In severe cases that do not respond to conservative treatment (rest, medications, physical therapy), surgery may be indicated. Surgery can include open repair with an osteotomy of the femur, or arthroscopic repair in which the impingement is accessed through small incision through the muscle tissue.
Indications for open repair depend on surgeon preference, but generally if significant femoral neck retroversion or severe deformity of the femoral neck are present, an osteotomy through open repair is recommended. Posterior impingement may also indicate an open repair, depending on severity.
It has been suggested that labral repair or surgery for femoroacetabular impingement may lower the risk of developing DJD or slow the rate of degeneration.
Recovery and restrictions depend on the type of procedure performed. The first couple months are typically focused on restoring range of motion to proper pelvic alignment and gait, and strengthening the hip and core muscles.
Open repair with osteotomy generally includes a period of limited weight bearing with assistance from crutches for 2 weeks and no running or high-impact exercise for 2 to 3 months. Return to full sports can begin 3 to 6 months depending on functional improvement.
Labral debridement with trimming of the acetabular rim has a much quicker recovery and restrictions are limited, but depend on surgeon recommendations.
In a study of 37 patients with mild femoroacetabular impingement who chose conservative measures, only 11% choose surgery and 89% had improvement in harris hip score from 72 to 91 at 2 years after diagnosis.
Open repair for femoroacetabular impingement has shown better outcomes when there is less degeneration in the hip joint before surgery.
In patients with associated labral tears, labral repair was significantly better with regards to function and patient satisfaction than debridement.