Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome

Abstract

Purpose: To serve as a guide for non-operative physicians in the management of femoroacetabular impingement syndrome and provide an algorithm as to when to refer patients for potential surgical management.

Recent findings: Supervised physical therapy programs that focus on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core-focused programs. There is promising evidence for the use of intra-articular hyaluronic acid and PRP as adjunct treatment options. Recent systematic reviews and meta-analyses have found that in young active patients, hip arthroscopy demonstrates improved short-term outcomes over physical therapy. The decision for the management of FAIS is complex and should be specific to each patient. Consideration of the patient's age, timing to return to sport, longevity of treatment, hip morphology, and degree of cartilage degeneration is required to make an informed decision in the treatment of these patients.

Keywords: Cam lesion; Conservative treatment; Femoroacetabular impingement syndrome; Hip impingement; Physical therapy; Pincer lesion.

Fig. 1

AP and Dunn lateral X-ray views demonstrating a classic cam deformity in a 29-year-old male with symptomatic FAIS. The alpha angle on this hip is 71° on the left with a Tonnis grade 1, Kellgren-Lawrence grade 1, and minimal osteophytic lipping

Fig. 2

A) Frog leg view of the lateral hip in a 45-year-old female with symptomatic FAIS demonstrates a pincer lesion with Tonnis grade: 0–1 and alpha angle: 57. B) Corresponding coronal proton dense MRI of the right hip demonstrates labral hypertrophy with tearing and labral ossification resulting in the pincer lesion

Fig. 3

Recommendations for the clinician’s approach to the management of FAIS