physical therapy and oral medications, an intra-articular injection may be necessary. This intervention delivers medication directly into the hip joint space, typically under ultrasound or fluoroscopic guidance for precise placement. A corticosteroid, a potent anti-inflammatory medicine, is often mixed with a local anesthetic and injected into the joint.
The injection serves both diagnostic and therapeutic purposes. Significant, temporary pain relief confirms the hip joint is the source of the pain. Therapeutically, the corticosteroid reduces inflammation, providing a window of relief that facilitates more effective engagement in physical therapy exercises that were previously too painful.
Surgical Correction of the Hip Joint
Surgical correction is the definitive fix for FAI when conservative management, including injections, fails to provide adequate long-term relief or when significant structural damage exists. The most common procedure is hip arthroscopy, a minimally invasive technique using small incisions to insert a camera and specialized instruments. This allows the surgeon to visualize and correct the underlying structural abnormality without a large open incision.
The core of FAI surgical correction is osteoplasty, the mechanical reshaping of the bones to eliminate abnormal contact. For a cam lesion, the surgeon removes the excess bone bump on the femoral head and neck junction, restoring a smoother contour. In cases of pincer impingement, the overhanging bone rim of the acetabulum is carefully trimmed (rim trimming).
The protective labrum, often damaged by the structural abnormality, must also be addressed. If the labrum is torn but repairable, it is reattached to the acetabular rim using surgical anchors and sutures. If the tissue is too damaged, the surgeon may perform a labral reconstruction using donor tissue or tissue from the patient’s body. Repairing the joint capsule after the procedure is often performed to restore anatomical stability and improve long-term outcomes.
Post-Intervention Rehabilitation
A dedicated post-intervention rehabilitation program is essential following structural correction, especially hip arthroscopy. This process begins almost immediately after surgery to protect healing tissues and restore joint function. Initial recovery phases include restricted weight-bearing, often using crutches, to protect the repaired labrum and reshaped bone surfaces.
Physical therapy focuses on passive and controlled range-of-motion exercises to prevent stiffness without stressing repair sites. Early precautions include avoiding active straight-leg raises or aggressive hip flexion to prevent tension on the labral repair and capsular closure. Rehabilitation progresses through intermediate phases that gradually introduce strengthening exercises for the hip and core muscles. The goal is to achieve a non-limping gait pattern within six to eight weeks.
The full recovery timeline, particularly for a return to unrestricted activity or sports, typically lasts four to six months or more. This final phase emphasizes advanced strengthening, agility, and sport-specific training. Patient commitment to this structured, phased recovery translates the surgical correction into a successful functional outcome.