Judicious use of cortisone inside the joint can sometimes be performed even while putting in some anesthetic. Cortisone is simply a potent anti-inflammatory medication that may reduce inflammation within the joint and diminish symptoms. The chemical effect of cortisone may last for four to six weeks but sometimes can help break a cycle of inflammation and result in long-term improvement. More practically, if the joint’s irritable, it may provide a window of time while the joint is feeling better and allow a patient to work on surrounding soft tissue symptoms, which are normally best addressed with supervised physical therapy. In the presence of more severe arthritis, cortisone injections may provide sufficient improvement to postpone the eventual need for a hip replacement. Repeated cortisone injections are usually avoided in non-arthritic circumstances. With structural problems like FAI, habitual injections are just treating the symptoms and not addressing the underlying problem. In the long run, this can prove to be detrimental. Again, on a one-time basis, this may be appropriate, especially as part of the effort to exhaust reasonable conservative treatment before opting for surgery.
The damage associated with FAI can worsen with time. If the symptoms are stable, there is no sense of urgency to rush towards surgery. If the symptoms are worsening despite efforts at non-surgical management, then it is probably best to be proactive and recommend surgical intervention rather than continue with a wait-and-see approach.
Surgical correction of FAI was first described by open hip surgeons; most notably Reinhold Ganz in Bern Switzerland. (Related Study: Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip) But even before Ganz’s definitive treatise had been published, the procedure had been brought to the United States. (Related Study: Anterior Femoroacetabular Impingement: A Clinical Presentation) Subsequently, arthroscopic surgeons began to figure out how to adapt these techniques to less invasive arthroscopic methods. Much of this pioneering work was performed here in Nashville. (Related Study: Arthroscopic Management of Femoroacetabular Impingement: Minimum 2-Year Follow-up)