20Shoulder Care
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement
28Knee Care
ACL Tear
Cartilage Injury
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Trochleoplasty
17Hip Care
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Repair
Labral Reconstruction
Nanofracture
Trochanteric Bursa Debridement
2Biologics
Bone Marrow Aspirate Stem Cell Concentrate (BMC)
Platelet-Rich Plasma “PRP”

FEMOROACETABULAR IMPINGEMENT (FAI)

Femoroacetabular impingement (FAI) is a condition caused by misshapen bone(s) in the hip. The hip joint is a “ball and socket” type joint comprised of two bones – the femoral head (ball) and a part of the pelvis called the acetabulum (socket). In normal hips, the ball and socket glide smoothly without any restraint. However, in patients with FAI, the ball and/or socket are misshapen, and the bones make abnormal contact with each other (e.g. “impinge”). This abnormal contact between the bones may lead to damage to the labrum (rim of cartilage surrounding the acetabulum) and/or to the articular cartilage that lines the ends of the bones.

FAI is thought to be due to a combination of genetic and developmental influences. Some people are born with a misshapen hip whereas other patients may develop a misshapen hip later in life (for example, from participation in certain sports). There are two types of FAI: CAM impingement and pincer impingement. In the majority of cases, patients have a mixed type of impingement, which includes a combination of CAM and pincer impingement.

CAM Impingement: this type of impingement occurs as a result of an abnormal shape to the femoral head. Instead of being round, the femoral head has a “bump” on one side, which leads to abnormal contact with the socket (acetabulum) with hip motion.

Pincer Impingement: this type of impingement occurs when the socket is deeper or extends further than normal around the ball. With hip motion, the labrum and cartilage between the ball and the socket can be “pinched” and may tear.

Symptoms

  • Catching in the groin
  • Groin pain or thigh pain with squatting down and bending the hip
  • Pain and instability with activity and/or sports that require repetitive motion of the hip

Diagnosis And Treatment

Dr. Keller considers each patient’s symptoms, as well as a detailed physical examination, x-rays, and usually and MRI of the hip to make the diagnosis of FAI. Non-surgical treatment includes rest, activity modification, physical therapy to strengthen the hip and core muscles, and non-steroidal anti-inflammatory drugs. Injections, including steroid injections, are also helpful as they serve a dual purpose: to reduce pain and as a diagnostic test to determine if all of the patient’s pain is from the inside of the hip joint. If the patient fails non-operative management, then Dr. Keller may recommend surgery.

If surgery is necessary, Dr. Keller usually recommends an arthroscopic approach to the hip using two or three small incisions. During surgery, Dr. Keller introduces a camera into the hip through one incision and instruments into the hip though the other incisions. The two major bony procedures that are performed for impingement are femoroplasty and acetabuloplasty.