Femoroacetabular Impingement: Symptoms, Causes & Treatment
A sharp catch in the groin when tying your shoes, or a deep ache after a long drive, can be the first signs of a structural hip issue. Femoroacetabular impingement (FAI) develops when irregular bone growth changes the way the hip joint moves — and untreated, it can lead to early osteoarthritis.
What is Femoroacetabular Impingement?
The hip is a ball-and-socket joint. The “ball” is the femoral head (the top of the thigh bone) and the “socket” is the acetabulum (part of the pelvis). A healthy hip features smooth cartilage that lets the ball glide effortlessly inside the socket.
Femoroacetabular impingement (FAI) occurs when extra bone grows along one or both of these surfaces. The bones no longer fit together perfectly and begin rubbing against each other during movement. Over time, this friction damages the cartilage and the labrum — the ring of cartilage that seals the joint — and can trigger early osteoarthritis if left untreated.
Types of Hip Impingement
Specialists classify FAI into three categories based on where the extra bone growth occurs.
- —Pincer impingement — Extra bone extends out over the rim of the socket. The prominent rim pinches the labrum whenever the hip bends.
- —Cam impingement — The femoral head is not perfectly round. A bump forms on the edge of the ball, grinding cartilage inside the socket as the hip rotates.
- —Combined impingement — Most patients with this condition have a combination of both pincer and cam features.
Symptoms of FAI
Many people have irregular hip bones but never experience pain. Once the joint sustains enough damage from friction, however, symptoms begin to disrupt daily life.
- —Groin ache — Deep ache in the groin area, especially after sitting for long periods.
- —Sharp pinch — Stabbing pain when turning, twisting, or pivoting on the affected leg.
- —Catching or clicking — A mechanical sensation in the front of the hip during movement.
- —Stiffness — Reduced range of motion that worsens with deep flexion.
- —Activity-specific pain — Discomfort getting in and out of a car, squatting, or playing sports that demand deep hip flexion such as hockey, soccer, or martial arts.
Causes and Risk Factors
Hip impingement happens because the hip bones do not form normally during the childhood growing years. The resulting cam or pincer bone spur is what eventually leads to joint damage and pain.
- —Athletic activity — High-impact sports place repeated stress on the hip, making symptoms more likely to surface.
- —Genetics — A tendency to develop abnormal bone shapes in the hip can be inherited.
- —Childhood hip conditions — Disorders such as Legg-Calve-Perthes disease or slipped capital femoral epiphysis can alter bone development during growth.
Diagnosis
You should seek medical evaluation if hip pain lasts more than a few days. The orthopaedic specialist will review your medical history, perform a physical examination, and order imaging.
The impingement test — bringing the knee toward the chest and rotating it inward — often recreates the specific groin pain when FAI is present. Imaging then confirms the diagnosis.
- —X-rays — Clear images of bone structure to identify cam or pincer bone spurs.
- —MRI scans — Reveal soft tissue damage including labral tears and articular cartilage injury.
- —ICD-10 coding — Your provider will assign a specific FAI code based on whether the right, left, or both hips are affected.
Non-Surgical Treatment
Treatment focuses on managing pain and improving mobility. Most plans begin with non-surgical care before considering operative options.
- —Activity modification — Avoid the specific movements that cause pain — adjusting squat depth, modifying training, or pausing high-impact sport.
- —NSAIDs — Over-the-counter medication such as ibuprofen reduces pain and inflammation.
- —Physical therapy — Targeted exercises improve hip range of motion and strengthen the muscles supporting the joint.
- —Corticosteroid injection — When rest and therapy fall short, a strong anti-inflammatory injected directly into the joint can temporarily relieve pain.
Surgical Treatment
If non-surgical treatments fail to relieve pain, the orthopaedic specialist may recommend surgery. The goal is to correct the structural abnormality and repair any damaged soft tissue.
Today, surgeons typically perform this procedure arthroscopically — small incisions and a tiny camera allow access to the joint with miniature instruments. During surgery the specialist may:
- —Trim the socket rim — Remove the bony overhang responsible for pincer impingement.
- —Reshape the femoral head — Shave down the cam bump so the ball rotates smoothly in the socket.
- —Repair the labrum — Stitch or clean up the torn ring of cartilage that seals the joint.
- —Smooth the cartilage — Address any damaged articular cartilage discovered inside the joint.
Arthroscopic surgery generally results in less pain and a faster recovery than traditional open hip surgery.
Recovery and Prognosis
Recovery from hip arthroscopy takes time and patience. Crutches are typically required for the first few weeks to protect the repaired joint, and physical therapy begins almost immediately to restore strength and flexibility.
Most patients return to light, everyday activities within a few weeks, while full recovery and return to high-impact sport takes three to six months. By successfully reshaping the joint, surgery relieves pain and frequently prevents further damage to the hip.
Get Expert Hip Care
If you frequently experience groin pain during routine movements, do not wait for the symptoms to worsen. Schedule an evaluation with an experienced orthopaedic specialist to discuss your hip health and map out a treatment plan.
