Hip Pain – Surgery or Physio?

So you’ve been to see the doctor with your hip pain and he has told you that you’ve got femoroacetabular impingement, or ‘FAI’ as you’ve seen it written on google. You’re not sure what to make of this and you think it will help if you chat about it with other people but the problem is – everyone’s giving you different advice. The man in the pub has a friend who had hip pain and had surgery and it was a nightmare. The woman in the hairdressers had surgery and it was great. A few people at your running club went for physiotherapy instead.

So who do you listen to? How do you know what to do? Luckily, the British Medical Journal (BMJ) has done some of the hard work for you and has recently published a study to compare the two treatment options.

Basic Anatomy

The hip is a ball and socket joint, comprising of the acetabulum (socket in the pelvis) and the head of femur (top of your thigh bone) and it looks like this:

The Hip Joint

If you have femoroacetabular impingement, it means that there is an irregularity in the structure of your hip joint at the ball, the socket or a mixture of both. This can be described as follows:


1- Cam- irregular shaped femoral head (ball)
2- Pincer- extra bone on the edge of the acetabulum (socket) which covers the femoral head a bit more than it should
3- Mixture of cam and pincer Ball

This can cause part of the femoral head (ball) to impact against the acetabulum (socket) during everyday movements, which can cause pain. It has been suggested that in some cases this impact can increase the risk of developing osteoarthritis (wear and tear) in the joint.

So how common is this problem? It has been shown that 1 in 5 people are living with FAI and actually may never find out, as less than 25% of people with the condition will experience pain as a result.

Next most important question- what should be done about it?

For most people, the aim of any treatment is to improve pain and function. If you take the surgical route, the surgeon will do keyhole surgery to very slightly reshape the hip and clean up any damage caused to the hip as a result of the mechanical malfunction. There is a possibility that this can reduce further damage to the joint. One thing worth considering is that wear and tear to the joint is a natural part of the ageing process and will occur anyway, regardless of whether you have FAI or undergo any type of hip surgery.


If you take the physio route, your treatment programme will be based on what kind of activities you need and want to be able to do. You will talk about activity modifications (such as avoiding your painful movements for a little while!), work on your range of movement, increase the strength of the muscles in your hips and legs and improve your core stability. It is worth considering that the success of a physiotherapy programme can undoubtedly be affected by how much active involvement you are prepared to have in helping yourself to get better- i.e. if you’re given exercises to do, and you don’t do them, you won’t get the outcome you want!


So going back to the BMJ study that we mentioned earlier, it was found that 8 months into the study, more patients who took the surgical route had seen improvement in their symptoms than the patients who opted to follow the physiotherapy pathway. A similar outcome has also been found in some other studies. However, it is important to remember that lots of different factors influence the improvement of symptoms: anxiety and depression, pre-pain level of function, how well you follow advice from your surgeon or physiotherapist, as well as age and sex to name a few.

As such, what works for one person might not work for another. To find out what might work best for you, talk to your doctor or physiotherapist but there’s nothing to say you can’t consider a combination of both treatment options.