Femoroacetabular Impingement

We have recently learned that bone spurs are an important cause of pain in the hip. While some bone spurs occur with arthritis, others can occur without arthritis, often for reasons we do not understand. There are two types of spurs: a spur on the femoral head is called a "cam lesion" and one on the acetabulum (cup) is called a "pincer lesion".

These spurs can occur even in young patients (e.g., adults in their 20s). They cause pain by action of the bone spur rubbing against the normal bone (e.g., bone spur on the femur rubs against the normal acetabulum). In addition, these spurs can cause cartilage (labral) tears over time, which in turn also cause pain.

Femoroacetabular impingement can be diagnosed by plain x-rays of the hip, CT scans, or MRI scans. However, a knowledgeable orthopedic surgeon and/or radiologist familiar with this problem must review these studies because often the findings are subtle. Because this is such a new diagnosis, it is easy for physicians who are not aware of the diagnosis to miss these findings. Although it may seem a burden to lug in a heavy pile of x-rays, at Advanced Orthopedics, Dr. Farjo will always ask patients to bring in films for any special studies that may have been performed prior to seeing him and/or obtain new studies as needed to ensure that his patients have the most accurate diagnosis.

Treatment often begins with stretching exercises, non-steroidal anti-inflammatory medications, and activity modification. If this fails, surgery is often indicated to remove these bone spurs. Open surgery, utilized by other surgeons, is quite invasive and requires dissection through important muscles, large incisions, dislocation of the hip, placement of metal hardware, and increased risk of permanent scar tissue. Dr. Farjo at Advanced Orthopedic Specialists specializes in hip arthroscopy; arthroscopic resection of these bone spurs are possible with much less risk, scar tissue, pain, and therefore patients have a faster recovery.

VIDEO: Hip arthroscopy for FAI Pincer Lesions — Acetabuloplasty, by Laith Farjo, MD

Femoroacetabular impingement (FAI) is a common cause of hip pain. FAI typically causes labral tears in the hip. This video demonstrates the use of arthroscopy to remove a bone spur on the acetabulum (called a pincer lesion). This procedure is known as arthroscopic acetabuloplasty or arthroscopic acetabular rim trimming.