This condition can lead to the formation of bone spurs around the femoral head and/or acetabulum, which can interfere with the smooth gliding movement of these bones against each other, resulting in damage to the articular cartilage (a smooth cushioning surface of the ball and socket) or a tear in the labrum (soft elastic tissue that forms the socket ring) in the hip joint. In severe cases, this condition can cause degenerative joint disease and arthritis.
There are two types of hip impingement, namely pincer and cam impingement. Pincer impingement occurs due to the socket's over-coverage, while cam impingement occurs when the abnormally shaped femoral head doesn't fit well in the acetabulum. Combined impingement refers to cases where both types are present.
Femoroacetabular osteoplasty (FAO) is a surgical procedure used to treat FAI. It involves the removal of the protruding bony areas of the hip joint to allow an impingement-free range of motion of the hip
FAO aims to achieve the following objectives:
Femoroacetabular osteoplasty can be carried out using three different procedures: open surgical dislocation, arthroscopy, or mini-open surgery.
Open surgical dislocation involves making a surgical incision of approximately 6 to 10 inches. The upper thigh bone is then cut to dislocate the femoral head from the socket, which enables the surgeon to access all the parts of the hip joint. This complete dislocation allows for the repair of labrum tears and bony abnormalities of the femoral head, while protecting the blood supply to the hip during the operation. The procedure usually takes 2-3 hours and requires an overnight stay in the hospital. However, it is not recommended for patients with athletic demands, significant hip degeneration, or older patients.
During the femoroacetabular osteoplasty (FAO) procedure, your surgeon aims to reshape the abnormally shaped hip bones and repair any damage to the labrum and articular cartilage. One approach to FAO is arthroscopy, where a small camera and lighted device called an arthroscope is used to view and treat the affected area. This technique requires two to four 1 cm incisions. Arthroscopy is suitable for treating various problems associated with FAI, including cartilage damage, labrum tears, and bone friction. Additionally, arthroscopy can reshape the femoral head or trim the acetabulum to restore the smooth movement of the joint.
Arthroscopic microfracture, a technique used to stimulate the growth of healthy cartilage by delivering stem cells to the damaged area, can also be performed during this procedure. The time required for the procedure depends on the severity of the condition. Arthroscopic procedures take approximately an hour without the need for labral repair and bony decompression, while those requiring labral repair and decompression can take between 2-4 hours. Care must be taken during osteoplasty to avoid damage to blood vessels.
Another approach is the mini-open procedure, which combines both open and arthroscopic techniques. In this procedure, the surgeon makes an incision and inserts an arthroscope. They then perform a capsulotomy to improve visualization and instrument navigation. The hip is slightly extended, and the surgeon uses a high-speed or arthroscopic burr to treat the labrum, acetabular rim, and internal compartments of the abnormal hip bones. This approach minimizes the risk of damage to nerves and femoral cartilage.
Post-operative care: After the surgery for FAI, it is common to experience numbness or tingling due to anesthesia, but this should subside. The catheter for urinary retention will be removed the day after the procedure. You will receive intravenous fluids and pain-relieving medications overnight, as well as anti-coagulation therapy to prevent blood clots. On the day after surgery, you may be recommended for physical therapy, and once you have completed this, you can be discharged to go home.
It will take approximately 3 to 4 months of rehabilitation after the FAI surgery to fully recover and resume normal activities.
Like any surgical procedure, there are risks and potential complications associated with hip FAO surgery, including hip dislocation and instability, abnormal bone formation in soft tissues, nerve injury, dead bone at the femoral head, femoral neck fracture, scarring, infection, and deep vein thrombosis.
On the other hand, the benefits of FAO surgery include restoring physical activity and reducing pain in patients with FAI who have minimal or no arthritis.