Femoral Acetabular Impingement (FAI)

Femoral Acetabular Impingement (FAI)

The is one of the most common causes of hip pain around the world. Sometimes the way our hips form from childhood can lead us to develop problems as teen or middle aged adults.


Arthroscopic view of a resected CAM lesion

FAI describes a situation where the ball and socket do not fit together in an optimal way, leading the ball to scratch or irritate the socket. If the problem is with the socket or acetabulum, it can be because it's too deep (coxa profunda) or it is too rotated, i.e. PINCER lesion (anteverted or retroverted - pointed to the front or to the back, respectively). Sometimes the problem is on the ball (femur) side and can be because of an irregular shape (coxa valga) or bumpy oversized surface (CAM lesion).

This process of boney impingement is very common and many patients have both CAM and PINCER problems. Failure to address the boney impingement at the time of the original surgery is one of the most common reasons patients are referred to us for a revision or repeat hip arthroscopy surgery. Here you can see an image of a femur where the CAM bump has been resected and shaved, allowing a smoother fit in the hip socket.

There are several types of impingement, including CAM and PINCER most commonly, but also coxa profunda (deeper than normal socket), acetabular retroversion, and ischiofemoral impingement (strain to the quadratus femoris from tightness between the lesser trochanter and the ischium). These issues are in distinction from hip Dysplasia, where the socket is too shallow, though this can often result in cartilage damage and labral tearing.

CAM impingement: increased bony prominence w a loss of concavity at the femoral head neck junction. This can result in increased contact pressure with hip flexion and therefore cartilage damage in the dome of the socket (acetabulum) and labral tearing.

 

Pincer Impingement:
Due to overhang or prominence of the upper part of the acetabulum, the bone and labrum can get pinched or crushed or torn from repetitive impact with hip flexion.

I would like to thank you sincerely for the great care that you have provided me. I am deeply grateful to both of you and all your wonderful clinic and hospital team.

Dr. Hyman diagnosed my problem right away. I had surgery a couple of months later and now after 2 years I feel like a new person.

Since Dr. Hyman operated on my left hip I’ve been able to walk better, longer, and with better ease than I could ever imagine.

I thank God every day that I had that surgery since I have finally gotten rid of the pain that has kept me awake at night for years.

I appreciate you taking the time to educate me about my injury. I also appreciate the kindness and professionalism of the entire staff at Atlanta Sports Medicine.

Thank you so much from the bottom of my heart. For the first time in approximately a year and a half I am pain free.

I appreciate the attentive, professional care and could not envision a better experience. I truly am thankful to be under your care.