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Total Joint Center Leads the Way Treating Femoroacetabular Impingement Syndrome

For patients who suffer from it, "Femoroacetabular Impingement Syndrome" is more than a mouthful; it's a painful condition that can lead to serious disability. Fortunately, if they're in the San Francisco Bay Area, they have access to breakthrough treatment from the foremost expert in the field. Thomas G. Sampson, MD, Medical Director of the Total Joint Center at Saint Francis Memorial Hospital, has developed an arthroscopic procedure to correct the condition that's proving to be a remarkable success.

Unlike many other hip problems, Femoroacetabular Impingement (FAI) Syndrome typically affects younger patients. The majority are in their 30s, though patients can be as young as thirteen and as old as 80. Most are very active. "Very few couch potatoes have this, " says Dr. Sampson. Professional bull riders seem particularly susceptible; Dr. Sampson has treated over a dozen.

In a nutshell, FAI results from a mismatch between the ball and the socket. Patients develop either an asymmetry in the ball or a ridge in the socket. This damages the hip cartilage, producing lesions, and can be extremely uncomfortable.

The primary symptom is hernia-like groin pain. Sufferers often think it's a sprain that just didn't get better. The pain can also occur around the hip, toward the buttock or side. The discomfort is positional, occurring when they sit or flex their hip.

FAI can be detected by an MRI but not by a normal x-ray, so it often goes undiagnosed. Patients typically go several years before the syndrome is correctly identified. Gone unchecked, it develops into osteoarthritis of the hip and can lead to severe disability.

The condition was first recognized in Europe, about fifteen years ago, by Professor Reinhold Ganz and the Bern Hip Group. Originally, it was believed to be a complication of surgery, but the Bern Group soon discovered that it affected other patients as well. To correct it, Ganz developed a very effective open surgical procedure. However, the procedure required a large incision and hospitalization, and could result in complications. Recovery was fairly slow, requiring ten weeks on crutches.

Five years ago Dr. Sampson recognized that their procedure could be done far more easily and effectively as an arthroscopic operation. He developed the surgery himself, turning what was a lengthy operation with a hospital stay into an outpatient procedure.

Dr. Sampson has trained orthopedic surgeons nationwide in the new technique. He continues to make new advancements and streamline the procedure even more. He's currently helping develop new instruments to shave bone more effectively and to treat defects of the hip, and exploring new ways to promote cartilage healing.

In Dr. Sampson's procedure, the patient is positioned on a special table and given either general or regional anesthesia. The hip is distracted to separate the surfaces of the ball and socket to permit the surgeon to get the instruments in. In the first part of the procedure, surgeons smooth, shape and remove damaged cartilage. They may also do a treatment to stimulate new cartilage production. The next phase is cutting, contouring and shaping the bone to get rid of the mismatch, producing a spherical head in a spherical socket.

The entire operation takes about an hour and a half, and patients go home one to two hours after surgery. They can put weight on the leg and take care of themselves immediately. It's recommended that they continue to use crutches for two to six weeks, for fall prevention only. If there's no arthritis, they can return to normal daily activity in one to two weeks, and sports in three to six months.

The results have been overwhelmingly positive, even in difficult cases. Recurrence of the condition is extremely low. "I've been tackling some pretty tough cases lately, with patients who need hip replacements, trying this instead," Dr. Sampson reports. "The results are surprisingly good."

"It's exciting," says Dr. Sampson. "People seem to be doing quite well."