Nonsurgical Versus Surgical Management of Femoroacetabular Impingement

What Does the Current Best Evidence Tell Us

Ian Gao, MD; Marc R. Safran, MD


J Am Acad Orthop Surg. 2021;29(10):e471-e478. 

In This Article

Nonsurgical Management

Traditionally, the management of symptomatic FAI starts with activity modification, a trial of nonsteroidal anti-inflammatory drugs, and physical therapy (PT). Activity modification includes a period of relative rest and avoiding hip positions that provoke symptoms (ie, avoiding range of motion extremes, such as with squatting or lunging). PT starts with muscle control and stability work that targets the pelvic, hip, and gluteal muscles. It then progresses to stretching and strengthening.[14] The addition of a core strengthening program to a FAI PT protocol is also beneficial. In a prospective, randomized controlled trial evaluating nonsurgical management of FAI with formal PT using a core strengthening and hip/pelvic girdle strengthening protocol versus PT using a hip/pelvic girdle strengthening only protocol, Aoyama et al[15] found that the core strengthening group compared with the hip/pelvic girdle strengthening only group had significantly higher Vail hip scores (81.6 ± 18.5 versus 61.1 ± 11.6; P < 0.05) and significantly higher International Hip Outcome Tool (iHOT) scores (78.7 ± 22.4 versus 53.0 ± 22.3; P < 0.01) after 8 weeks of intervention. Baseline scores between both groups before PT were similar: Vail hip score 58.9 ± 12.8 versus 62.2 ± 9.9; P = 0.54 and iHOT score 49.2 ± 18.4 versus 45.8 ± 24.1; P = 0.73.

Most patients with symptomatic FAI can be treated nonsurgically. Pennock et al[16] prospectively followed 93 hips (76 patients) with symptomatic FAI with mean age 15.3 years and mean follow-up of 26.8 months and found that 82% of patients could be managed successfully with nonsurgical treatment (activity modification, PT, and 12% received intra-articular corticosteroid injection), although these patients reduced or changed sporting activities. Similarly, Emara et al[17] showed notable clinical improvements with nonsurgical management in 89% of patients (of 37 patients) with FAI and mild deformity (alpha angle <60°).