Should I Choose Physical Therapy or Surgery for Hip Impingement?

The rates of surgery for femoroacetabular impingement (aka: FAI, hip impingement) have skyrocketed in recent years. Recent studies have shown that both Physical Therapy and surgery are effective at reducing pain and improving function in people with hip impingement. In our Boulder County Physical Therapy practice we have frequent conversations with patients about this evolving body of research and how it should guide their care.

Just this year, 3 meta-analyses (Gatz et al 2020, Bastos et al 2020, Dwyer et al 2020) were published with the aim of answering the question “is Physical Therapy or surgery more effective for femoroacetabular impingement?”. Depending on how you interpret the data, the answer remains unclear. Two of these analyses (Gatz and Dwyer) report better outcomes in patients undergoing surgery whereas Batos et al found no difference at 6, 12 and 24 months between physical therapy and surgery. The studies are riddled with limitations including:

1.     Short term follow-up (longest 2 years)

2.     Lack of description or consistency in “Physical Therapy” or whether Physical Therapy was consistent with current best evidence

3.     No report of how the intervention impacted pain

4.     Lack of meeting minimum clinically important differences in reported outcome measures (which essentially means the data showed a trend towards improvement, but those numbers might not have resulted in a noticeable change in function for subjects in the study!)

So, if you are experiencing symptoms related to hip impingement, where does this leave you?

There is strong evidence that BOTH Physical Therapy and surgery can help with symptoms and activity limitations related to hip impingement in younger active individuals without joint arthritis. At MEND, we recommend working with a physical therapist that can assess contributing factors to your symptoms and design an individualized program as your first line treatment option. We commonly find impairments in both strength and mobility in patients with FAI and have excellent results with a multifaceted approach targeting these impairments. Surgery should be reserved for those individuals that do not achieve their goals with Physical Therapy until further data indicates the efficacy of one management strategy over another.