Hip impingement or femoroacetabular impingement (FAI) is a painful pinching of soft tissue around the hip. Although the concept of this problem has been known since the 1930s, it only really became popular in the 200s, when a suitable arthroscopic surgical approach was developed. Subsequently, the number of hip impingements treated increased rapidly and there were concerns that excessive costs and uncertainties in treatment could arise due to ambiguities in the diagnostic criteria. To counteract this, there was no standardized definition of hip impingement, diagnosis and possible treatment approaches. In 2016, a group consisting of radiologists, sports physicians, physiotherapists and surgeons therefore drew up a joint statement on FAI.

Definition of

“FAI syndrome is a movement-dependent clinical complaint of the hip with a combination of symptoms, clinical signs and imaging findings. It is a symptomatic contact between the thigh (femur) and the hip socket (acetabulum).”

This means that an abnormal X-ray image or a painful hip alone is not enough to speak of an FAI. Several criteria must be met.

Symptoms

The main symptom of FAI is pain. However, how or where this occurs can vary greatly. The pain is usually localized in the groin or hip, but can also spread to the lower back, buttocks, back of the thigh and even to the knee. In addition, the pain is often associated with a mechanical component, such as a certain position or movement, and can be accompanied by a cracking, blocking or releasing sensation.

Clinical signs

In the clinical examination, restricted mobility may be the first indication of FAI. Whether one or more, or which direction is reduced, can vary depending on the patient. Changes in movement patterns in the hips and pelvis are also noticeable. Therefore, the gait pattern and motor control of the pelvic area should be tested in order to notice differences in the side-to-side comparison. Subsequently, pain in combination with the changes in movement patterns can lead to a weakening of the muscles around the affected hip. This also needs to be evaluated.

The FADDIR test is suitable for ruling out FAI. The hip is guided in flexion, internal rotation and adduction. If the test triggers the familiar pain, FAI should still be considered. However, if it is negative, i.e. the typical pain is not provoked, an FAI is unlikely.

Furthermore, surrounding structures (e.g. the groin) should be examined so that these can be ruled out as symptom triggers.

Imaging findings

An X-ray is ideal for examining an FAI and should therefore also be performed at the beginning. If there is no improvement in symptoms after appropriate treatment or other causes are suspected, an MRI or CT scan may be helpful.

Treatment

FAI syndrome can be treated both conservatively and surgically. Conservative therapy includes appropriate education, lifestyle adjustments and adaptations to activities. The therapy also aims to improve hip stability, neuromuscular control, strength, range of motion and movement patterns. The aim is to get the pain problem under control by adjusting the load and improving control of the hip region. In contrast, surgical procedures are performed directly on the joint and aim to modify the initial bony position and repair the damaged tissue.

It is important to advise each patient individually and find the right treatment. Recognizing whether the chosen treatment adequately influences the problem is an essential factor. The use of suitable questionnaires is suitable for detecting changes in therapy. In the case of FAI treatment, this would include the HAGOS or HOS questionnaire.

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Source:

Griffin, D. R., Dickenson, E. J., O’Donnell, J., Agricola, R., Awan, T., Beck, M., Clohisy, J. C., Dijkstra, H. P., Falvey, E., Gimpel, M., Hinman, R. S., Hölmich, P., Kassarjian, A., Martin, H. D., Martin, R., Mather, R. C., Philippon, M. J., Reiman, M. P., Takla, A., . . . Bennell, K. L. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med, 50(19), 1169-1176. https://doi.org/10.1136/bjsports-2016-096743

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