Conservative Treatment for Mild Femoroacetabular Impingement

Abstract

Purpose. To report early results of conservative treatments (including modifications in activities of daily living) for mild femoroacetabular impingement. Methods. 27 male and 10 female athletic patients aged 23 to 47 years presented with unilateral hip pain secondary to femoroacetabular impingement and an alpha angle of <60º. Patients were instructed to adapt to their safe range of movement and perform activities of daily living with minimal friction. The Harris Hip Score and non-arthritic hip score before and after treatment were compared. Open or arthroscopic hip surgery to remove the impinging bone was indicated when conservative treatment failed. Results. Patients were followed up for 25 to 28 months. Of the 37 patients, 4 underwent surgical treatment after conservative management failed. For the remaining 33 patients, the mean Harris Hip Score improved significantly from 72 before treatment to 91 at the 24-month follow-up. The mean non-arthritic hip scores improved from 72 to 91, and the mean visual analogue scores for hip pain from 6 to 2. Six of the 33 patients had recurrent hip pain and discomfort but not severe enough for surgical treatment. Conclusion. Conservative treatment did not improve the range of hip movement, despite improvement in function and symptoms. Yet it achieved good early results, as long as the patients could modify activities of daily living to adapt to their hip morphology.

Femoroacetabular Impingement: A Retrospective Case Study With 8-Year Follow-Up

“…18 The observed improvement in function and symptoms with conservative treatment in this study remained as long as the patients could modify activities of daily living to adapt to their hip disorder. 18 Conservative therapy is mainly palliative, however, and cannot correct the actual morphology of the underlying bone. Furthermore, chiropractic treatment focusing on high-velocity, low-amplitude manipulation of the FAI hip to improve passive ROM would be counterproductive and could exacerbate the condition.…”

“…4,17 Three recent publications have reported success with conservative management. 18,20,22 Emara et al documented positive results in the conservative management of patients with mild FAI. 18 In this study all patients underwent 4 stages of conservative treatment including the avoidance of excessive physical activity, the use of anti-inflammatory drugs, finding a safe range of movement and adapting to it, and modification of certain provocative activities of daily living (ie, avoiding the combination of flexion, adduction, and internal rotation of the hip).…”

“…18,20,22 Emara et al documented positive results in the conservative management of patients with mild FAI. 18 In this study all patients underwent 4 stages of conservative treatment including the avoidance of excessive physical activity, the use of anti-inflammatory drugs, finding a safe range of movement and adapting to it, and modification of certain provocative activities of daily living (ie, avoiding the combination of flexion, adduction, and internal rotation of the hip). 18 The observed improvement in function and symptoms with conservative treatment in this study remained as long as the patients could modify activities of daily living to adapt to their hip disorder.…”

“…Furthermore, chiropractic treatment focusing on high-velocity, low-amplitude manipulation of the FAI hip to improve passive ROM would be counterproductive and could exacerbate the condition. 2,16 In instances where there is significant progression of FAI, joint preservation surgery may be warranted to remove the mechanical obstruction of bone to preserve the joint and prevent end stage OA, 18 and to repair labral injuries and other internal joint derangements. In some cases of hip OA, however, conservative therapy including chiropractic hip joint manipulation can be beneficial, particularly in those patients who do not require and/or who are wishing to avoid joint replacement surgery.…”

Current concepts in the treatment of adolescent femoroacetabular impingement

“…Emara et al [43] followed up patients with FAI with alpha angles less than 60°managed conservatively through activity modification for 24 months. They found that non-operative treatment was effective in improving function and symptoms, although no improvement in the range of motion (ROM) was noted.…”