Hip arthroscopy

What is hip impingement (FAI)?

The hip is a ball-and-socket joint. In femoroacetabular impingement, or FAI, the shape of the bones causes them to pinch against each other when the hip bends and turns.

There are two main shapes. A cam shape is extra bone on the ball. A pincer shape is extra bone on the rim of the socket. Many people have some of both. Over time, this contact can irritate the labrum, the ring of tissue around the socket, and the cartilage inside the joint.

People with FAI often feel pain deep in the groin or front of the hip. It may flare with deep bending, long periods of sitting, or sports that involve twisting and kicking.

How is FAI diagnosed?

A bone shape on an X-ray is not enough to make the diagnosis. An international consensus uses the term “FAI syndrome” to make clear that your symptoms are central. The diagnosis needs three things together: the right symptoms, positive findings on exam, and matching imaging (Griffin, 2016).

This matters because a scan can show an unusual shape in a hip that causes no trouble. Dr. Pareek will look at your story, your exam, and your images together before suggesting a plan.

Do I need surgery for FAI?

Not always. The same consensus lists conservative care, rehabilitation, and surgery as suitable treatments (Griffin, 2016). Many people start with physical therapy, activity changes, and time away from the movements that cause pain.

Randomized trials help show what to expect. In the UK FASHIoN trial, 348 people with FAI syndrome had either hip arthroscopy or a personalized physical therapy program. Both groups improved at one year. The surgery group improved more, and the gap was just above the size that researchers consider meaningful to patients (Griffin, 2018).

A second trial of 222 people compared surgery with physical therapy and activity changes. At about three years, function scores were higher in the surgery group. X-rays showed no difference in joint space between the groups, though X-ray data were available for only 45% of people, so that finding is limited. MRI scans suggested less cartilage damage after surgery (Palmer, 2025).

The fair summary is that both paths help many people, and surgery has shown a modest added benefit for people with confirmed FAI syndrome. It has not been proven to prevent arthritis. Waiting to try therapy first is a common and reasonable choice.

What is hip arthroscopy?

Hip arthroscopy is surgery done through small incisions with a camera inside the joint. The surgeon uses special tools to treat the problem from the inside.

For FAI, the main step is reshaping the bone so that it no longer pinches. If the labrum is torn, it is often treated in the same operation. You can read more about that in the hip labral tear guide.

The leg is placed in gentle traction during surgery to create a small space in the joint. Most people go home the same day.

Who is a good candidate?

Surgery is more often discussed when all of these are true:

• You have ongoing hip pain that limits daily life, work, or sport.
• Your exam and imaging match your symptoms.
• You have given non-surgical care a fair try, or you and your surgeon agree it is unlikely to be enough.
• You do not have significant arthritis in the hip.

The UK FASHIoN trial enrolled people with no arthritis in the hip, so its results do not apply to arthritic hips (Griffin, 2018). Hips with established arthritis usually need a different plan. A shallow hip socket, known as hip dysplasia, can also change the plan and may call for a different kind of operation.

What are the risks?

Most recoveries are straightforward, but this is still surgery. Possible problems include infection, numbness, stiffness, ongoing pain, and the need for more surgery. In the UK FASHIoN trial, one person in the surgery group developed a hip joint infection (Griffin, 2018). Physical therapy has its own side effects too. Muscle soreness was the most common problem reported in both groups.

Will I get back to sport?

Many athletes do. A review of 18 case series found that on average 87% of athletes returned to sport, and 82% returned to the same level as before their symptoms (Casartelli, 2015). Those studies had no comparison group, and arthritis or cartilage damage at the time of surgery can affect the result. Results vary, and not everyone gets back to the same level.

Should I get a second opinion?

If you were told you need hip surgery and want another view, or if your pain continues after a past hip operation, a fresh look can help. Here’s how a second opinion works.

Where can I see Dr. Pareek?

Dr. Pareek sees hip patients at HSS in New York and at HSS in New Jersey. Bring any X-rays, MRI images, and reports you already have.

What does recovery look like?

These are typical ranges. Your surgeon’s plan comes first, and recovery varies from person to person.

• Weeks 0-2: Protect the hipMany people use crutches and have limits on weight and hip motion. Gentle motion often starts early, sometimes on a stationary bike.
• Weeks 2-6: Come off crutchesMost people work toward walking without crutches and a normal stride. Physical therapy focuses on motion and on waking up the hip and core muscles.
• Weeks 6-12: Build strengthStrength work grows harder and daily activities feel easier. Many people with desk jobs are back at work well before this stage.
• Months 3-6: Return to sportRunning, cutting, and sport drills are added in steps. Timing depends on your sport and on how the hip responds.
• Months 6-12: Keep improvingSome people keep gaining strength and comfort for a year or longer. These are typical ranges, and your surgeon's plan governs.

Related reading

• Do I need surgery for a labral tear?

Sources

1. Griffin DR, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016;50:1169-1176.
2. Griffin DR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet 2018;391:2225-2235.
3. Palmer A, et al. Medium-term results of arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of femoroacetabular impingement syndrome: a multi-centre randomised controlled trial. Br J Sports Med 2025;59:109-117.
4. Casartelli NC, et al. Return to sport after hip surgery for femoroacetabular impingement: a systematic review. Br J Sports Med 2015;49:819-824.