FAQ About Surgical Indications and Outcomes for Athletic Hip

“Athletic Hip” or Femoroacetabular Impingement (FAI) is seen most often in high-level athletes who participate in sports that require cutting and pivoting movements combined with rapid acceleration and deceleration.

Athletic hip typically includes adductor strains, a core muscle injury, inflammation of the pubic bone and sports hernia. In some cases, surgery is not required as part of the treatment plan. However, if a labral tear is present, surgery may be necessary to restore the hip to an acceptable level of pain-free function.

There are three types of Athletic Hip, but often any of the types can cause:

• stiffness in the groin
• pain in the front of the thigh or down the buttocks
• popping or clicking in the front of the hip as you move
• loss of motion in the hip

• CAM Impingement occurs when the “head” of the femur is not perfectly round and cannot rotate smoothly.
• Pincer Impingement occurs when the hip socket creates an “overhang” of the femoral head.
• Combined-Type Impingement occurs when both CAM and Pincer Impingements are present.

Other possible injuries could include:

• Subluxation/Injury: occurs when the femur “ball” is not fully in the socket. Over time the hip can become dislocated.
  • Causes: falls, sports injuries, tear or trauma from a motor vehicle accident
• Hypermobility/Borderline Dysplasia: creates instability of the hip joint. This is most often seen in dancers, gymnasts or those with Ehlers-Danlos Syndrome.
  • Indications: degrading joint cartilage (Chondral lesion), ligament tears, snapping hip syndrome, bursitis or a bone condition called Osteochondritis dissecans.

Your physician will take a thorough evaluation of your history and quality of life, a physical exam, range-of-motion and strength tests and additional specialized tests if needed.

History and quality of life will include a discussion and evaluation of the type of pain you’re experiencing, what mechanical challenges are occurring, functional limitations and impact on your quality of life.

During your physical exam, the physician will investigate how your hip flexes, extends and rotates. X-rays will likely be used for a clearer image of your hip joint. From there, diagnostic hip injections to confirm that your hip is the source of pain may be recommended, or additional cross-sectional imaging (CT or MRI) will be used.

Based on the diagnostic results, one or more of the following will be recommended as your treatment plan:

• Conservative care is typically recommended when:
  • Pain began less than eight weeks ago.
  • There is no specific injury.
  • There are no mechanical symptoms.
  • Lumbar pain/posterior pain is occurring.
  • Atypical hip pain is present.
• Physiotherapy-Led Rehabilitation
• Surgery:
  • Arthroscopic, minimally invasive surgery followed by 12-16 weeks of therapy.
    • Return to jogging – 3 months
    • Return to sport – 4-6 months
    • Full recovery – 9+ months

With proper diagnosis and treatment, most patients can return successfully to their sport. Those requiring arthroscopic hip surgery have a high rate of return to the same or higher competition level compared to their pre-injury level. Those requiring open surgery have a high rate of return. Outcomes tend to vary based on each patient’s desire to return and their dedication to physical therapy rehabilitation.