Overview

Femoral-acetabular impingement (FAI) is a dynamic condition of the hip that can be a source of pain and disability and can potentially lead to arthritis. This condition is diagnosed when the shape of the femoral neck and acetabulum are abutting one another causing pain or damage. A Hip arthroscopy is a minimally invasive hip surgery that uses a small camera called an arthroscope. During surgery a special device helps separates the ball and socket of the hip joint allowing your surgeon to introduce the arthroscope into your joint. With this technique we can visualize the hip joint, find the source of impingement, and proceed appropriately. FAI may present alongside labral tears that can be treated or reconstructed during your hip arthroscopy surgery.

Indications / Candidacy

Hip arthroscopy can be used to correct Femoral acetabular impingement (FAI). This can occur as a result of underlying anatomic abnormalities, an accident, or even trauma during sport. Patients experiencing FAI may have pain with prolonged sitting, walking and/or deep flexion of the hip. This pain may resonate in the anterior, lateral and posterior area of the hip, which is called the C-sign. The ideal patient for arthroscopic treatment of FAI is a young non-arthritic patient who is symptomatic and has clinical and radiologic evidence of impingement. Hip arthroscopy can also be used to treat patients with labral tears and perform labral reconstruction (replacing the labrum with a cadaveric tendon graft) if needed.

Good Candidates for Hip arthroscopy may need treatment for the following:

  • CAM impingement: when there is a bump lesion on the femoral neck that impinges on the acetabulum (the socket)
  • Pincer impingement: when the acetabulum (the socket) is protruding out and impinging on the femoral neck
  • Labral lesions or tears
  • Removal of loose and foreign bodies
  • Removal of osteochondral fracture fragments
  • Treatment of synovial diseases

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. Femoral-Acetabular impingement (FAI) can be treated using hip arthroscopy. To learn more about this condition, follow the link below:

Condition

Femoral-Acetabular impingement (FAI)

Condition

Post Perthes deformity

Surgical Technique

  1. Patient is put in a lateral position on the operating table on an anti-slip mattress.
  2. Patient’s leg is placed in a boot (that resembles a ski boot) on a hydraulic leg support.
  3. We do NOT use any posts between the legs. Rather the hip is distracted using the patient’s own body weight against the weight of their leg, by tilting the table slightly head down (Trendelenburg).
  4. Distraction is visualized on the intra-operative radiographs and the leg is then sterilized. Portal placement (usually 2-3 small 1cm incisions are made and insertion of the arthroscope and the instruments follows.
  5. Capsular release is done between the hip scope portals
  6. Identification of the different anatomic structures and the labral tear if present.
  7. If presence of labral tear, identification of the extent of the tear is ascertained and then the labral is separated from the acetabular edge and acetabular edge is burred to bleeding bone. This allows the labral to heal back to acetabular.
  8. If the patient has a pincer component to the impingement, then the bony protrusion is removed with a burr until normal acetabular coverage. If the patient’s labrum is not repairable, a decision about preforming a labral reconstruction (using a cadaveric tendon to remake the labrum) is made.
  9. Set up anchors and repair labrum or placed new labrum reconstruction. Once labrum is repaired or reconstructed, the traction is released.
  10. Assess CAM impingement on femoral side, if present, remove with burr.
  11. Verify complete excision of CAM with fluoroscopy and with a variety of hip movements using the hydraulic leg support (i.e., flexion, adduction and internal rotation).
  12. Capsular closure then performed when required
  13. Close the wound, apply standard dressing and intra-articular injection of anesthetic for pain management.

Results

The goal of surgical treatment for FAI is to recreate the spherical contour of the femoral head and improve, repair/reconstruct any damage to the head, and repair/reconstruct the labrum to restore normal mechanics and joint sealing. A Hip arthroscopy for FAI has been shown to provide excellent outcomes, with pain relief and return to sports or activities comparable with, and even better than, open surgical hip treatment. The small surgical device that is used during arthroscopy causes very little trauma to the joint, minimizing hip pain and scarring. After surgery and proper physiotherapy, patients find they have improved comfort, range of motion and function of their hip joint.

Potential Complications

As with any surgical procedure, Hip Arthroscopy can have difficulties and complications. In most cases, our team of specialist can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Extravasation of fluid into the thigh or retroperineal space
  • Numbness in groin, thigh, leg or foot that can persist for several days to several weeks (Neuropraxia), but this is much more rare now that we don’t use a post between the legs.
  • Scope trauma to articular cartilage
  • Hip dislocation post op (rare)(in patients at risk a brace will be prescribed)
  • Superficial infections, deep vein thrombosis, neuro-vascular injuries which are potential risks in any surgical procedure but are rare
  • Continued pain in hip or future pain in hip due to underlying process of arthritis
  • Recurrence or regrowth of the CAM or pincer lesion causing femoral acetabular impingement

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active and eat a healthy diet prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre- and post-op appointment dates
  • Plan for personal care givers

Post-Operative Care

  • Hip arthroscopy is an outpatient procedure (same day surgery) and you will NOT be staying at the hospital overnight
  • Leave the original dressing in place for the first 10-14 days after surgery. The incisions must remain dry.
  • A hip spica brace will be pre-fitted for you to wear for the first 2-6 weeks after surgery. This brace blocks certain hip movements, such as flexion past 90 degrees and prevents external rotation.
  • You are required to use crutches for 14 days after surgery and can only put partial weight on your affected leg
  • Physiotherapy should be started 3-5 days following surgery, using the protocol you will be given upon your departure
  • While at home, it is usually better to sit in a recliner chair/bed (when you are not resting/sleeping) with leg elevated for comfort
  • It is beneficial to change positions often after hip arthroscopy
  • 2 weeks out from surgery, you may begin to progress your weight bearing slowly as directed by your physical therapist

Patients who will undergo this procedure should read:
Immediate post-operative care
Physiotherapy recommendations
Progress report for physiotherapy

Follow-ups after surgery

  • Patients will be required to attend all post-operative appointments
  • Your first follow up appointment is typically two weeks after your surgery
  • Physical therapy should start ideally on day 3-5 post op and should be twice a week.
  • Rehabilitation and physiotherapy is usually required for the first 3 months after surgery and daily exercise should be performed as instructed by your physio and following our protocol.
  • Return to sports is not expected before at minimum of 3 months after surgery and can take as long as 6-9 months post-operatively.

Case studies

15 year old hockey player with right hip pain and FAI with CAM

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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.