Hip Femoroacetabular Impingement is the most common hip condition that Rupesh Tarwala, MD, top hip arthroscopic surgeon, treats at NY Bone and Joint Specialists. This is a very common cause of pain, especially for young athletes that often needs arthroscopic correction. Rupesh Tarwala, MD spent years undergoing the highest quality training and gaining experience in hip arthroscopy because the minimally invasive technique has such excellent results and allows for much faster recovery for his patients. Athletes of all levels seek out Rupesh Tarwala, MD for his best in class reputation for arthroscopic treatment of hip femoroacetabular impingement, so you can feel confident you are receiving top quality care.

At NY Bone and Joint Specialists, you can expect to receive not only the best orthopedic care in NYC, but a warm, welcoming, and pleasant atmosphere. We take care of all insurance processes on your behalf and make sure to remind you of follow up and physical therapy appointments. We will always see you at your convenience at our offices, including the Upper East Side and Midtown Manhattan as well as Englewood and Hoboken New Jersey locations.


Hip Femoroacetabular Impingement (FAI) refers to abnormal contact and friction in the hip joint caused by imperfect fitting between head of the femur (ball) and acetabulum (socket). The labrum, or cartilage that holds the joint stable, will be pinched as the bones in your joint rub together, causing multiple symptoms. The types of FAI differ according to what part of your joint is out of place and what surrounding tissues are affected.

Hip joints are ball and socket joints that are supported by cartilage and ligaments. The femoral head, or ball at the end of the thigh bone, fits into the acetabulum, or socket of the hip bone. Smooth articular cartilage covers the surface of these bones so that they glide against each other when you move your leg. A thicker cartilage, called the labrum, seals the ball into the socket, surrounding the rim of your joint, making it stable. There are three forms of hip femoroacetabular impingement:


Cam-type impingementThis type of impingement happens more frequently in males than females. It is often called pistol-grip deformity and is usually genetic. The femoral head is not round enough on one side to fit totally inside the acetabulum and labrum seal. This causes friction at the end of the socket when you move your thigh and hip joint especially during deep flexion and rotation movements like squatting. Since it cannot rotate smoothly, bone spurs will continue to develop on the non-rounded end of the bone which will hit the labrum and then grind the articular cartilage inside the joint when rotating your thigh.


Pincer-type ImpingementThis type of impingement is more common in females and may be caused by a specific hip deformity called hip dysplasia. The rim of the acetabulum is too large and covers the ball too much so it hangs over the femoral head and crushes the labrum. The labrum can be pushed and pinched down towards the neck of the femoral head rather than sealing the ball into the socket.


Mixed-Type ImpingementThis type of hip femoroacetabular impingement is a combination of both Cam-type and Pincer-type hip femoroacetabular impingement.

FAI develops early and may go unnoticed throughout your life. It usually affects both hip joints and may happen in combination.


The causes of hip femoroacetabular impingement are not entirely understood. The shape of the hip joint changes to cam or pincer type during child development, it seems. It may be the result of genetics or abnormal movement. It is a common source of pain for young adults, especially athletic ones as more movement will usually incite symptoms.

Some people may go through their entire lives with FAI and never experience any symptoms. When pain does start to develop. It is because the labrum is being impinged, and the condition will likely only worsen from there.

Athletes or those with particularly active lifestyles will experience problems from FAI more than those who are sedentary. Though repetitive movements are not the cause of FAI itself, it can be the reason that the abnormal joint shape causes issues. It is a common source of pain for young adults, especially athletic ones as more movement will usually incite symptoms. Rupesh Tarwala, MD helps athletes so they may resume their active lifestyle and pursue the sports they love.


If you have a Hip Femoroacetabular Impingement you will first feel a deep pain in your groin that may even extend to the outside of your hip. Some people describe it as a ‘C’ sign as they cup their hand and put it around their trochanter which is the prominent bone on side near the pant pockets. This pain is especially present during common activities that require you to rotate your thigh bone within your hip socket, just like walking.

While this pain may be a dull ache, it can turn into a sharp, stabbing pain with certain activities which involve hip flexion, like squatting or sitting up, as the condition worsens.

Although the bone abnormalities are usually present on both hips, pain is usually on felt on one side that suffers the brunt of the pressure.

As your labrum continues to be pinched, it will eventually tear and even fragment in severe cases. Articular cartilage will also begin to thin under this type of impingement. This will cause the bones to rub together and the tissues to become inflamed.

FAI will often lead to labral tears. With a labral tear, you will feel your hip bone click or lock during certain movements. This may result in stiffness and weakness.

As the joint becomes more unstable a number of other problems may ensue, which is why it’s important to seek treatment from a top orthopedist like Rupesh Tarwala, MD right away. Another common issue besides labral tears, is hip bursitis. Because your joint will rotate abnormally, it will start straining the ligaments and tissues supporting the joint. This will rub the bursa sac on the outside of your hip that allows the bone to glide over the iliotibial band. During bursitis, the bursa can tear and inflame, causing you severe pain.


Rupesh Tarwala, MD, orthopedic hip surgeon, will usually be able to determine if you have FAI with a physical exam. After inquiring about your medical history and the activities and routines that cause pain, Rupesh Tarwala, MD will manually move your leg to reproduce the common symptoms of FAI. By bending your knee to your chest and rotating your thigh inward toward the other, the labrum should be pinched and the pain should be reproduced, giving your orthopedist a good idea of the state of your joint.

An x ray will provide Rupesh Tarwala, MD with a better picture of the abnormal shape of your bone and how it is effecting your overall joint. It is important to know the position of your bones so Dr. Tarwla can determine how to correct the misalignment.

An MRI will be necessary so your top arthroscopic hip surgeon, Rupesh Tarwala, MD, can see an image of your soft tissues. This test will reveal the cartilage damage in the joint and determine if severe pain is caused by a labral tear, loose fragments of cartilage in the joint, or other damage.

CT scans are definitely helpful if arthroscopic surgery is necessary to correct bone shape. It gives a much more detailed image of your bone structure than an x ray and will tell Rupesh Tarwala, MD exactly how your bones need to be reshaped.



In less severe cases, hip femoroacetabular impingement may be treated conservatively. It is important to address the symptoms of FAI early because prolonged FAI can cause increasing damage to the joint. Other orthopedic problems usually always follow when FAI is not corrected.

Physical Therapy – It is important to avoid intense or prolonged activity for a number of weeks when you are diagnosed with FAI. During that time you should begin physical therapy. Your physical therapist will evaluate your range of motion, severity of pain, your gait, and the strength of surrounding muscles to put together appropriate routines for your case. Physical therapy is essential not only for relieving pain and symptoms, but training your body to adjust to the abnormality so the symptoms do not return throughout your life. Though stretches will not changes the shape of your bone, it can make muscles and ligaments more flexible to reduce contact with the bone and avoid further impingement. Stiff muscles can also reduce the range of motion of your hip joint which will give the bones less room to move with hitting the labrum. Gradual exercises will increase the strength of supportive muscles to prevent future stiffening. Your physical therapist will also address your posture and gait, so as to avoid a limp or abnormality while walking that can cause issues throughout your entire body, including your knee, back, and neck.

Corticosteroid Injections – An intra-articular injection can help reduce inflammation for about 6 months at a time. Pain relief with steroid injection varies patient to patient. The steroid medication is administered directly into your joint and numbs the area before providing long term anti-inflammatory relief. This is helpful for cases that are not so severe to need surgery, but where the pain makes physical therapy difficult.


For some patients, surgery is the best option to correct hip femoroacetabular impingement. Orthopedic surgeon Rupesh Tarwala, MD, may recommend surgery before trying conservative methods for a few weeks to avoid progression of your condition. These are cases in which the bone spurs cannot avoid pinching the labrum, especially for athletes whose rigorous activities will make FAI a constant problem. It is a good idea to continue physical therapy before surgery even if conservative treatment has not helped, to correct gait and muscle imbalances that your body has adapted as a result of the pain.

Hip Femoroacetabular Impingement can usually be corrected arthroscopically. Minimally invasive surgery requires two to three small incisions on either side of your hip joint where your Rupesh Tarwala, MD can insert a camera and tiny tools. Dr. Tarwala will remove damaged labral or articular cartilage from the joint and shave down the bone spurs that are causing the issue. Rupesh Tarwala, MD, may then use anchors to keep the undamaged labrum in place to stabilize the joint, which is known as labral refixation. This type of arthroscopy is an outpatient procedure. It will take less time to recover and create less scarring and risk for complications. Physical therapy is still necessary to ensure that scarred tissue does not build up and that your joint does not stiffen. It is also important to strengthen your core muscles to better support the healing joint.

It may be necessary to undergo open surgery to reshape your bones properly. In this case a larger incision is necessary so Rupesh Tarwala, MD can dislocate the joint and shave the bone as needed. This type of surgery has a much longer rest and recovery time than orthopedic surgery. It is essential to follow a strict physical therapy routine post operatively to regain function and normal range of motion in your hip.

In severe cases of FAI where cartilage damage is extensive, hip resurfacing or partial or total hip joint replacement may be a better option. Rupesh Tarwala, MD is also especially trained in total hip replacements. In these procedures, either a portion or your entire inner socket and femoral head are removed and replaced with metal and plastic prosthesis. These prosthesis are fitted to your body and will mimic the gliding movement of a proper joint. These surgeries are not done without prolonged, unsuccessful conservative therapy. Physical therapy is crucial following hip replacements or resurfacing. Your physical therapist will first manually stretch your joint to keep it from healing stiffly and preserve its range of motion. You will be trained to walk properly again, which may be long process, but completely necessary to regain function in the hip and a normal gait, otherwise the prosthesis could wear down quickly, you could experience spine issues, and other orthopedic problems could result in places like your knee, back, and neck. It will also be important to regain strength in your core and leg muscles to support your new joint, otherwise the added strain could cause complications with the prosthesis. Rupesh Tarwala, MD will also see you for follow ups following your hip joint replacement to make sure you are healing properly and there are no post-operative complications.

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