Nonoperative Treatment for Femoroacetabular Impingement

Femoroacetabular impingement (FAI) has been recognized as a frequent cause of hip pain in young adults. However, it is not known whether an effective nonoperative treatment is available and whether there is any evidence to back up such a treatment. The researches purpose in this review was to establish whether nonoperative treatments exist for FAI in the published literature and whether there is any evidence to support their use. PubMed, Medline, EMBASE, CINAHL, AMED, and Cochrane Library databases were searched by use of the following terms: femoroacetabular impingement, femoro-acetabular impingement, and hip impingement. The search was restricted to English only but with no time limitations. The review was undertaken at 2 academic institutions within the United Kingdom; any article that described or provided evidence that related to a nonoperative treatment for FAI was included. Fifty-three articles met the researchers criteria, of which, 48 were review and/or discussion based. Five articles summarized primary experiments that described or evaluated nonoperative treatment, of which, 3 reported favorable outcomes. Many review and/or discussion articles (31 [65%]) indicated that a trial of conservative care was appropriate. Activity modification was most often suggested(39 [81%]), and nearly half encouraged physical therapy as a treatment (23 [48%]).

The authors concluded that the review literature appears to support initial nonoperative treatment for FAI. While the available literature with experimental data is limited, there is an indication that physical therapy and activity modification provide some benefit to patients. They suggest that nonoperative treatment regimens, particularly physical therapy, need to be evaluated more extensively and rigorously, preferably against operative care, to determine the actual clinical efficacy.