How soon should you have surgery for FAI once symptoms develop?

This is a difficult question and we don’t have all the answers to this, however, I believe there are some important things to take into consideration. The type and nature of the FAI condition is important to establish. Some types of FAI, in particular cam impingement tend to cause hip damage in a more aggressive fashion than pincer-type impingement. The concern about this is that the cartilage of the articular surface starts to get injured and this is a material that cannot regenerate itself once damage starts. This means that overtime the joint will be more prone to the development of osteoarthritis. The injury pattern in pincer impingement is different and much less aggressive and does not damage the articular cartilage in the same way.

I often find that patients, in particular athletic individuals, have had symptoms of groin strain type pain for a number of years and frequently a clear diagnosis has never been made. Unfortunately they then present with significant arthritis changes for which a hip preservation procedure is no longer an option.

I have come round to the view that once a patient is symptomatic and the diagnosis is one primarily of a cam impingement then it is better to intervene sooner rather than later. If these individuals continue to be active in sport with these symptoms then further damage will be occurring inside the hip. In many respects, the younger the patient the more sense there is to intervene early before any or when only minimal damage is present. In my experience It is rare for there to be major articular damage in adolescents or those younger than about 23. In addition, at this age the joint seems to recover from surgical intervention exceptionally well and return to sport and activity is quicker than in older individuals.