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Hip

FAI Treatment Options

When the symptoms are consistent with FAI and the diagnosis is confirmed by imaging, intervention is warranted to prevent the onset or progression of osteoarthritis. Patients should be aware that chiropractic manipulation and physical therapy can worsen symptoms.

Nonsurgical treatment

Initially, nonsurgical treatment may be recommended. It includes physical therapy to improve function and pain, activity modification, over-the-counter pain medications, rest and cortisone injections. Conservative management can help relieve symptoms of a small tear but cannot fix the tear or the impingement.

Dr. Jorge Chahla’s approach to surgical treatment is hip preservation, pain reduction and optimized function of the natural hip joint for the long-term. Surgery is tailored to each patient’s specific needs.

Surgery

FAI is a complex problem. Each of the elements below must be addressed during surgery to provide a durable solution to pain and dysfunction, and to avoid the limitations and disadvantages of joint replacement.

  1. Hip deformities and abnormal bone growth cause misalignment of the hip bones, and abnormal hip motion that causes impingement of soft tissue which leads to pinching and tearing of the labrum.
  2. Labral damage destabilizes the hip joint, results in additional joint impairment, restricts motion and leads to weakness and instability.
  3. Weakness and instability lead to compensatory behavior that results in changes in gait to take the load off of the damaged part of the hip and reduce pain, displaces the center of gravity and facilitates muscle disuse and dysfunction.
  4. In some cases, instability places excessive demand on the muscles, ligaments and tendon in the hip which causes progressive damage to the labrum and cartilage.
  5. Misalignment of the bones and compromised joint stability leads to the degeneration of the articular cartilage on the ball or femur, and the acetabulum or hip bone which leads to osteoarthritis of the hip. FAI is a significant contributor to the development of premature hip arthritis and joint deterioration.

Surgical correction of symptomatic FAI with joint preservation techniques includes osteotomy, osteoplasty, surgical dislocation, arthroscopy, and cartilage restoration; and surgical repair or reconstruction of labral tears.

Surgical hip dislocation

Surgical hip dislocation is an open surgical procedure that addresses the complicated underlying conditions involved with FAI. This procedure spares the surrounding muscles and preserves the blood supply to the joint. It is considered to be the “gold standard” of open surgical treatment of FAI. It is a highly specialized procedure. Surgical dislocation may be recommended when the problems are too severe or too expansive to be treated with hip arthroscopy.

Hip Arthroscopy

When symptoms persist or the labral tear is severe, hip arthroscopy is a well-established surgery to treat FAI and related defects including labral tears, ligament injuries, and damage to the articular cartilage. Arthroscopy is minimally invasive surgery that reduces pain and improves function in patients of all ages. Hip arthroscopy offers faster recovery, lower complication rates, less trauma and bleeding, less pain, and only requires small incisions. Intra – articular injection of Marcaine or cortisone that reduces pain is an indicator that a patient would respond positively to hip arthroscopy.

Who is a good candidate for hip arthroscopy for FAI?

FAI is a common cause of hip and groin pain in young, active patients, and predisposes to premature joint degeneration. In this group of patients, hip arthroscopy provides optimal outcomes. However, pre-existing osteoarthritis and cartilage damage are factors that negatively affect the outcome of hip arthroscopy for FAI. For this reason, when these factors are present, hip arthroplasty or total hip joint replacement may be recommended.

Hip Arthroscopy Procedure

Hip joint deformities that cause impingement are addressed with femoral head and acetabular osteotomy or osteoplasty. The means that the bones are surgically reshaped, so they fit together without friction, which prevents the damage that leads to osteoarthritis. However, the exact surgical procedure is determined by the type of impingement. Hip arthroscopy is performed using general anesthesia.

The torn labrum can be either repaired or reconstructed to reseal the ball and socket joint. Repair of small tears may be accomplished by sewing the tear together. However, when the labrum is torn off the bone, arthroscopic reconstruction will be needed. Reconstruction is technically challenging.

Cartilage restoration procedures such as microfracture, osteochondral allograft transplantation (OATS), autologous chondrocyte techniques, and implantation of autologous chondrocytes on a matrix may provide a solution to treat damage of the joint cartilage.

Cartilage restoration procedures such as microfracture, OAS, autologous chondrocyte techniques, and implantation of autologous chondrocytes on a matrix may provide a solution to treat damage of the joint cartilage.

In severe cases, open surgery may be recommended. However, when surgery is delayed and damage is severe, surgery can help but problems may develop in the future.

Dr. Jorge Chahla specializes in the treatment of complex knee, hip, and all sports related injuries. He is a pioneer in cartilage restorations and minimally invasive techniques for hip joint preservation. FAI surgery is complex. Dr. Chahla is the ideal surgeon for complex FAI repair and restoration. Contact him to schedule a consultation today.


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