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

Surgical Management: Open Approach

When nonsurgical management of symptomatic FAI fails, surgical management is generally indicated. The goal of surgery is to reduce symptoms by restoring the normal femoral head/neck and acetabular anatomy, eliminating impingement, and treating associated labral and chondral pathology.[1]

Ganz et al[18] first described open surgical hip dislocation for the management of FAI, and this approach showed good clinical outcomes.[19,20] Steppacher et al[19] performed surgical hip dislocation with femoral neck osteoplasty and/or acetabular rim trimming with labral repair in 75 patients (97 hips) with FAI. At the 10-year follow-up, the Merle d'Aubigné-Postel score increased from preoperative 15.3 ± 1.4 to postoperative 16.9 ± 1.3 (P < 0.001), and the survivorship from any of the defined failures (conversion to THA, radiographic evidence of worsening OA, or a Merle d'Aubigné-Postel score <15) was 80%. They concluded that 80% of patients treated with open surgical hip dislocation for FAI have good clinical results without OA progression at 10 years. Their strongest predictors for failure were age older than 40 years, body mass index >30, lateral center edge angle <22° or >32°, and posterior acetabular coverage <34%. Novais et al[20] performed open surgical hip dislocation with femoral head/neck osteochondroplasty and/or acetabular rim trimming with labral repair in 24 adolescent athletes with FAI (mean age 15.5 ± 2.0 years, range 11 to 19 years) with a mean follow-up of 22 months (range 12 to 39 months). They found that 87.5% of athletes successfully returned to play after open FAI treatment with median time to return to play of 7 months. Of those who returned to play, 90% returned at a level that was equivalent to or greater than their level of play before surgery. There were also notable improvements in median modified Harris Hip Score (mHHS) (52.8 preoperative vs 92.0 postoperative, P < 0.0001) and median Hip Disability and OA Outcome Scores (HOOS) (39.4 preoperative vs 91.3 postoperative, P < 0.0001).