Tough-to-diagnose hip condition caused her 'excruciating pain' until she got a new type of surgery

New York-based physical therapist Brittany Garrett, now 33, was sidelined by excruciating hip pain for close to eight years before she got an accurate diagnosis and effective treatment.

She tried physical therapy to improve her flexibility, among other treatments, but nothing seemed to help. The former volleyball player's pain was so intense that it was getting in the way of her career and her active lifestyle.

"I have to be able to demonstrate exercises, do lunges, be on my feet, get on and off the floor and lift heavy things, and I couldn't," Garrett recalled.

She eventually underwent imaging exams, including an MRI that showed she had femoroacetabular impingement (FAI), an underdiagnosed condition that occurs when abnormal growths at the hip joint cause painful friction and set the stage for hip osteoarthritis, the wear-and-tear form of the disease.

"It was a relief to have the diagnosis and know that it was an anatomical issue, and there was also relief in knowing that I could have surgery to get rid of pain and get my life back," Garrett said.

In the past, this type of surgery involved huge incisions and dislocating the hip, but now some surgeons can treat FAI with minimally invasive hip surgery via tiny incisions and instruments guided by a small camera, reducing risks and downtime.

Garrett underwent two minimally invasive surgeries to address each hip in 2022. "Recovery was a lot easier than I expected," she said. "The hardest part was really just being on crutches and relying on someone to bring me water."

But she's not complaining. "I can now sit longer than 30 minutes without getting deep, aching groin pain. I can lie on one side, do squats, and work out four or five times a week," she said.

What is FAI?

FAI occurs when there are bony overgrowths called spurs that develop around the femoral head (the ball-shaped bone at the top of the thigh bone) and/or along the acetabulum (the socket in the pelvis where the femoral head fits). The extra bone prevents the ball and socket from moving smoothly during activity and can cause tears of the cartilage (labrum) on the outside rim of the hip joint.

"It is a common problem and may be the leading cause of hip arthritis in the world," said Garrett's doctor, Dr. Etan Sugarman, an orthopedic surgeon at Lenox Health Greenwich Village in New York City.

Despite how common FAI is, most people will see multiple doctors before getting a proper diagnosis, he said.

"Many people do not necessarily know much or anything about it," Sugarman said. "Standard X-rays can miss the problem, so specialized X-ray views are necessary to properly visualize the problem."

Some people are also diagnosed with related or overlapping conditions that may be secondary to hip damage or incorrectly diagnosed, he noted. The typical pain that patients experience may not be severe, but may be enough that it interferes with their activities, and young adults may not consider having it evaluated until the damage is more significant.

FAI tends to strike young active people like Garrett, he said. Treatment often starts with physical therapy aimed at improving the range of motion in your hip and strengthening the muscles that support the joint, followed by injections or medication to cool pain and inflammation, and then, ultimately, surgery.

"It was a huge surgery and a significant whack in the past," Sugarman explained.

Not anymore. "With the minimally invasive surgery, major complications are significantly decreased," he said. The surgery takes about 1.5 to two hours to complete, and people can go home the same day, without the need for heavy painkillers, he said. Sugarman has performed around 300 of these procedures so far.

Fewer complications, faster recovery

"The majority of people have the problem in both hips, but what we have seen is that only about 40% are symptomatic on both sides, so we treat the side that is symptomatic first," he said. The other hip can be treated down the road if necessary.

Recovery is also a lot easier and smoother than it was with the older surgery, he added.

"You use crutches for two weeks, and I recommend a protective brace for two weeks," Sugarman said. "Most people are walking fairly comfortably by three to four weeks after surgery and are back to everyday activity in six weeks."

The hope is that treating FAI early can stave off the need for advanced hip osteoarthritis and joint replacement down the road. "We don't have long-term data to support this yet, but that is the thought process," Sugarman said.

Dr. Brian Walczak, an orthopedic surgeon at the Rush University System for Health in Chicago, also performs minimally invasive surgeries to treat this common hip condition.

There are three types of FAI: pincer, cam and combined impingement, he explained.

Pincer occurs because extra bone extends out over the normal rim of the acetabulum, crushing the labrum.

In cam impingement, the femoral head is not round and can't fit smoothly inside the socket.

With combined impingement, both the pincer and cam types are present.

"FAI causes groin pain and can make it hard to get in and out of a car and may act up after driving or sitting for a few hours," Walczak said. Other symptoms may include stiffness and limping.

"Prior to the early 2000s, we weren't able to do surgery without dislocating the hip, and it involved many months of healing," he said. "Now, we make small holes around the hip and use a camera to guide us, which results in less pain, faster recovery and a quicker return to activity and sport."

Walczak's advice? "If you are a young athlete and playing competitive sports and start to develop hip pain, come in and be evaluated," he said.

In addition to imaging, your doctor may do an impingement test to diagnose FAI. This involves bringing your knee up towards your chest and then rotating it inward toward your opposite shoulder. If this causes pain, the diagnosis is FAI.

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