Femoroacetabular Impingement Syndrome Surgery – Do You Really Need It?

FAIS Surgery Versus Conservative Management of FAIS

In recent years there has been a plethora of high quality research trials looking at FAIS surgery versus conservative management of FAIS. 

To read more about what this condition is and its causes click here to read our earlier blog 

To learn more about if you have Femeroacetabular Impingement Syndrome click here to read our previous blog. 

The first important point here is that no treatment is required for asymptomatic FAI – if you have a FAI bony shape but no pain, then there is no need to seek active treatment. There was a period where surgeons were offering preventative surgery to ‘correct’ bony variations but there is absolutely no evidence for this approach and problems may be created in hips that may never have become painful. The world’s leading surgeons and other health professionals in this field all agree that PREVENTATIVE SURGERY is NOT RECOMMENDED¹. 

In patients who are treated for FAI syndrome, symptoms frequently improve, and they return to full activity, including sports. Without treatment, symptoms of FAI syndrome will probably worsen over time. The long-term outlook for patients with FAI syndrome is unknown. However, it is likely that cam morphology is associated with hip osteoarthritis, degeneration of the joint cartilage over time. It is currently unknown whether treatment for FAI syndrome prevents hip osteoarthritis.  



What is The Evidence for FAIS Surgery versus Non- Surgery

Scientific evidence for management of FAIS has only recently started to emerge, with the first high-quality surgical studies (randomised clinical trials) published in 2018² ³. Early pilot trials assessing outcomes of high-quality physiotherapy programs have also been published. 

The evidence so far suggests: 

  • Both surgery and physiotherapist-led rehabilitation provide significant reductions in pain and improvements in function 
  • Surgery may provide outcomes that are mildly better than rehabilitation alone, if you only have access to limited, publicly funded care.  The affect of more frequent physiotherapy intervention, compared to these currently more limited intervention trials, as yet has not been researched.  
  • Surgery comes with increased health risks, although complications are uncommon 
  • Neither intervention at this point restores full painfree function – 1-2 years later participants of these trials still report ongoing problems and have often not returned to full sporting participation 4. 
  • Surgery is not a ‘fix’ and optimal outcomes will require substantial commitment to high-quality rehabilitation that targets individual deficits in hip and trunk muscles strength, balance and functional ability 5.   

So Is It Worth Trialling Non-Surgery First?

Considering the available evidence, a trial of non-surgical care for 3-6 months, with excellent adherence to the specific advice and prescribed exercise program is recommended before considering a surgical intervention. In some circumstances, earlier progression to surgery may be recommended but there are currently no clear guidelines as to who should consider an early surgical option. 

How Can You Find a Hip Pain Professional That can Help?

Always seek out a health professional with extensive experience and up-to-date knowledge in this area. Visit our directory to find a Hip Pain  Professional near you.







Kirsty McNabDr. Alison Grimaldi


This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.

Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

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Check Out More You Can Read on this Area at HipPainHelp:

Anterior Hip Pain: scroll down and read more about the front (anterior) of the hip joint and how different structures can be involved in pain at the front of the hip.

Hip Flexor Pain and Iliopsoas Pain (Hip and/or Groin Pain): The muscles that sit at the front of the hip are called the hip flexors and act to lift your knee towards your chest (flexion). It is these muscles that can be involved with hip flexor pain. Learn about the hip flexors including iliopsoas muscle and their relation to pain.

Femoroacetabular Impingement Syndrome (FAIS) – what is it and what are the causesLearn about the differences between FAI and FAIS, and what might be the cause of this condition. This is another condition that may result in pain at the front of the hip.

Causes, Affects & Exercises for Lordosis to Reduce Hip and Back Pain:Learn how tilting the pelvis forward may affect your hip flexor muscles

What is the Best Good Posture for Hip Pain Relief: Is there any one good posture that could best help with hip pain relief is not such an easy question to answer!

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Don’t miss our next blog……

Check out our next blog series

Over a series of 3 blogs we will look at Hip dysplasia, what it is, what are the different types of dysplasia, the symptoms, causes, and possible treatments.

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