How to Diagnose Hip FAI
Dr. Boykin will initially perform a history and physical exam where he will ask the patient the location of the pain, the pain level, what specific activities and movements cause pain, and what makes the pain better. He will then perform a detailed physical examination to assess for FAI, range of motion, tightness of the muscles around the hip, hip instability, and diseases of the lower spine. The classic test for FAI and anterior labral tears involves placing the hip in a position of flexion, internal rotation, and adduction to see if this causes the patient’s pain. Upon presentation all patients will have hip specific radiographs to examine for any bony abnormalities, FAI, or other causes of hip pain. In many cases, Dr. Boykin will order an MRI of the hip to examine the extent of damage to the articular cartilage, labrum, and other soft tissue structures surrounding the hip (which are not well seen on X-rays). This type of testing will allow Dr. Boykin to confirm the diagnosis as well as to determine the severity of the injury and to ensure that there are no other injuries in the hip joint (fractures, etc.).
Treatment Options for Hip FAI
Depending on the severity of the damage to the hip joint and the types of therapies that the patient has already tried, Dr. Boykin may first recommend non-surgical treatments. These include an initial trial of rest, activity modification, physical therapy to strengthen the hip and core muscles, and non-steroidal anti-inflammatory drugs. If these fail to provide relief, Dr. Boykin will then perform an injection of local anesthetic and steroids into the hip. This procedure serves a dual purpose: to provide a therapy to reduce the pain and as a diagnostic test to determine how much of the patient’s pain is from the inside of the hip joint. This is an important indicator as to how well the patient would respond to surgical treatment, if needed. In some cases, these treatment methods may be successful in completely alleviating the patient’s pain. If these non-operative treatment methods do not prove to be helpful, Dr. Boykin may begin to discuss surgical options with the patient.
What is Hip FAI Surgery?
FAI has only recently been appreciated as a source of hip pain and disability and therefore the surgical treatments for this have been evolving and improving. Initial surgical options for FAI included open surgery to dislocate the hip joint and treat the FAI and damage to the labrum and cartilage. While this procedure is successful, and may still be required in certain patients, newer techniques have allowed surgeons to accomplish the same goals with minimally invasive arthroscopic surgery. In the vast majority of cases, Dr. Boykin will perform an arthroscopic surgical approach to the hip using small incisions, a camera, and special instruments. During this surgery he will treat the FAI by removing the bump from the femoral head and recreating a round surface and/or removing the extra bone from the socket. He will then treat any tearing of the labrum and damage to the articular cartilage. Dr. Boykin strongly believes in preserving as much of the labrum and cartilage as possible; therefore, he uses a technique to repair the labrum rather than just take away the area of damage. If the labrum is damaged beyond repair, in most cases he will perform a reconstruction, rebuilding the labrum with tissue from the outside of the patient’s hip. Dr. Boykin will use his experience to determine which surgery a patient will better recover from to provide the patient with the best chance of returning to their activities. These procedures have been shown to be highly successful in active people, including professional athletes, back to their sports and activities.
For information regarding FAI, labral tears, or any other hip-related injury, feel free to contact Dr. Robert Boykin, orthopedic surgeon treating patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.