ARTHROSCOPIC SURGERY FOR FAI IN YOUNG ATHLETES

By Marc Safran, M.D., Professor of Orthopedic Surgery, Stanford University and Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • FAI surgery is sometimes necessary to return the athlete to sports participation
  • Results from FAI surgery are generally excellent, with 95% of athletes returning to sport at about 4-6 months after surgery

Last week we wrote about a condition called “femoroacetabular impingement”, commonly referred to as “FAI”. The hip is a ball-and-socket type of joint. FAI is a condition where the femoral head (the ball), acetabulum (the socket), or both do not fit normally in place due to an alteration in the shape of the femoral head or rim of the acetabulum. The result is increased contact (impingement) as the hip is placed through a range of motion. ch1_image_020

Patients with FAI often complain of pain in the groin with sports activity, after prolonged sitting or even with walking. Many athletes often describe pain in the groin with deep flexion or rotation of the hip during activity. Occasionally, a popping or clicking in the front of the hip is described.

We diagnose FAI through a careful evaluation of your description of the pain, an examination of the hip and pelvis, along with an assessment of your sports participation. Imaging studies typically begin with x-rays, which are very useful to look at the shape of the bone and any bone spurs. We will usually also do a special type of MRI scan called an “arthrogram MRI” in which some dye is injected into the hip joint to highlight the soft tissue structures.

The first step in treating the problem is usually done without surgery. Rest from the sport or activity causing the pain combined with anti-inflammatory treatment can get the pain under better control. Physical therapy to correct weakness or imbalance in the hip and core musculature is done. The nonsurgical approach can be successful in some cases.

But in many cases where the bone overgrowth is simply too much, the impingement will continue to cause pain when the young athlete attempts to return to sports. In those cases, arthroscopic surgery can be done.

The emphasis with arthroscopic surgery is to tailor the procedure to the exact type of problem in each hip. For young athletes we have a strong preference for performing the most conservative procedure that results in restoration of as close to normal anatomy as possible. This typically includes removal of the impinging bone spurs to restore the natural shape of the ball and socket, repairing the ring of tissue around the socket (called the labrum), and tightening loose ligaments.

The surgery is done as a come-and-go procedure, meaning that there is no overnight stay in the hospital. The specific recovery will be different for each person depending on the type of repair, but for the typical FAI surgery you can expect to be on crutches and in a hip brace for two weeks after surgery. We recommend that physical therapy start early (as early as week 1) and generally continue through week 12 – 24.

A review of our results from FAI surgery across all age groups showed that 95% of athletes (all levels – including recreational, high school, college, and professional / Olympic) successfully returned to sports with excellent pain relief, function, and performance. The physical therapist or performance specialist will have the athlete go through a series of tests to determine readiness for return to sport, and return can be expected at 4 to 6 months after surgery, depending on the type of sport.

SideLineSportsDoc