Imaging, the Alpha Angle and Surgery Versus Physiotherapy for FAI

Rintje starts with an AP pelvis and lateral X-ray, adds CT for three-dimensional questions such as femoral anteversion or acetabular retroversion, and uses MR arthrography with intra-articular contrast to detect labral lesions. An intra-articular injection can help separate hip from non-hip pain: if provoking movements are pain free about an hour later, the hip is the likely source. The alpha angle measures how far the femoral head departs from a circle, with 60 degrees the generally agreed threshold for cam morphology. The FASHIoN trial randomized almost 350 people with FAI syndrome to arthroscopic surgery or personalized hip therapy of 6 to 10 sessions over 12 to 24 weeks. Both groups started with iHOT-33 scores of 35 to 40 and both improved. At 12 months after randomization, arthroscopy was statistically better, by 6.8 points in the intention-to-treat analysis and 8.2 per protocol. Rintje notes that 6 to 10 sessions is a low dose of physiotherapy compared with Dutch practice and treats his own patients conservatively first. He also outlines hip arthroscopy positioning, traction and portals.