Hip Arthroscopy - Femoroacetabular Impingement (FAI)

About Hip Arthroscopy

Arthroscopy is a surgical technique that uses a small camera to visualize the joint. Specialized equipment allows your surgeon to evaluate and treat certain hip problems through small buttonhole incisions.

Hip arthroscopy may be helpful for individuals that have not seen improvement on a treatment program that does not involve surgery. These non-surgical treatments may include rest, avoidance of painful activities, medications and/or physical therapy.

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There are several different hip conditions that could be eased by hip arthroscopy surgery. These include the following:

• Labral Tears
• Femoroacetabular Impingement (FAI)
• Hip Dysplasia
• Snapping Hip Syndromes
• Loose Bodies
• The Pediatric Hip

Labral Tears

The labrum is a soft tissue ring that surrounds the socket of the hip joint. It is an important structure for hip stability. Labral tears can be painful. While tears can occur in any circumstance, most labral tears are associated with underlying bony abnormalities, such as femoroacetabular impingement and hip dysplasia. When surgically treating labral tears, it is very important to treat the underlying bony problems as well. 

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement is a mechanical hip problem where there is a mismatch between the ball and socket. Ideally, the femur (ball) and the acetabulum (socket) would fit perfectly together so that the two sides would not pinch each other during motion. Unfortunately, the femur and acetabulum can butt one another, either due to variations in the bone shape or from excessive hip motion as seen with sports. Repetitive pinching can injure the cartilage and labrum, damaging the hip surface and may lead to early arthritis. There are two types of impingement: Cam and pincer. 

1. Cam impingement is used to describe a femoral (ball) head that is not round. When moving the hip, the area that is not round forces itself into the socket and mechanically pinches the joint. Cam impingement has been shown to be more common in athletes. The goal of surgery is to remove the excess bone and improve the movement of the hip joint.

2. Pincer impingement is used to describe an over-covered or deep socket.  During range of motion, a deep socket will pinch sooner than a normal socket and can mechanically wear down the protective cartilage lining of the joint.  The goal of surgery is to remove the excess socket, thus improving hip mechanics.

Surgical treatment of FAI has two goals. First, the short-term goal is to improve function and decrease pain. Second, the hope is to preserve the hip joint by improving the mechanics of the joint and minimizing the need for hip replacement in the future. While current research shows favorable results in improving pain and function, there is yet no long-term data confirming that FAI surgery slows down the arthritic process.

Hip Dysplasia

Hip dysplasia is a term used to describe a shallow acetabulum (socket).  A shallow socket causes abnormal loading of the cartilage and labrum (soft tissue socket) and can lead to early arthritis. Some mild dysplasia problems may be treated arthroscopically, while others are more suitable for open procedure surgery (periacetabular osteotomy).

Snapping Hip Syndromes

There are tendons that cross the hip joint that can cause a snapping. The snapping may or may not be painful. Regardless, most snapping syndromes can be treated without surgery. Some snapping problems do not get better and can be treated with arthroscopic surgery.

Loose Bodies

Loose bodies within the hip joint can be painful. There are numerous problems that can lead to loose bodies in the hip. They can, however, be removed arthroscopically.

The Pediatric Hip

The adolescent hip has other conditions that can cause movement difficulty. 

• Slipped Capital Femoral Epiphysis (SCFE): The exact cause of SCFE is not well understood.  This problem describes a growth plate disorder where the ball of the hip joint slips off the neck of the femur.  For some reason, the growth plate, or physis, weakens during the growth process.  These slips occur more often in males and are often seen in overweight individuals during the early teenage years. When a SCFE is diagnosed, these injuries are urgently treated with pinning of the hip to stop further deformity. Once growth has finished, the hip often has an abnormal shape and individuals may continue to complain of pain and functional problems. These problems can be treated with arthroscopic or open techniques in order to improve the shape and help preserve the hip.

• Perthes Disease: Perthes is a condition where the femoral head in a young, developing hip collapses. It is thought that this occurs due to a temporary loss of the blood supply to the hip. Individuals with Perthes disease walk with a limp and may have associated pain. Usually this occurs before the age of 10. Pediatric orthopedists treat this problem with various non-surgical and surgical options. Once the hip bones are mature, the hip can continue to have a bony deformity and may be painful. For those individuals that continue to have pain, both arthroscopic and open surgical techniques may be helpful to preserve the hip.

Other hip conditions include the following:

• Bursitis
• Gluteus tendon tears
• Nerve entrapment
• Synovial disorders
• Hip instability