How Is FAI Hip Impingement Treated With Arthroscopy?

Arthroscopy corrects the underlying bone abnormalities and repairs damaged soft tissue through small incisions. For eligible patients, this procedure restores hip motion, reduces friction, and improves joint function. Because it preserves healthy tissue, most patients return home the same day and begin rehabilitation shortly after outpatient surgery.

At Total Orthopedic & Sports Medicine, our orthopedic hip specialist, Dr. Jarrett Boroniec, carefully evaluates your condition before recommending any procedure. If hip arthroscopy is appropriate, he will develop a personalized surgical and recovery plan designed to optimize your recovery. Throughout your recovery, our team provides coordinated care to restore movement, improve hip function, and help you return to an active lifestyle. Call 855-321-6784 to book your appointment.

How Does Arthroscopy Treat FAI Hip Impingement?

During hip arthroscopy surgery, the surgeon treats the damaged areas inside the hip joint while correcting the structural changes that cause repeated pinching. This allows the joint to move more freely, reduces stress on the surrounding soft tissues, and helps restore comfortable movement during everyday activities and sports.

Here is the step-by-step process the surgeon follows during hip arthroscopic surgery:

Examine the Joint and Confirm the Damage

Your surgeon first inserts a small camera to inspect the inside of your hip. The live images provide a detailed view that may reveal damage not fully visible on MRI scans. Your surgeon then checks the labrum, cartilage, and bone surfaces. They also move the joint carefully to locate the exact point of abnormal contact. These findings guide the remaining procedure.

Repair the Damaged Labrum

After examining the joint, your surgeon evaluates any labral tears caused by repeated pinching. If the labral tissue remains healthy enough, it is secured back to the rim of the socket with small anchors. This repair helps restore the labrum’s seal around the joint. However, severely damaged tissue may require careful trimming or reconstruction. Preserving the labrum whenever possible supports joint stability and load distribution.

Treat Injured Cartilage

Healthy articular cartilage forms the smooth, white surface that allows smooth, pain-free hip movement. If the surgeon finds frayed cartilage, they remove unstable edges that could catch during movement. They may also stabilize small damaged areas to prevent loose pieces from irritating the joint. However, arthroscopy cannot replace cartilage that has already been completely lost. Therefore, the extent of cartilage damage can affect both the procedure and the expected outcome.

Correct Pincer Impingement

If pincer impingement causes excessive socket coverage, your surgeon reshapes the rim of the hip socket. They remove only the excess bone responsible for pressing against the labrum during movement. This creates additional space for the joint to move without repeated pinching, while preserving hip stability. Once reshaping is complete, the surgeon reattaches the repaired labrum, as needed.

Reshape the Cam Deformity

If cam impingement is present, your surgeon reshapes the raised area where the femoral head meets the neck of the femur bone. They use specialized surgical instruments to restore a smoother contour. During this step, imaging helps confirm that enough bone has been removed without overcorrecting the area. The improved shape allows the ball to rotate more freely inside the socket. As a result, the procedure reduces the abnormal impact between the femoral head and acetabulum, allowing the ball-and-socket joint to move with less repeated pinching.

Check Movement and Close the Capsule

Before completing the procedure, your surgeon moves the hip through different positions to confirm that the corrected surfaces no longer collide. This final check helps verify that the bony irregularities have been adequately addressed. Then, the surgeon closes the capsule surrounding the joint when appropriate. Capsular closure can help maintain stability after the procedure, particularly when the capsule is widely opened. Once the repair is complete, the goal is to support normal movement while protecting the treated structures during healing.

Why Doesn’t Hip Impingement Heal on Its Own?

Hip impingement does not typically heal on its own because the root cause is usually a structural abnormality in the hip joint rather than a temporary muscle or ligament injury. As you continue to move, repeated acetabulum bone impact caused by hip impingement can worsen cartilage and labral damage. In fact, a 2024 clinical review found that repetitive trauma from FAI can progressively damage the acetabular labrum, chondrolabral junction, and articular cartilage.

Unlike many soft-tissue injuries, which heal over time, untreated developing femoroacetabular impingement can gradually alter the joint itself. In addition, untreated FAI can make the joint impaired, causing bone breakdown and worsening cartilage damage. Ongoing mechanical stress may also enlarge labral tears and increase the risk of developing early hip osteoarthritis. However, early evaluation and appropriate treatment can help relieve symptoms, preserve joint function, and limit further damage.

How Do You Know if FAI Requires Hip Arthroscopy?

Hip arthroscopy is generally considered after conservative treatment measures fail to provide lasting symptom relief. Rather than focusing only on pain relief, treatment may need to address the abnormal bony irregularities causing pain, ongoing joint damage, and restricted movement.

Although every case is different, you may be a good candidate for hip arthroscopy if you experience any of the following symptoms:

• A persistent dull ache or hip pain continues to limit your daily activities.
• A locking or catching sensation in your hip.
• Pain may radiate to the side of the thigh and buttocks.
• Twisting, pivoting, or deep bending consistently triggers pain.
• Your hip feels stiff, and you notice a decreased range of motion over time.
• Groin pain returns whenever you resume sports, climb uphill, or increase your activity level.

However, symptoms alone do not determine whether surgery is the right choice. Some people experience severe pain with relatively minor joint damage, while others have more advanced damage but fewer symptoms. That is why the surgeon considers your overall condition, how your symptoms affect your quality of life, and whether the structural problem is responsible for your limitations before recommending surgery.

How Do Surgeons Decide if You Need Arthroscopy?

Our orthopedic hip surgeon, Dr. Jarrett Boroniec, first confirms that your symptoms are caused by FAI rather than another hip condition. Then, he compares your physical examination with your imaging findings to determine whether the damage can be effectively treated with arthroscopy.

During your evaluation, Dr. Jarrett Boroniec may use the following methods to assess your hip and confirm the diagnosis:

• Review your medical history to understand when symptoms began, how they have progressed, and what activities trigger pain.
• Assess your gait to identify limping or movement abnormalities.
• Measure your hip range of motion to identify painful or uphill restricted hip movement.
• Perform strength testing of the hip, core, and surrounding muscles.
• Perform impingement tests, such as the FADIR and FABER maneuvers, to reproduce symptoms and identify the source of pain.
• Rule out other conditions affecting the lower back, pelvis, or surrounding joints that can mimic FAI.
• Review X-rays to identify cam lesions, pincer lesions, joint alignment, and other bony abnormalities.
• Evaluate CT scans, MRI, or MR arthrogram images to assess the labrum, cartilage, and other soft tissues inside the hip.
• Review previous treatments and your response to rest, anti-inflammatory medications, or hip injections.

One of the biggest challenges with FAI is that its symptoms often overlap with labral tears, muscle strains, sports injuries, lower back disorders, and other hip conditions. At our clinic, we frequently evaluate patients who have spent months living with hip pain because they were initially diagnosed with the wrong condition. However, Dr. Jarrett Boroniec carefully correlates your history, examination findings, and imaging to identify whether FAI is actually responsible for your symptoms before recommending any treatment. If you’ve been living with ongoing hip pain, schedule a comprehensive evaluation.

A Pattern We Notice in Patients Who Delay Evaluation

Over the years, we have observed that patients who eventually undergo hip arthroscopy rarely come to us because of a single injury. More often, they arrive after months or even years of gradually changing their movement pattern. By the time they schedule an evaluation, many have unknowingly adjusted their daily routine around their hip rather than addressing the underlying problem.

Some of the changes we commonly hear:

• Park closer to avoid longer walks.
• Skipping hiking trips, recreational sports, or family outings.
• Choosing chairs that are easier to stand up from.
• Avoiding long car rides because sitting becomes uncomfortable.
• Changing how they get into or out of their car.
• Use the opposite leg whenever possible while climbing stairs.
• Avoid deep squatting, gardening, or playing on the floor with children or grandchildren.

Many people don’t think of these changes as symptoms. Instead, they assume they’re simply getting older or need to “live with it.” However, based on our experience, these gradual changes often become routine before patients realize how much their hip is affecting their everyday life. Recognizing these patterns early allows us to identify the underlying cause and recommend the most appropriate treatment before further joint damage occurs.

Questions Dr. Jarrett Boroniec Asks During Your First Visit

During your first visit, our orthopedic surgeon may ask the following questions to understand your symptoms and identify movement patterns that trigger pain:

• When did your pain first begin?
• Which movement hurts the most?
• Can you sit through a long drive?
• Does the pain occur before, during, or after activity?
• What have you already tried?

Can Hip Arthroscopy Treat Every Type of FAI?

No, hip arthroscopy cannot treat every type or stage of femoroacetabular impingement (FAI). It is highly effective for correcting cam, pincer, and combined FAI when the joint is still healthy enough for preservation. However, advanced arthritis, severe hip dysplasia, or complex structural deformities often require open surgery or another surgical approach. A 2023 study reported only 57% hip survivorship at 10 years after FAI arthroscopy in patients with advanced osteoarthritis.

Even when two patients have the same type of FAI or similar MRI findings, they may not get the same treatment. Treatment decisions are not based solely on imaging. Your surgeon carefully assesses the health of your cartilage and labrum, the presence of arthritis, your symptoms, and hip function. He also considers your age, activity level, and treatment goals before recommending the treatment best suited to your condition.

Can a Torn Hip Labrum Be Repaired During Arthroscopy?

Yes, a torn labrum can be repaired during hip arthroscopy if the tissue has an adequate blood supply and is healthy enough to heal. During the procedure, your surgeon evaluates the size, location, and quality of the tear before deciding whether to repair, reconstruct, or remove the damaged tissue. However, preserving the labrum whenever possible offers pain relief and supports long-term hip stability and function.

In addition, hip arthroscopy allows the surgeon to clearly visualize the inside of the hip joint through a high-definition camera while minimizing disruption to the surrounding muscles and soft tissues. It also helps repair the labrum while correcting associated problems, such as cam or pincer impingement, during the same procedure. This comprehensive approach helps restore normal hip mechanics without the need for a larger open incision, often resulting in improved mobility.

How Long Does the Surgery Usually Take?

Hip arthroscopy usually takes 1 to 2 hours, although more complex FAI surgery procedures may take longer. The exact surgical time varies depending on the severity of the impingement, the extent of labral cartilage damage, and the number of problems that need to be addressed. For example, repairing the labrum while also reshaping either the femur or the socket typically requires additional time to ensure both procedures are performed precisely.

What Is the Recovery Time for FAI Hip Arthroscopy?

According to our experience, most patients recover from FAI hip arthroscopy within 4 to 6 months. However, FAI hip arthroscopy recovery time may extend depending on the extent of the procedure, activity goals, and whether pain persists during rehabilitation. Most patients typically use crutches for 2 to 6 weeks post-surgery and gradually progress through a structured rehabilitation program. In contrast, returning to sports or other high-impact activities usually requires adequate healing, restored strength, and clearance from your surgeon.

In addition, research shows that recovery after FAI hip arthroscopy is gradual. For example, a 2024 systematic review of 14 studies involving 1,105 patients found that most patients were able to bear full weight-bearing during the first 4 to 6 weeks, with strengthening and functional exercises introduced as healing advanced. Another prospective study published in PubMed found that patients following an accelerated rehabilitation program returned to sport at an average of 5.3 months after FAI hip arthroscopy. These findings suggest that many individuals can regain function within the first 4 to 6 months when recovery progresses as expected.

Which Exercises Help During FAI Hip Impingement Recovery?

Walking, stationary cycling, stretching, and targeted strengthening exercises are commonly recommended to help restore hip function after FAI hip arthroscopy. As healing progresses, your rehabilitation program gradually incorporates balance, flexibility, and functional training to restore strength and hip function. Each exercise is introduced at the appropriate stage to protect the repair while promoting a safe recovery.

Here are some common exercises an orthopedic surgeon may recommend during recovery:

• Standing Iliotibial Band Stretch: Improves flexibility along the outside of the hip and thigh.
• Seated Rotation Stretch: Increases flexibility in the piriformis and surrounding hip muscles after prolonged sitting.
• Knee-to-Chest Stretch: Gently stretches the gluteal muscles while improving hip mobility.
• Supine Hamstring Stretch: Maintains hamstring flexibility and helps reduce muscle tightness.
• Hip Abduction: Strengthens the outer hip muscles that stabilize the pelvis during walking.
• Hip Adduction: Builds strength in the inner thigh muscles to support hip stability.
• Prone Hip Extension: Strengthens the gluteal muscles and improves hip extension.
• Internal Hip Rotation: Improves strength and control of inward rotation of the hip.
• External Hip Rotation: Strengthens the muscles responsible for outward hip rotation.

To help you better understand each stage of recovery, Dr. Jarrett Boroniec has created a comprehensive exercise guide for patients recovering from FAI hip arthroscopy. It outlines the exercises commonly recommended after surgery and when they are typically introduced during recovery. The guide also includes practical tips to help you perform each movement safely and effectively. But if you have questions about your recovery or need personalized guidance, schedule an appointment with Dr. Jarrett Boroniec.

What Risks Should You Know Before Surgery?

Hip arthroscopy is generally a safe procedure, but like any surgery, it carries risks such as infection, blood clots, nerve injury, joint stiffness, and persistent pain. Although these complications are rare, they can affect recovery and may require additional treatment. However, following your surgeon’s postoperative instructions can help reduce the risk of complications and support a smooth recovery.

Here are some of the most common risk factors that may increase the risk of complications after hip arthroscopy:

• Smoking can delay healing and increase the risk of infection
• Diabetes, especially if blood sugar levels are poorly controlled
• Obesity may place additional stress on the hip during recovery
• Advanced cartilage damage can affect healing and long-term outcomes
• Certain medical conditions, such as bleeding disorders or weakened immune function
• Previous hip surgery may make the procedure more technically complex

Identifying these risk factors before surgery helps your surgeon plan appropriate care, but monitoring your recovery is also important. During the healing process, certain symptoms may indicate a complication that requires prompt medical attention. For example, contact your surgeon if you develop a fever, increasing redness or drainage around the incision, severe swelling, calf pain, or sudden shortness of breath.

How Successful Is Hip Arthroscopy for FAI?

The hip arthroscopy success rate is approximately 85% to 90% in patients with femoroacetabular impingement (FAI), providing significant pain relief and improved hip function. In fact, a PubMed systematic review found that approximately 87.7% of patients returned to sports after surgery, while patient-reported outcomes improved significantly across all included studies.

Another 2023 systematic review published in Arthroscopy found that 45% to 87.4% of patients achieved the Patient Acceptable Symptom State (PASS) at least 5 years after hip arthroscopy. Similarly, 64% to 100% achieved the Minimal Clinically Important Difference (MCID), showing clinically meaningful improvements in hip function.

Can Hip Impingement Return After Surgery?

Yes, hip impingement (commonly referred to as FAI) can return after surgery. However, recurrence is rare when the underlying bone abnormality is fully corrected, and rehabilitation is completed as recommended. In some cases, new symptoms develop due to incomplete bone reshaping, a new injury, or progressive joint degeneration rather than actual recurrence.

In addition, recurring hip pain does not always mean the impingement has returned or that another preservation surgery is required. A proper diagnosis is essential to determine whether symptoms are caused by recurrent impingement, soft tissue irritation, or another hip condition. In many cases, symptoms improve with conservative treatment options such as activity modification, anti-inflammatory medications, or image-guided injections, depending on the underlying cause. However, doctors may recommend revision surgery if symptoms persist despite treatment and imaging confirms residual or recurrent impingement.

Can Hip Arthroscopy Delay the Need for Hip Joint Replacement?

Yes, hip arthroscopy can delay the need for hip replacement by correcting the underlying cause of femoroacetabular impingement (FAI) before extensive joint damage occurs. By restoring normal hip mechanics and correcting underlying biomechanical abnormalities, the procedure may slow disease progression and preserve the natural joint. However, the best outcomes are typically achieved when surgery is performed before extensive cartilage damage progresses to bare bone, advanced arthritis, or bone breakdown.

Common Patient Scenarios

Many people have similar questions and concerns after knowing they have femoroacetabular impingement (FAI). Here are some of the most common situations patients discuss during their visits:

My MRI Says I Have FAI, but My Hip Doesn’t Hurt All the Time

Intermittent pain does not always mean the condition is mild. Many people with FAI experience symptoms only during certain movements or activities, while joint damage may continue to progress. An orthopedic evaluation helps identify whether the condition requires treatment before more significant joint damage develops.

I’ve Stopped Playing Sports, but My Hip Still Hurts

Stopping sports does not always relieve symptoms because the structural impingement remains. As a result, even everyday activities such as walking, climbing stairs, or sitting for long periods may continue to trigger pain. A thorough evaluation can identify the underlying cause and guide the most effective treatment.

My X-Ray Shows FAI, but Another Doctor Told Me I Don’t Need Surgery Yet

Many people with FAI never require surgery. Treatment depends on your symptoms, physical examination, cartilage health, activity level, and response to conservative care rather than imaging findings alone. Surgery is generally considered only when non-surgical treatment no longer provides adequate relief.

I’m Worried I’ll Make My Hip Worse If I Keep Exercising

Having FAI does not mean you need to stop exercising. Instead, the goal is to avoid movements that repeatedly pinch the hip joint. For example, deep bending, twisting, and pivoting exercises may worsen symptoms over time. With the right activity modifications, many people can continue exercising comfortably.

I’m Too Young for a Hip Replacement. What Are My Options?

Many younger patients with FAI are good candidates for joint-preserving treatment rather than hip replacement. When appropriate, hip arthroscopy can correct the underlying impingement, treat associated labral injuries, and help preserve the natural hip joint before advanced arthritis develops.

Visit Total Orthopedic & Sports Medicine for FAI Hip Impingement Treatment!

You expected your hip pain to improve with rest, but it keeps returning whenever you walk, exercise, climb stairs, or sit for long periods. Meanwhile, the ongoing pinching in your hip may continue to damage the labrum. This makes everyday movement more difficult and increases the risk of long-term joint deterioration.

At Total Orthopedic & Sports Medicine, Dr. Jarrett Boroniec carefully evaluates your symptoms, examination findings, and imaging before recommending hip arthroscopy. Every recommendation is based on the condition of your labrum, cartilage, and bone, ensuring your care is guided by the underlying cause of your symptoms instead of temporary pain relief alone. For coordinated evaluation and follow-up care under one roof, call 855-321-6784 or visit our clinic in the Bronx.

FAQs