Hip Arthroscopy and FAI: 46 Questions Patients Ask

The labrum is a rim of cartilage around the socket that deepens it and seals the joint. FAI is the most common cause of labral tears in active people; tears can also come from injury, hip dysplasia or loose (hypermobile) joints.

The hip shape develops while you are growing. Cam shapes are more common in people who played high-level sports during adolescence. Many people have FAI shapes, but only some develop symptoms.

Usually a deep, pinching pain in the groin or front of the hip, often with a "C-shaped" ache around the side. It is typically worse with sitting in low chairs, getting out of a car, squatting, pivoting or sports. Some patients notice clicking, catching or stiffness.

No. In a review of people without hip pain, about a third had a cam shape (more than half of athletes) and about two-thirds had a labral tear on MRI.¹ Treatment is based on your symptoms and exam, not on imaging alone. International consensus defines FAI syndrome as the combination of symptoms, clinical signs and imaging findings.²

The bone shape does not change on its own, but symptoms often settle with physical therapy and activity changes. A torn labrum has a limited ability to heal because of its poor blood supply.

FAI is one recognized contributor to hip arthritis. In a large Dutch cohort, people with a cam shape had substantially higher odds of developing hip arthritis over 10 years.^3,4 Not everyone with FAI develops arthritis, and surgery is done to relieve symptoms, not only to prevent arthritis.

Yes. FAI shapes are often present in both hips, but symptoms may occur on only one side. When both hips need surgery, they are done separately, a few months apart; in one study, both hips improved after staged surgery.⁵

Dr. Dold starts with your history and a detailed hip exam, including impingement tests, then takes specialized X-rays from several angles to measure the bone shape. An MRI or CT may be added to look at the labrum and cartilage and to plan surgery. See hip impingement (FAI).

Usually an MRI is enough. An analysis of studies comparing the two found that a high-quality 3-Tesla MRI detects labral tears about as well as an MR arthrogram (which requires an injection of dye into the joint).⁶ Dr. Dold will order the test that best answers your question.

An image-guided injection of numbing medicine into the joint helps confirm that the pain is coming from inside the hip. Patients who get good relief from the injection tend to do better after surgery, while patients who get no relief tend to do less well.⁷

Yes. The low back, sports hernia (athletic pubalgia), hip flexor tendons, gluteal tendons and stress fractures can all cause similar pain. Part of Dr. Dold’s evaluation is making sure the hip joint is the true source before recommending surgery.

Dysplasia means the socket is too shallow, which can make the hip unstable rather than impinged. Mild (borderline) dysplasia can sometimes be treated arthroscopically with careful capsular repair, while more significant dysplasia may need a periacetabular osteotomy (PAO).⁸ See hip dysplasia.

Yes, and non-surgical care is usually tried first. Dr. Dold offers physical therapy, activity modification, anti-inflammatory medication, image-guided injections and PRP.

Supervised, active programs focused on core and hip strength and movement control work better than unsupervised or passive treatment.⁹ Avoiding deep hip flexion and pinching positions also helps.

An image-guided steroid injection can relieve pain and help confirm the diagnosis, but relief is often short-lived. In one study, meaningful relief lasted beyond 6 weeks in only a small number of patients with FAI and labral tears.¹⁰

Platelet-rich plasma (PRP) is made from your own blood and is offered as a non-surgical option for some patients. Research on PRP specifically for FAI and labral tears is still limited, and PRP is not FDA-approved for this use. Dr. Dold will discuss whether it makes sense for you. See PRP injections for hip pain.

Randomized trials show that, on average, hip arthroscopy gives better hip function and quality of life than physical therapy for FAI syndrome.^11,12,13 The differences are moderate, and some patients do well with therapy alone; in one trial, many patients assigned to therapy later chose surgery.^14,15 That is why the decision is individualized.

Surgery is considered when pain persists despite a good course of non-surgical treatment, the exam and imaging confirm FAI or a labral tear, and the joint has little or no arthritis.

Minimally invasive "keyhole" surgery. A small camera and fine instruments are passed through two or three small incisions to treat the problem inside the joint. Learn more about hip arthroscopy.

Depending on what is found, he reshapes the cam bump (femoroplasty), trims the pincer rim (acetabuloplasty), repairs the labrum with small anchors or reconstructs it with a graft when it cannot be repaired, treats damaged cartilage and removes loose fragments, then closes the joint capsule.

Dr. Dold repairs the labrum whenever possible. In a randomized trial, repair gave better function than trimming (debridement),¹⁷ and a 2026 analysis of 2,730 hips found fewer conversions to hip replacement after repair.¹⁸ When the labrum is too damaged to repair, it can be reconstructed with a graft, which has shown durable results at 5 years or more.¹⁹

The capsule is the strong ligament envelope around the hip that keeps it stable. Dr. Dold repairs it at the end of every case. A systematic review found fewer revision surgeries with capsular repair,²⁰ and a meta-analysis found higher success with complete closure than with incomplete closure.²¹ Some randomized trials in selected patients found similar short-term results either way.²²

Hip arthroscopy is done under general anesthesia. Your anesthesiologist will go over the plan with you.

The procedure usually takes about 60 to 90 minutes, and most patients go home the same day.

Dr. Dold may add platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC), taken from your own body, as an adjunct during surgery to support healing. Evidence is still developing: a meta-analysis of BMAC with labral repair found a trend toward better results that was not statistically significant,^23,24 and one randomized trial of PRP during FAI surgery found no significant benefit.²⁵ These treatments are not FDA-approved for this use, and Dr. Dold will discuss whether they are right for you.

To prevent heterotopic ossification, extra bone that can form in the soft tissues after hip surgery. In a randomized trial, naproxen for 3 weeks after hip arthroscopy lowered this from 46% to 4%.²⁶

The amount of arthritis matters more than age. Patients with significant arthritis or joint-space narrowing are less likely to benefit,²⁷ and studies of patients over 40 and 50 show good improvement but higher rates of later hip replacement.^28,29 If arthritis is advanced, hip replacement may be the better option. See hip replacement questions.

Yes, when it is clearly indicated. In a review of adolescents, 94% returned to sport and complications were rare.³⁰

Most patients have moderate pain for the first several days, controlled with ice, anti-inflammatory medication and a short course of stronger pain medication if needed.

For 4 weeks after surgery, with protected weight bearing, also called toe-touch weight bearing (TTWB): you rest the foot lightly on the ground, to protect the repaired labrum and reshaped bone while they heal.

Yes, for about 4 weeks. The brace limits extreme hip motion while the repair heals. Randomized trials show similar pain and function with or without a brace, and one found less fear of movement in braced patients.^31,32

Within the first few days. Many patients start stationary cycling within the first week. Rehabilitation progresses in stages, following international consensus guidance, from protecting the repair to restoring motion, strength and sport-specific movement.³³

After surgery on the left hip in an automatic car, usually about 1 to 2 weeks; after surgery on the right hip, about 2 to 4 weeks. You must be off narcotic pain medication and able to brake safely. Studies show braking reaction time returns to normal by about 4 weeks.³⁴

Students and people with desk jobs usually return in about 1 to 2 weeks. Jobs that involve standing, lifting or physical labor take longer. In a large review, about 7 in 10 patients returned to work, with desk workers returning more often than manual workers.³⁵

Usually at about 3 to 4 months, once strength and movement testing show the hip is ready.³³

Most athletes return at about 3 to 6 months, depending on the sport and what was repaired. In a large review, about 80% of athletes returned to sport at the same or a higher level.³⁶

Most patients feel much better by 3 months, but improvement continues for 6 to 12 months as strength returns.

Most patients have meaningful improvement in pain and function. Long-term studies show that about 90% of hips are preserved, without needing a hip replacement, 10 years after surgery, especially when there was little arthritis at the start.^37,38

Serious complications are rare. A review of more than 6,000 patients found major complications in about 0.6% and minor complications, most often temporary numbness from traction, in about 7.5%.³⁹ Other risks include stiffness, infection, blood clots, persistent pain, heterotopic ossification and the need for further surgery.

Some patients need a second surgery, and some eventually need a hip replacement, most often those who had arthritis at the time of arthroscopy.^39,27 Repairing the labrum and closing the capsule are linked to lower revision rates.^18,20

Call for fever, increasing redness or drainage from the incisions, calf pain or swelling, new numbness, or pain not controlled by your medication. Go to the emergency room for chest pain or shortness of breath.

Hip arthroscopy is covered by most insurance plans when it is medically necessary. Dr. Dold accepts most major insurance plans, including Medicare and Tricare; please call 469-850-0680 to confirm your coverage. See insurance.

Work on core and hip strength before surgery, arrange a ride home and help for the first few days, practice using crutches, and set up your home so you can move around easily while on crutches.

Request an appointment online or call 469-850-0680. Dr. Dold also offers hip second opinions. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30 to 10:30 am.