Femoroacetabular impingement (FAI) happens when the shape of the hip bones causes extra rubbing inside the hip joint. This rubbing places pressure on the labrum and cartilage, leading to pain and joint damage over time.

The X-ray below shows “CAM impingement”, where the ball part of the hip joint is not perfectly round.

“Pincer impingement” occurs when the hip socket covers too much of the ball part of the joint, causing additional damage.

Some patients have both CAM and pincer impingement at the same time.

In addition to repairing damage inside the joint, surgeons can reshape the bones arthroscopically to restore a more normal hip shape.

Doctors evaluate FAI using X-rays and sometimes MRI scans or CT scans. Dr. Carreira may order additional imaging on a case-by-case basis to better evaluate the alignment of the pelvis.

Hip Arthroscopy Rim Trimming to Address Femoroactabular Impingement (FAI)

Hip Dynamic Examination as Treatment of Femoroactabular Impingement (FAI)

The hip arthroscopy video below shows the hip being moved after surgery to check that the impingement was corrected and that the labrum is no longer being pinched.

Video of Severe CAM Impingement (Femoroactabular Impingement)

Soft Tissue Impingement Removal to Address Femoroacetabular Impingement (FAI)

The above video demonstrates a soft tissue type of CAM impingement. In this case, thick soft tissue is causing the impingement instead of bone.

Boney CAM impingement is solved by bone saving. However, in this case, we can see that the patient has little bone impingement and rather a lot of soft tissue impingement, so the solution is to remove the extra tissue. You can see that before the surgery, the soft tissue at the femoral neck is at the bottom of the screen pushing against the labral tissue at the top of the screen.

After testing the hip through movement, doctors confirmed there was no longer pressure on the labrum with motion.

Photo of Soft Tissue Impingement

The photo provides an example of soft tissue impingement – and not the widely understood bony impingement. This soft blob of tissue was completely removed from a patient by Dr. Dominic Carreira. That soft tissue was a thickened layer of bone and soft tissue, which acts like bony impingement.

Photo of Significant CAM Impingement (Femoroactabular Impingement)

Photos of Femoroacetabular Impingement (FAI)

Exercises to Avoid with Femoroactabular Impingement (FAI)

FAI places abnormal pressure on the labrum and cartilage of the hip joint. Avoiding certain exercises shown below may help reduce symptoms.

Maintaining Flexion Angles

Keeping the hips at angles with the body near 90 degrees or greater may help avoid positions that cause impingement.

Squats

Squats place large amounts of pressure on the hip because of deep bending. Doing shallower squats may help decrease stress on the joint while still allowing for exercise and muscle growth.

Deadlifts

Deadlifts involve deep hip bending and heavy weight, which can increase pressure on the hip.

Leg Press

The leg press is similar to a squat but horizontal and can place stress on the hip joint during deep bending. By bending less, one can put less stress on the hip.

Rowing Machine

The rowing machine involves very deep hip bending and repeated fast movement, which may irritate the hip.

Cycling

Seat position greatly impacts the extent of impingement. Cycling with a low seat increases hip bending and may worsen impingement. Raising the seat height may help.

Mountain Climbers

Mountain climbers can cause hip pain because of repeated fast deep hip bending.

Lunges

Lunges may also increase hip impingement if the movement is too deep. Try shallower lunges to build muscle and protect the hip.

A PDF version of exercises to avoid with FAI is available.

Dr. Carreira has also posted related videos on YouTube.