FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.

Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Sunday, 29 January 2012

FAI (Hip Impingement) surgery success rates

There is a lot of talk of FAI / hip impingement surgery success rates. Some studies (short and medium term) have been done by eminent surgeons around the world with success rates as high as 96%... however the forums are full of failure, in part that is the nature of forums, in that the failed surgeries often cluster together for support and advice. 
However having been a member of such forums for a number of years now I have also seen many newly diagnosed FAI patients come to such a forum for advice on their hip impingement diagnosis and prognosis and stay throughout their surgery and rehab... but then not recover.

I was responding to one such newcomer's question this morning, who wanted to know if anybody did ever get better after surgery and I thought I would copy the reply I gave to her here also, as I was asked the same question on here only last week and it is the best advice I feel I could give to any newly diagnosed person with FAI:

I think success is MUCH dictated by surgeon selection, there are a LOT of learner FAI surgeons out there and they won't tell you that, pick VERY, VERY wisely. 

Success is also dictated by the 'surgeon's patient selection'... in that a straight forward case of FAI appears to have fairly good success rates, what can really muddy the water is FAI surgery on patients who 'also' have dysplasia, or accelerated cartilage damage, or hyper-mobility issues or extreme versions such as global retroversion... these complications can drop the success rates significantly. And to complicate things further it is often the more experienced surgeons who know when 'not' to operate as they are 1. more experienced and 2. not so keen to get another FAI surgery under their belt for surgery numbers.

Another factor in FAI surgery success is that the longer you have had 'symptomatic' FAI, the more muscular and tendon adaptations you evolve and this adds significant time onto rehabbing, correcting worn in patterns of movement can take some undoing. 

There is one other factor that I am aware of causing post op, frequent complications and that is scar tissue. We are told to rehab fairly intensely, yet some of the people that religiously do so still build scar tissue inside the hip capsule. Intense levels of physio (or activity) can cause inflammation, which in turn can cause scar/adhesions. So basically on rehab if it irritates your hip, simply take it more gently. Do persist with the physio rehab because you need to strengthen and stretch those incorrectly working muscles, but do also listen to when your body says slow down. 

However I am not convinced so many scar tissue problems relate to our post op behaviour and suspect that it is possible that surgical technique (how the surgeons open the hip capsule during a scope) could be significant to the formation of adhesions and hip instability. Some of the US surgeons are just now finding that patients having wide capsulotomys during keyhole are more likely to develop adhesions than in techniques using smaller incisions through the hip capsule to access the joint. Theory been less disruption causes less scar. There were a couple of reports I read online from ISHA winter 2011 which I will locate and post up, one by Christopher Larson revealing this... and I do believe early style surgical technique to be a significant factor in the formation of scar tissue... 

Anyhow my point is that this can be a wonderfully successful procedure, but that much depends upon 'your' surgeon selection and 'his' patient suitability selection and the best advice I can give is for you to be mindful of these factors, your 'exact' condition and choose your surgeon wisely and NEVER be afraid to seek a second or third opinion, or forth opinion, it is your body... settle for any surgeon in haste, repent at your leisure!

See list of best FAI surgeons here: