Femoral acetabular impingement (FAI)
is described as impingment of the femoral head on the labrum of the acetabulum, resulting in destruction of the labrum and symptoms of groin pain and reduced hip range of movement. FAI can present as a pincer or cam lesion but more commonly both. It is closely associated with sports such as GAA, soccer, and AFL. Femoral acetabular impingement can be quite limiting, preventing the athlete from competing at the levels they desire to. Risk factors for femoral acetabular impingement include trauma and genetics. Its more commonly seen in young men but does affect women also.
I recently attended the 3rd hip and groin sports injury symposium at the Whitfield Clinic Medical Centre in Waterford. The day was chaired by Mr. Tadhg O’Sullivan, (clinical director) of the Hip & Groin Clinic. Guest speakers included Dr. Alan Byrne from the F.A.I., Mr. David Lyons (Kildare GAA Physiotherapist) and Mr. Antonio Andrade (Orthopaedic surgeon).
The day centred around a live hip arthroscopy undertaken by Mr. Patrick Carton(Hip & Groin Orthopaedic surgeon) and his team, with the guest speakers informing the assembled health care professionals on their clinical and personal experiences of femoral acetabular impingement.
Surgical Vs Conservative Management
The decision for surgical intervention over conservative management is multi factorial. Factors such as age and level of sports participation seem to be the two most influential reasons for surgery. If for example you have a 25 year old inter county player diagnosed with FAI, and a desire to return to the highest level. The decision to operate would be probable. On the other hand, if the inter county player is 35, and planning to retire in the next year, conservative management would be the probable course of action. Regardless of the course of action, the development of osteoarthritis in later life is increased.
At the symposium it was stressed a number of times that the hip is not causing the person pain, rather what the person is doing with the hip. This implies that it is activity driven. Therefore you can have Femoral acetabular impingement but no symptoms or pain depending on your activities levels.
The live arthroscopy was performed on a mid twenties inter-county gaa footballer. The objective of the arthroscopy was to debribe a cam and pincer lesion, and utilise a novel labral cuff refixation. This new approach aims to maximise the integrity of the hip joint and increasing stability by preserving structures such as the chondrallabral junction. The operation took about 1 & 1/2 hours.
Post operative care involves rehabilitation and follow up visits. Initial rehab is targeted at allowing the procedure to settle and reducing pain. After two weeks stationary cycling and pool work is introduced. By 7 weeks the hope is that the client will be able to start running with full training expected by 3 months. It is important to note that these estimates are based on operations without any complications.
I felt it was a very beneficial day spent at the Whitfield clinic. It was both insightful and informative. Getting the perspective of orthopaedic surgeons gave me a new appreciation for what they do and the levels of detail they plan for.