- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY, NSW | MORNINGTON, VIC |
- 03 9421 6133
- Melbourne & Mornington VIC |
- Albury, NSW
Femoroacetabular Impingement (FAI)
Understanding hip joint shape abnormalities and how they may lead to pain and restricted movement
Femoroacetabular impingement (FAI) is a condition that occurs when abnormal contact between the bones of your hip joint leads to pain, stiffness, or limited range of motion. In a healthy hip, the ball (femoral head) moves smoothly within the socket (acetabulum). With FAI, the shape of either the ball or socket or, both is altered, causing the bones to rub against each other during movement. Over time, this repeated contact can damage the cartilage and labrum, increasing the risk of hip osteoarthritis if left untreated. FAI often affects young and active individuals, including athletes, but it can also occur in people with no history of sports participation. If you’re experiencing hip or groin pain, particularly when sitting for long periods or during hip flexion movements (such as squatting or twisting), a thorough orthopaedic assessment can help determine whether FAI is the cause.
On this page, you’ll find clear, information about the causes, symptoms, diagnosis, and management options for femoroacetabular impingement, including non-surgical treatments and surgical procedures like hip arthroscopy if required.
What is femoroacetabular Impingement (FAI)?
Femoroacetabular impingement (FAI), commonly referred to as hip impingement, is a condition where abnormal contact occurs between the ball (femoral head) and socket (acetabulum) of the hip joint. This contact can damage the cartilage and labrum over time, leading to pain, stiffness, and reduced movement.
FAI most often affects young to middle-aged adults and may develop gradually or following repetitive hip movements, particularly in sports such as football, dance, hockey, and martial arts.
There are two main types of FAI:
- Cam impingement: Caused by an abnormal shape of the femoral head, which creates friction against the socket during movement.
- Pincer impingement: Occurs when the socket (acetabulum) has extra coverage or overhang, pinching the femoral neck.
- Many people have a combination of both (mixed FAI).
Over time, untreated FAI may increase the risk of developing hip labral tears or early hip osteoarthritis.
Common symptoms of FAI
Symptoms of femoroacetabular impingement can vary depending on the severity and type of impingement. They may include:
- A sharp or aching pain in the front of the hip or groin
- Pain that worsens with prolonged sitting, squatting, running, or twisting
- Clicking, locking, or catching sensations in the hip
- Stiffness or reduced range of motion
- Pain during or after exercise, particularly with deep hip flexion
- Difficulty with movements like tying shoes, getting in and out of cars, or climbing stairs
In some cases, symptoms may come and go before gradually worsening over time.
What causes femoroacetabular impingement?​
FAI is caused by subtle abnormalities in the shape or structure of the hip joint that lead to abnormal joint mechanics. These changes may be:
- Congenital (developed during growth)
- Activity-related, particularly in athletes during adolescence
- Due to repetitive stress, especially in sports involving deep hip flexion and rotation
Risk factors for FAI may include:
- High levels of sporting activity during adolescence
- Structural differences in hip anatomy
- Family history of hip problems
- Previous hip injury
Not everyone with FAI anatomy will experience symptoms. Treatment is usually only required when the condition becomes painful or limits function.
How is FAI diagnosed?
A diagnosis of femoroacetabular impingement typically begins with a thorough consultation and physical examination. During your appointment, Dr Jason Hockings will ask about your symptoms, medical history, and any activities that may aggravate your hip pain.
Investigations may include:
- X-rays: To assess the shape of the femoral head and socket
- MRI or MR arthrogram: To evaluate soft tissues such as the labrum and cartilage
- CT scan (in selected cases): For 3D assessment and surgical planning
These tests help confirm the diagnosis, assess any associated labral damage, and guide treatment options.
Non-surgical treatment options
For mild to moderate symptoms, a trial of non-surgical treatment may be recommended. These options aim to reduce inflammation, improve hip mechanics, and avoid positions that worsen symptoms.
Non-surgical strategies may include:
- Activity modification (avoiding deep squats, prolonged sitting, or pivoting)
- Physiotherapy focused on hip strength, flexibility, and movement control
- Anti-inflammatory medications (as appropriate)
- Image-guided corticosteroid injections to reduce inflammation and confirm diagnosis
Dr Hockings will discuss whether these approaches are suitable for your specific situation. In some patients, non-operative care may effectively manage symptoms long-term.
When might surgery be recommended?
Surgery may be considered if symptoms of FAI are persistent despite a structured course of physiotherapy and activity modification, or if imaging shows clear structural damage such as a labral tear or cartilage injury.
Signs that surgery may be appropriate include:
- Ongoing groin pain affecting work, sport, or daily activity
- Failed response to conservative treatments
- Confirmed labral damage or cartilage wear
- Restriction in hip movement that limits your quality of life
Early intervention may help protect the joint and delay or prevent the onset of arthritis in some cases.
Hip arthroscopy is the most common surgical treatment for femoroacetabular impingement. This minimally invasive procedure involves inserting a small camera (arthroscope) and specialised instruments through tiny incisions to address the structural abnormalities within the joint.
During the procedure, Dr Hockings may:
- Trim or reshape excess bone from the femoral head (cam lesion)
- Remove excess bone from the acetabulum (pincer lesion)
- Repair or debride a torn labrum
- Address any cartilage damage
Hip arthroscopy is usually performed as day surgery or with a short hospital stay. Most patients can begin walking on the same day with crutches and start physiotherapy shortly after.
Recovery after FAI surgery​
Recovery from hip arthroscopy varies depending on the extent of the surgery and your individual circumstances. In general:
- Crutches are used for 1–2 weeks (or longer if labral repair is performed)
- Physiotherapy begins within days of surgery and continues for several months
- Most patients return to work within 2–4 weeks, (depending on job type)
- Return to sport may take 3–6 months
Dr Hockings and his team will provide a personalised rehabilitation plan tailored to your goals and lifestyle.
If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.