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Femoroacetabular impingement

Also called hip impingement, FAI, FAI syndrome, femoroacetabular impingement syndrome, FAIS

Early contact between the thigh bone and the hip socket that comes with symptoms. How consensus groups define it, how common it and its bone shapes are, and what trials of surgery and exercise programmes found.

Region
Hip
Updated
October 7, 2026
Reviewed
October 7, 2026 · how entries are checked

What it is

How consensus groups define it

The 2016 Warwick Agreement, an international consensus, introduced the term femoroacetabular impingement syndrome2. The term was meant to reflect the central part that symptoms play2. Under the agreement, the label needs three things together: fitting symptoms, positive clinical signs, and findings on imaging2.

A 2021 paper describes the syndrome as a motion-related disorder of the hip1. In it, the upper femur (thigh bone) and the hip socket make early contact that causes symptoms1.

A 2024 paper on a cohort, a group of people followed over time, sums up the 2016 consensus10. In its summary, cam morphology on imaging alone does not make the syndrome10. Hip or groin pain tied to movement or position should also be present10.

The two bone shapes

The hip is a ball-and-socket joint: the ball is the head of the femur and the socket is the acetabulum (hip socket)11. The 2021 paper describes two shape patterns in the syndrome, cam and pincer1. The UK FASHIoN trial report describes each5:

  • Cam morphology (morphology means shape): a flattening or outward curve where the head of the femur meets its neck5.
  • Pincer morphology: the socket covers too much of the head of the femur, in one place or the whole way round5.

The 2022 Oxford consensus describes primary cam morphology as a mostly benign (harmless) bony bump that is highly prevalent in many athlete populations12.

The tissues inside the joint

The UK FASHIoN report says the syndrome brings damage inside the joint that builds over time5. That damage includes the hip labrum, a rim of tough tissue around the edge of a joint socket5. It also includes the articular cartilage, the thin layer covering the ends of bones where they meet in a joint5. The report says the syndrome is associated with the development of hip osteoarthritis5. Osteoarthritis is a long-term joint disease in which the cartilage lining the joint wears away.

Engraving of the right hip joint seen from the front with most of the capsule removed and the femoral head pulled out of the socket. A pale rim, labelled cotyloid ligament (the old name for the acetabular labrum), runs around the edge of the acetabulum, the ligamentum teres runs from the socket to the femoral head, and the cut edge of the capsular ligament is seen around the socket and the femoral neck.
The hip socket and its labrum, from the frontHenry Vandyke Carter, in Henry Gray, Anatomy of the Human Body (1918), Fig. 342. Public domain, via Wikimedia Commons. (source, Public domain)

Who it affects

How common the syndrome is

In a survey of 500 white adults aged 20 to 49 in Vancouver, Canada, 3.0% had the syndrome4. A 2026 systematic review of 18 population-based studies found a single study reporting how common the syndrome is14. It concluded that the true prevalence, the share of people in a group who have a condition at a given time, is largely unknown14.

In a geographic database study of 1,893 people aged 14 to 50 seen for hip pain, 716 (38%) met a three-part definition15. That gave an incidence (how many new cases appear in a group over a set time) of 54.4 per 100,000 person-years15. Person-years are a count of people multiplied by the years each was followed. Recorded cases were more frequent in female than male patients, at 73.2 against 36.1 per 100,000 person-years15.

How common the bone shapes are

GroupCam morphologyPincer morphology
Adults in population-based studies (2026 systematic review)7.3% to 38.2% of people147.6% to 17.9% of people, with definitions that varied between studies14
Volunteers with no symptoms (2015 systematic review)37% of hips, from 7% to 100% between studies367% of hips, from 61% to 76% between studies; the review noted the shape was poorly defined3
Athletes aged 10 to 35 (2026 meta-analysis of 47 studies)An estimated 48%16An estimated 18%16

Two 2016 systematic reviews reached different conclusions about athletes17,18. One, of 60 imaging studies, found cam-type findings significantly more common in athletes than in people without symptoms17. The other, of 30 studies, could not show a higher prevalence in athletes, and judged the data insufficient to determine the true prevalence18. The 2026 review of athletes found that few studies reported findings in female athletes16.

A prospective study followed 63 preprofessional soccer players for about 2.4 years19. Cam prominence rose from 2.1% to 17.7% of hips whose growth plate was open at the start19. A growth plate is a layer of cartilage near the end of a growing bone. After it had closed, there was no significant increase19.

What studies found

The bone shapes and later osteoarthritis

Pooled prospective studies, which follow people forward in time, link cam morphology with later osteoarthritis, and findings on pincer morphology are mixed20. An odds ratio is how many times higher the odds of an outcome are in one group than in another.

  • Cam: a 2021 meta-analysis found hips with cam morphology more likely to develop hip osteoarthritis in prospective studies, with an odds ratio of 2.5220. A 2026 meta-analysis of 23,886 hips found an odds ratio of 1.87 for developing osteoarthritis on X-ray within 4 to 8 years21.
  • Pincer: the 2021 meta-analysis found pincer morphology associated with hip osteoarthritis in cross-sectional studies, which look at a group once, but not in prospective studies20. In 2026 prospective data on 18,935 hips, severe pincer morphology was associated with developing osteoarthritis on X-ray within 8 years22. Moderate pincer morphology was not22.

In one prospective cohort of 1,002 people aged 45 to 65, 21 of 1,386 hips met criteria for the syndrome with cam morphology10. Those 21 hips had 6.85 times the odds of new osteoarthritis on X-ray within 10 years, compared with hips meeting no criteria10. The confidence interval, a range that shows how precise a result is, ran from 2.10 to 22.3510.

A 2026 review article states that not everybody with cam morphology will develop femoroacetabular impingement syndrome or osteoarthritis23. The same article calls the shape a causal risk factor for hip osteoarthritis23.

The course without surgery

In a prospective study, 76 patients with the syndrome (93 hips, mean age 15.3) followed a stepped non-surgical protocol for about 27 months24. Of the hips, 70% were managed with rest, therapy sessions and activity changes alone, and 18% went on to arthroscopy24. In a second study of 100 adolescents with hip pain and a positive impingement sign, 51 were available at a mean of 5 years25. Their mean score on a hip scale had risen from 69.6 to 89.5, with no significant drop between 2 and 5 years25.

A 2023 meta-analysis covered 1,153 patients with non-arthritic hip-related pain, including this syndrome26. It found moderate-certainty evidence that 54% responded satisfactorily to non-surgical care26. The confidence interval ran from 32% to 76%26. The review said the essential elements of that care remain unclear26.

One randomised trial, PhysioFIRST, compared two exercise programmes in 154 people aged 18 to 50 with the syndrome27. Six months of targeted strengthening and six months of standardised stretching did not differ in change in hip-related quality of life27. In a secondary analysis, 72% of the strengthening group and 52% of the stretching group rated their pain as improved at six months27.

Trials of arthroscopy against non-surgical programmes

Four randomised trials, which assign people to groups by chance, have compared arthroscopy with a non-surgical programme1,5,6,7.

TrialWho was studiedWhat was found
UK FASHIoN348 people aged 16 or over with the syndrome and no osteoarthritis, at 23 UK hospitals5At 12 months, an adjusted difference of 6.8 points in hip-related quality of life favoured arthroscopy, above the 6.1-point minimum clinically important difference5
FAIT222 people aged 18 to 60 with symptomatic impingement6At eight months, a daily living score was 10.0 points higher after arthroscopy once adjusted, against a minimum clinically important difference of 96
Military trial80 patients at a military hospital, 91.3% of them active-duty service members7Both groups improved, and the difference between them was not significant at two years7
Australian FASHIoN99 people, mean age 331At 12 months a cartilage MRI measure showed no statistically significant difference, and hip-related quality of life had improved by 14 units more after surgery1

In UK FASHIoN the non-surgical programme was typically 6 to 10 outpatient consultations aimed at strengthening the muscles around the hip28. In FAIT the programme was up to eight sessions that emphasised core stability and movement control, with activity changes6.

Pooled results read differently from UK FASHIoN and FAIT5,6,8,9. A 2025 meta-analysis of 21 randomised trials found statistically higher scores after arthroscopy on two measures, without reaching minimal clinically important differences8. A 2025 meta-analysis of six randomised trials compared arthroscopy with a non-surgical programme or joint washout9. It found a significant difference in function favouring arthroscopy at 12 months but not at 6 months9. Its authors judged that clinical superiority was not shown9.

Harms and later surgery

In UK FASHIoN, 72% of the arthroscopy group and 60% of the programme group reported an adverse event (an unwanted effect), most often muscle soreness5. Five of the six serious adverse events in the arthroscopy group were related to the procedure, including one hip joint infection5. FAIT reported no serious adverse events in either group6.

In UK FASHIoN, 38 people in the programme group (24%) chose arthroscopy between one and three years after randomisation28. In the military trial, 28 of those assigned to the programme went on to have surgery, which the authors list as a limitation7.

Sport after arthroscopy

Two reviews give different figures29,30. A 2018 meta-analysis covered 35 studies of athletes after surgery for the syndrome29. It found limited to moderate strength evidence that 74% returned at their preinjury level29. A 2015 systematic review of 18 case series covered athletes after hip surgery for femoroacetabular impingement30. On average, 87% returned to sport and 82% to the same level as before their symptoms30.

In a cross-sectional study of 189 athletes aged 18 to 30 from a Danish registry, 57.1% were playing their preinjury sport at preinjury level31. That was at a mean of 33 months after hip arthroscopy31. Of the whole sample, 16.9% reported optimal performance with full participation31. A 2021 meta-analysis of 20 studies estimated that 12.1% of athletes did not return to sport after arthroscopy for the syndrome32. It found evidence of publication bias, when studies with striking results are more likely to be published32.

Connections

The UK FASHIoN report names the hip labrum and articular cartilage as tissues damaged within the hip joint5.

Studies of movement relate to the back squat33. A 2018 meta-analysis of 14 studies found that people with the syndrome squatted to a lesser depth than controls33. Their range of hip flexion (bending) did not differ, and the differences between groups were small to moderate33. In a squatting study, 15 people with the syndrome, unlike 14 healthy controls, activated the obturator internus about as much going down as coming up34. That muscle is one of six deep hip rotators11.

A 2015 systematic review of 16 studies looked at people with symptomatic impingement35. The physical difference most often reported was reduced range of motion in the directions of impingement35. Others included reduced strength of the hip adductors and the hip flexors, the muscles that bend the hip35.

A 2026 European consensus of 57 experts recommended “hip joint-related groin pain” as one of five terms for athletes and physically active adults36. The other four terms, covered under athletic groin pain, are adductor, iliopsoas, inguinal and pubic-related groin pain36.

Femoroacetabular impingement involves

Femoroacetabular impingement has studies of squat depth in

Femoroacetabular impingement has been measured in studies of

Femoroacetabular impingement has studies of hip strength in

Femoroacetabular impingement is compared with

Sources

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Every source the library cites

Changes

  • First published.