Femoroacetabular Impingement Syndrome – The Warwick Agreement.

Endorsed by 25 clinical societies the Warwick Agreement on FAI syndrome have put together a MDT agreement on the diagnosis and management of FAI. Interest in this topic has risen ever since the introduction of arthroscopic surgery at the start of the millenium with increasing prevalence and publications citing the disorder. The meeting focussed on 6 key questions and the aim was to definitively appraise the literature to create clarity on a complex syndrome.

The questions asked were as follows:

  1. What is FAI syndrome?
  2. How should FAI syndrome be diagnosed?
  3. What is the appropriate treatment of FAI syndrome?
  4. What is the prognosis of FAI syndrome?
  5. How should someone with an asymptomatic hip with cam or pincer morphology be managed?
  6. Which outcome measures should be used to assess treatment of FAI syndrome?

In summary the answers can be amalgamated to the following:

FAI sundrome is a motion-related clinical disorder with a triad of symptoms and clinical signs as well as imaging findings. It is caused by premature contact between the proximal femur and the acetabulum in two distinct presentations, CAM or PINCER (as well as combined). Soft tissue damage as well as the presence of repetition-related pain must be present.

The pain associated with FAI must be position or motion dependent presenting primarily in the hip or groin, with a clicking, catching, locking or giving way sensation. An x-ray or MRI can provide evidence of the extend of the bony change and is required for a clinical diagnosis of FAI.

In terms of management conservative, rehabilitation or surgery all have their place however the evidence to compare effectiveness is limited. The image associated with this writing is the suggested pathway for management. The prognosis associated with the management plan is clear. With treatment people with FAI can return to full activity and sports however without treatment symptoms will worsen with an unclear outlook. If the person is asymptomatic it is unknown when symptoms will develop but it is suitable to begin preventative rehabilitation with surgery appearing to be not indicated at this time.

After intervention is is appropriate to use the iHOT, HOS and HAGOS outcome measures as these are all reviewed and validated measures.

Further research does need to occur to cement the role of physiotherapy, in particular the contents of preventative and rehabilitation programmes. This should be somewhat easier with the outcome and clarity this meeting provided.

What do you think should be included in rehab for FAI? Let us know in the comments and on social media.