Femoroacetabular impingement (FAI) Surgical Treatment

Hip arthroscopy for FAI is typically considered when:

• Nonoperative treatment has not provided adequate relief after a reasonable period of time
• Imaging confirms structural abnormalities consistent with FAI, such as a cam or pincer deformity
• There is evidence of labral tearing or cartilage damage that is causing symptoms and limiting function
• Cartilage damage has not yet progressed to advanced arthritis

Patients with significant arthritis and loss of joint space tend to have less predictable results from arthroscopy and may be better served by other options, including hip replacement. Identifying FAI before reaching that point is one of the most important reasons to seek evaluation early.

Some hips have a shallow socket (hip dysplasia) or abnormal rotation of the femur or socket, either alone or in combination with FAI. Recognizing these patterns is essential, because treating them with arthroscopy alone can make the hip less stable. In these patients, Dr. Rynecki Baker will discuss whether an additional or alternative procedure, such as a periacetabular osteotomy to reorient the socket, or a femoral derotation osteotomy to correct the rotation of the ball, is more appropriate.

Rather than opening the hip through a large incision, hip arthroscopy is performed through a few small incisions, about the size of a buttonhole. A tiny camera called an arthroscope is inserted along with specialized instruments, projecting a magnified, high-definition image of the inside of the joint onto a screen. This allows Dr. Rynecki Baker to see and address the problem with great precision.

The procedure is performed under anesthesia on an outpatient basis, so most patients go home the same day. Gentle traction is applied to the leg to create space within the joint, and the procedure is planned in advance using x-rays, MRI, and often a 3D CT scan to map the exact location and size of the deformity.

During the procedure, Dr. Rynecki Baker typically addresses several problems at once, depending on what the hip needs:

• Reshaping the bone (osteoplasty): The excess bone causing the impingement, whether the cam bump on the femoral head or the overgrown rim of the socket, is carefully shaved down and reshaped. This removes the mechanical cause of the impingement and restores smooth motion. Dr. Rynecki Baker uses live x-ray imaging during surgery to confirm that the correction is complete.
• Repairing the labrum: In FAI, the labrum is often torn from repeated impact. Dr. Rynecki Baker reattaches the torn labrum to the bone using small anchors, restoring the suction seal and stability of the joint. When the labrum is too damaged or deficient to repair, a labral augmentation or reconstruction using a tissue graft may be performed.
• Addressing cartilage damage: If the articular cartilage lining the joint has been damaged, it is treated as part of the procedure. The specific technique depends on the extent and pattern of the damage, but the goal is always to stabilize the area and protect the remaining healthy cartilage.
• Capsular repair: After the work inside the joint is complete, Dr. Rynecki Baker repairs the opening made in the capsule, the tissue that surrounds and stabilizes the hip. She has done extensive research demonstrating that restoring the capsule improves patient outcomes and hip stability. If the capsule is lax, meaning there is too much tissue and not enough tension, she performs a plication to tighten the capsule and increase stability.

Recovery from hip arthroscopy is a gradual process, and following the rehabilitation plan closely is essential to a successful outcome. Most patients use a brace and crutches for the first few weeks to protect the hip while the repaired tissue heals. A structured physical therapy program begins early and progresses from restoring range of motion to rebuilding strength, retraining movement patterns, and finally sport-specific training to get you back to the activities you love.

General recovery milestones typically look like this, though every patient’s timeline is unique and depends on the procedures performed:

• First 2 to 4 weeks: Protected weight-bearing with crutches, gentle range of motion, and stationary cycling without resistance.
• 4 to 6 weeks: Transition off crutches to normal walking, with progressive strengthening of the hip and core.
• 6 to 12 weeks: Advanced strengthening, balance, and endurance training. Most patients return to desk work within the first few weeks and to more physical work during this period.
• 3 to 4 months: Gradual return to running and higher-level training as strength and control allow.
• 4 to 6 months: Return to sport for most athletes, guided by strength testing and movement quality rather than the calendar alone.

Full recovery and maximal improvement can continue for up to a year. Every patient receives a written protocol specific to the procedure performed.

Hip arthroscopy is a technically demanding procedure, and outcomes are strongly tied to the experience of the surgeon performing it. Dr. Rynecki Baker’s fellowship training at Hospital for Special Surgery, combined with her focused hip preservation and FAI research, means patients are in the hands of a specialist who has dedicated her career to this area. Her published research has contributed directly to the evidence guiding how and when hip arthroscopy is recommended for FAI, including work showing that sexual function meaningfully improves after hip arthroscopy, especially in positions requiring greater hip flexion.

No two hips are the same, and no two surgical plans should be either. From the initial consultation through every step of recovery, Dr. Rynecki Baker is committed to clear communication, honest guidance, and a treatment plan tailored to each patient’s anatomy, goals, and life.