What is femoroacetabular impingement surgery (FAI)?
In patients with femoroacetabular impingement (FAI) who do improve with non-surgical treatment options, an arthroscopic hip surgery may be recommended as the next treatment step. FAI is caused by irregular bony abnormalities that lead to abnormal contact between the ball and socket components of the hip joint. The abnormality may be present on the ball, also known as the femoral head, which is referred to as a “cam” lesion; whereas, an abnormality on the socket, also known as the acetabulum, is referred to as a “pincer” lesion. FAI surgery attempts to correct these bony abnormalities by removing the excess bone, also known as an “osteoplasty.” This results in restoration of normal motion through the hip joint without abnormal contact.
Who is a good candidate for FAI surgery?
FAI is a common cause of hip and groin pain in young, active patients. Some patients with mild to moderate FAI may experience symptomatic improvement with modification of their activity, taking over-the-counter anti-inflammatory medications, and physical therapy. However, the repeated microtrauma from FAI may damage the hip joint over time, causing instability, labral injury, and accelerated joint degeneration. For this reason, when patients continue to experience pain and imaging reveals damage to the labrum and/or the joint cartilage, surgery is recommended. FAI surgery attempts to prevent the onset or progression of joint degeneration, also known as osteoarthritis.
What does the procedure entail?
Preoperatively, you will get a computed tomography (CT) scan of your hip. This scan will allow your surgeon to evaluate the exact parameters of your deformity using a special software known as HipMap. HipMap will assist your surgeon in determining how much pincer and cam deformity is present so that it is precisely removed during surgery.
In the operating room, you will be lying on your back on the operating table. Once general anesthesia has been administered and you are asleep, both of your legs will be secured into padded boots. These boots will be attached to a system that pulls on your leg during surgery to open the hip joint space and give your surgeon space to work. Traditional systems have used a post between your legs that acts as a counter force against the pull on your leg, which may lead to potential postoperative nerve and tissue injury as well as groin pain. However, a post-less Pink Hip Kit is now used and a skin-friendly, breathable matt is placed underneath your body throughout the surgery. This avoids the need for a post and eliminates the potential for groin-related complications.
Most of the time, FAI surgery is performed arthroscopically. Arthroscopic procedures use small incisions with thin instruments and an arthroscope, also known as a small camera, to view the hip joint. Two to five incisions about the size of a buttonhole are created to access the hip. Arthroscopy is minimally invasive and studies have shown that it reduces pain and improves function in patients of all ages.
The bony irregularities of the FAI deformity can be corrected by either trimming down the rim of the hip socket, shaving down the bump on the hip ball, or a combination of both. This is referred to as FAI decompression or osteoplasty. The HipCheck software and real-time imaging are used during surgery to help your surgeon most accurately correct the deformity. If the rim of the hip socket requires trimming, the bone is subsequently secured in place with sutures to optimize the position of the ball and socket. All-suture anchors are used, which avoids the need for metal or plastic.
Arthroscopic FAI surgery is performed in an outpatient surgery center. This means you will go home the same day of surgery once you have recovered from anesthesia.
How long does it take to recover from surgery?
Recovery from FAI surgery typically takes around 4-6 months. However, pain relief and functional improvements in daily activities will likely be present at 3 months postoperatively. Most individuals will be able to return to sporting activities between 6 months and 1 year postoperatively. Our data indicates that patients continue to improve up to 1 year after surgery.
What should I do immediately after surgery?
After surgery, patients will be using crutches and wearing a brace, as weight bearing is restricted for the first 2 weeks. Showering is also not permitted for the first 48 hours, as the incisions should be kept dry. After 48 hours, the bandages may be removed, but a waterproof bandage should be applied when showering.
Icing the hip will help to reduce swelling. Pain medication may also be required during this period. A continuous passive movement (CPM) machine will be used for the first few weeks to gently move the operated leg and prevent stiffness and reduce scarring. Changing positions frequently is also recommended.
What does physical therapy look like?
Physical therapy will begin on day 1 or 2 postoperatively and will continue 2x per week for about 3 months. It will consist of learning how to use crutches, as well as performing range of motion and strengthening exercises that are tailored to each individual’s requirements.
The physical therapy regimen will be organized into 5 phases. The first phase consists of using crutches and will be aimed at protecting the joint, managing pain, and starting to rebuild muscle strength, flexibility, and hip range of motion. At 2 weeks postoperatively, crutches are no longer required if there is no increase in pain with walking. The second phase continues to work on restoration of range of motion and introduces progressive strength and endurance exercises. The third phase targets gait normalization and optimizes strength. Phase four introduces dynamic stability and proprioceptive training, as well as endurance and advanced strength training. The final fifth phase determines if the patient is ready to return to sport.