Intended for healthcare professionals

Practice Uncertainties

Is surgery effective in patients with femoroacetabular impingement syndrome?

BMJ 2019; 365 doi: (Published 18 April 2019) Cite this as: BMJ 2019;365:l1359
  1. Ruth SF Richardson, specialist registrar trauma and orthopaedics1,
  2. Karen Lothe, general practitioner2,
  3. Seb Sturridge, consultant trauma and orthopaedics1
  1. 1Frimley Park Hospital, Surrey, UK
  2. 2Upper Gordon Road Surgery, Surrey, UK
  1. Correspondence to R Richardson rsfrichardson{at}

What you need to know

  • Consider femoroacetabular impingement syndrome (FAIS) as a possible diagnosis in young adults with hip or groin pain and features suggestive of impingement on imaging

  • Trials suggest improved pain and functional outcomes with arthroscopic surgery but there is uncertainty about the extent of improvement compared with physiotherapy and the long term effect of surgery

  • Discuss the options of physiotherapy and activity modification as alternatives to surgery. Offer referral to an orthopaedic surgeon to discuss the indication for surgery if symptoms do not improve

Femoroacetabular impingement syndrome (FAIS) describes motion related hip pain, which is caused by premature bony contact between deformities at the femoral neck and/or the acetabular rim123 (fig 1). Young, active adults are commonly affected. A prospective study in the Netherlands found that 17% of adults presenting to primary care with hip/groin pain in a year (84 adults in all) were subsequently diagnosed with FAIS on radiological imaging,4 and a further 30% had a high clinical suspicion. Impingement can damage the joint cartilage over time and lead to osteoarthritis.2356

Fig 1

A bony enlargement on the anterior femoral neck (cam impingement), and/or at the acetabular rim (pincer impingement), causes premature contact especially during flexion and internal rotation. This repetitive trauma damages the labrum and the joint cartilage

Treatment includes conservative care with analgesics, lifestyle and activity modification, and physiotherapy, or surgery. Attempts to refine diagnostic and treatment criteria have been made;7 however, doubt remains about subcategories of FAIS and subgroup outcomes.89 Yet, the volume of arthroscopic hip surgery has grown exponentially.10 FAIS is the primary indication for this surgery.11 Within the past decade, the number of hip arthroscopies performed in the NHS has increased 10-fold. Almost 4000 surgeries are predicted annually by 2023.10 Controversy exists about how …

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