FAI Surgery: Necessary or Not? What New Research Reveals

Are you struggling with hip pain and considering surgery to treat your femoral acetabular impingement (FAI)?

Before you go under the knife, there's some eye-opening research you need to know about…

A recent randomized controlled trial compared hip arthroscopy surgery to physical therapy for treating FAI, and the results might surprise you.

What Is FAI and How Do Surgeons “Fix it”?

FAI stands for femoral acetabular impingement, aka “hip impingement.”

The theory proposed by surgeons is that evil bone spurs in your hip joint are destroying cartilage. Every move, big or small, is grinding away the inside of your hip joint (at least, that’s what doctors told me 14 years ago).

Given this dire situation, noble surgeons must go in and remove those evil bone spurs and reshape the hip to try and prevent the inevitable arthritis and save your life.

In just the last decade, this “bad bones” theory of FAI has opened the door to an explosion of hip surgeries. The theory sounds plausible, and there’s good money in it, which is why surgeons began operating on hips well before a single high-level research study compared surgery to physical therapy. That is UNTIL this paper was published…

The First Hip Arthroscopy RCT on FAI

This hip FAI surgery study was a randomized controlled trial where 80 patients were randomly assigned to either the hip surgery or physical therapy groups.

So, what did this paper show? Ready for the punchline?

At the end of two years, there was no significant difference in functional or pain scores between the surgery and PT groups.

Let that sink in for a moment.

After 2 years, patients who received (most likely) pretty generic physical therapy had the same results as those who had surgery.

But it gets even more interesting. Among military patients, one-third were not medically fit for duty two years post-treatment, regardless of whether they had surgery or PT.

Now, it's important to acknowledge that this study had some limitations. It's one of the first high-level trials we had directly comparing FAI surgery to conservative care.

Other research comparing surgery vs physical therapy has shown mixed results. But, it also has its own inherent limitations.

For example, one study only compared results after a few short months. Another study compared surgery to “physical therapy,” but when you dig into the KIND of physical therapy that was provided, it turned out it’s complete crap.

I’m well familiar with these “crap” physical therapy treatments because I wasted $26,000 on this kind of PT in my first 5 years of trying to come out of my own hip impingement.

For example, in one of these studies, patients received 8 measly sessions of physical therapy over an extremely long period of time. This is obviously not nearly enough one-on-one time to really learn how to improve strength and mobility.

In comparison, when we work one-on-one with people with hip pain, our Doctor of Physical Therapy team is available 24/7 rather than once every few weeks. BIG difference.

The bottom line is this: the overall research on physical therapy vs. surgery is a mixed bag and still full of holes. More research is needed to draw definitive conclusions, but the results of this particular study are still eye-opening.

The most important line (for me) in this entire paper was from the patients themselves. On average, after 2 years of either surgery or physical therapy, the average response from all patients was that they “felt about the same.”

So, if you want to feel “about the same” two years from now, go for surgery or traditional/generic physical therapy!

My Insurance Covers PT/Surgery…So, I Should Use It!

I talk to about 10-20 people per week who are applying for our Hip Fix™️ 1:1 Coaching Program, and I hear a recurring theme…

“Shane, my insurance covers PT/surgery, so that’s what I’m using to treat my hips.”

The ugly truth is that just because your insurance covers something doesn’t mean it’s the best option. In fact, depending on who you go to, you could be just throwing money down the drain or worse.

For example, my wife was recently struggling with a thyroid issue. She was having all kinds of weird symptoms and problems that were affecting her a lot. The doctors covered by her insurance kept prescribing more and more thyroid medication.

One day, frustrated, as she was approaching the upper limit of medication, she finally asked her Doctor…

“Doc, and what happens if I can’t take any more medication?!”

“We’ll figure out what to do once we get there.”

Needless to say, that wasn’t a good enough answer.

We made the tough decision to start paying out of pocket to a much more expensive functional medicine doctor.

8 months later, she almost doesn’t have to take her thyroid medication anymore and she’s feeling better than ever.

The point is this: she could have continue spending years of her life using treatments that were technically covered, but those would have been some miserable years. Instead, she found the right person, even though they were more of an investment, and has finally improved for the first time in years.

But, Some Pro Athletes Get Surgery… So It Must Work!?

A few other people might be thinking:

“Okay, okay…so it’s PT or surgery, and it's probably not a good idea just because insurance covers it. But I read in the paper that Big Name Athlete X, Y, or Z got hip surgery!”

Yes, it’s true that some high-level athletes get hip surgery. But these athletes are advised by the same doctors and surgeons who get paid big bucks to perform these surgeries.

And, even still, the results amongst the pros are hit-or-miss.

For instance, Bo Jackson, a celebrated dual-sport athlete, faced a career-ending situation with hip replacement surgery due to avascular necrosis, which drastically curtailed his football career, though he managed a brief return to baseball.

In basketball, Isaiah Thomas underwent a minimally invasive procedure for a labral tear in his hip, which significantly disrupted his career, leading to diminished performance and a series of team changes.

Similarly, Greg Oden, plagued by multiple injuries, including hip issues, saw his promising NBA career dissolve.

Alex Rodriguez, while not sidelined entirely by his hip surgery, experienced a marked inconsistency in his performance post-surgery.

Tennis star Andy Murray underwent hip resurfacing surgery and, despite making a comeback, has struggled to regain his former top-tier status.

These stories reflect a common theme: while hip surgeries can provide necessary relief in some and potential return to activity, they often come with complex recoveries and uncertain futures in the realms of high-stakes sports.

The bottom line: they aren’t bad, and they have their place–but they simply aren’t the “slam-dunk/home-run” they are made out to be. So, buyer beware!

So, if this study shows that surgery and generic physical therapy are equally ineffective, what are your alternatives?

We offer 2 options based on our own personal experience with FAI and working with over 30,000 people over the past 14+ years.

Option #1 is our “do-it-yourself” Hip Fix Program.

Option #2 is our high-level Hip Fix™️ 1:1 Coaching Program.

Both of these programs are powered by the TSR System for hip pain and have generated tons of positive reviews from students.

Let's look at a real-world example of how non-surgical treatments can make a difference for you if you are someone committed to an active lifestyle but are struggling with FAI.

Meet Ryan. Here’s what he had to say about his experience with our TSR methodology:

“I was diagnosed with arthritis and FAI about three years ago, and it was keeping me from being able to run, which is my passion. But after finally following the instructions you provided, I've now gotten to a point where I can continue running again. Through your instruction and The Hip Stick, I've been able to loosen up my adductors and glutes and get everything back moving again. I've been strengthening them and getting a lot more flexibility. Just to be able to back to running again made a huge difference in my life. So thank you for everything!” - Ryan DeBoer

Ryan is just one of the hundreds of positive reviews and testimonials our happy students have sent us over the past decade-plus of helping people with hip pain.

The bottom line is this: the decision to have surgery for FAI is a highly personal one that should be made in close consultation with your healthcare team.

But this recent research serves as an important reminder that surgery isn't your only option - and it may not even be the best one for you.

Before signing up for an invasive procedure with a long recovery time, make sure you've fully explored conservative treatment options like our DIY Hip Fix Program or our Hip Fix™ 1:1 Coaching Program. Your hips — and your peace of mind — will thank you.

I hope this article on FAI surgery vs physical therapy has been insightful. If you’re at a place where you're stuck and feeling hopeless, reach out and schedule a call with me or my team at gotrom.com.vip.

No matter where you’re at, there’s always hope. And you’re always just one step away from building (or rebuilding) your perfect body.