In the condition of femoroacetabular impingement (FAI), the abnormal shape of the bone leads to abnormal forces on the labrum and articular cartilage and causes early damage and hip pain.

The x-ray picture below demonstrates the loss of sphericity, or rounded shape, of the femoral head at the junction between the head and neck along the top portion of the femur (the ball portion of the ball and socket joint). This type of impingement on the femoral side is termed CAM impingement.

Along the acetabulum, or the cup side of the joint, impingement may also occur, termed pincer impingement. The overcoverage on the acetabular side also leads to joint damage.

Mixed forms of impingement, in other words, having both CAM and Pincer impingement, also may occur.

In addition to treating the damage in the hip joint, the shape of the femoral head and neck can be reshaped arthroscopically to recreate a normal contour.

Evaluation of femoroacetabular impingement (FAI) is completed through x-rays, and additional imaging may be helpful including MRI, CT scan, and software programs that interpret these types of images and guide the surgeon to the specific areas around the joint where FAI exists. Dr. Carreira may order additional imaging on a case by case basis, as the additional imaging serves as a detailed “road map” of the alignment of the pelvis. Femoral rotation and its contribution to stability and impingement are additional potential benefits of CT scanning and software processing of the images.

Hip Arthroscopy Rim Trimming to Address Femoroactabular Impingement (FAI)

Hip Dynamic Examination as Treatment of Femoroactabular Impingement (FAI)

The hip arthroscopy video below demonstrates dynamic examination of the hip following acetabular rim trimming and femoral osteoplasty and labral (labrum) repair. The hip is brought through range of motion under anesthesia to check for adequate treatment of femoroacetabular impingement (FAI). The labral tissue is free of any impingement forces which had contributed to its damage.

Video of Severe CAM Impingement (Femoroactabular Impingement)

Photo of Significant CAM Impingement (Femoroactabular Impingement)

Photos of Femoroacetabular Impingement (FAI)

Exercises to Avoid with Femoroactabular Impingement (FAI)

Femoroacetabular impingement places abnormal force on the labrum and the articular cartilage of
the hip joint and creates damage over repetition. Avoiding these exercises may decrease the effects of impingement and help decrease symptoms.

Maintaining Flexion Angles

Maintaining flexion angles (angle between trunk and thigh) of approximately 90 degrees or above avoids positions of impingement.

Squats

Squats typically combine high hip flexion and high loads. However, if you don’t go down as far, the angle between the trunk and thigh increases while still allowing for muscular activation and hypertrophy.

Deadlifts

There is a high degree of hip flexion at the bottom of this movement. In addition, because of the high capacity for load in this movement, there is increased force on the hip.

Leg Press

Essentially a horizontal version of squats, the leg press puts significant stress on the hip in deep hip flexion. However, one can adjust the depth of the movement, allowing for a decreased amount of hip flexion.

Rowing Machine

There is a high degree of hip flexion at the start of this movement (the greatest of the movements on this handout). This, in combination with the speed at which it’s done, puts significant stress on the hip.

Cycling

Seat height position significantly affects the extent of impingement. A lower seat position increases impingement. Try a higher position to decrease the amount of hip flexion.

Mountain Climbers

Mountain climbers usually cause hip pain due to the extent of hip flexion and speed with which the movement is done.

Lunges

Similar to squats, if you don’t go down as far, the angle between the trunk and thigh increases, decreasing impingement while still allowing for muscular activation and hypertrophy.

Download a PDF version of Exercises to Avoid with Femoroactabular Impingement (FAI).

Additionally, Dr. Carreira posted a number of related videos on his YouTube channel.