title: Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature.
abstract: OBJECTIVE
  Femoroacetabular impingement (FAI) has been identified as a common cause of hip pain in young adults. However, it is not known whether an effective nonoperative treatment exists and whether there is any evidence to support such a treatment. The purpose of this review is to establish whether nonoperative treatments exist for FAI in the published literature and whether there is any evidence to support their use. TYPE: A systematic review. LITERACY SURVEY: PubMed, Medline, EMBASE, CINAHL, AMED, and Cochrane Library databases were searched by using the following terms: femoroacetabular impingement, femoro-acetabular impingement, and hip impingement. The search was limited to English only but with no time constraints.
  
  
  METHODS
  The review was undertaken at 2 academic institutions within the United Kingdom; any article that described or provided evidence that related to a nonoperative treatment for FAI was included. Fifty-three articles met our criteria, of which, 48 were review and/or discussion based.
  
  
  RESULTS
  Five articles summarized primary experiments that described or evaluated nonoperative treatment, of which, 3 reported favorable outcomes. Many review and/or discussion articles (31 [65%]) indicated that a trial of conservative care was appropriate. Activity modification was most frequently recommended (39 [81%]), and nearly half promoted physical therapy as a treatment (23 [48%]).
  
  
  CONCLUSIONS
  The review literature appears to promote initial nonoperative treatment for FAI. Although the available literature with experimental data is limited, there is a suggestion that physical therapy and activity modification confer some benefit to patients. Nonoperative treatment regimens, particularly physical therapy, need to be evaluated more extensively and rigorously, preferably against operative care, to determine the true clinical effectiveness.
authors: Warwick Orthopaedics, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom. pdhwall@gmail.com
authors: Peter D H
authors: PD
authors: Wall
authors: Miguel
authors: M
authors: Fernandez
authors: Damian R
authors: DR
authors: Griffin
authors: Nadine E
authors: NE
authors: Foster
mesh_terms: D019317:Evidence-Based Medicine; D057925:Femoracetabular Impingement / Q000628:therapy*; D006801:Humans; D026741:Physical Therapy Modalities