By: Dr Zaid Matti
Femoroacetabular Impingement (FAI) is a common cause of hip pain and early osteoarthritis in young adults. Traditionally seen as a mechanical problem requiring surgical correction, there’s growing evidence that biological factors contribute to disease progression—and that orthobiologics like Platelet-Rich Plasma (PRP) may help modulate the condition before or after surgery.
In this blog, we’ll cover:
- What is FAI?
- Current evidence on FAI and joint preservation
- How orthobiologics, especially PRP, fit into the care pathway
- Practical guidance on how PRP may be used for joint preservation or recovery
🔍 What Is FAI?
FAI occurs when abnormal bone morphology of the femoral head (cam lesion), acetabulum (pincer lesion), or both causes repetitive contact between the femur and the acetabular rim, damaging the labrum and cartilage over time. It’s a recognised precursor to hip osteoarthritis.
Types of FAI:
- Cam type: Aspherical femoral head causes shear stress on the acetabulum
- Pincer type: Overcoverage of the acetabulum leads to compression of the labrum
- Mixed type: Features of both
Symptoms include groin pain, stiffness, and decreased hip flexion or internal rotation.
🧪 Latest Evidence in FAI Management
Surgical management, usually via hip arthroscopy, aims to reshape bone and repair or debride the labrum. While outcomes are generally favourable, the long-term goal is joint preservation—delaying or preventing the onset of osteoarthritis.
Recent studies suggest that:
- Cartilage damage is often present at the time of diagnosis, even in young patients【1】.
- Postoperative progression to osteoarthritis is still a risk, especially in patients with pre-existing cartilage damage or dysplasia【2】.
- Biological augmentation may improve outcomes by supporting tissue healing and modulating inflammation.
💉 Where Does PRP Fit In?
Platelet-Rich Plasma (PRP), rich in growth factors and anti-inflammatory cytokines, has been explored as a treatment to:
- Reduce intra-articular inflammation
- Support labral healing
- Delay joint degeneration
- Enhance postoperative recovery
1.
PRP Before Surgery (Joint Preservation Strategy)
In early-stage FAI or patients with borderline symptoms, PRP injections may:
- Provide pain relief
- Reduce synovitis and mechanical symptoms
- Delay or even avoid surgery in select cases
Supporting Evidence:
- A 2023 study in Orthopaedic Journal of Sports Medicine found that intra-articular PRP improved pain and function in patients with FAI, particularly those with mild cartilage damage【3】.
- PRP may be especially useful in younger patients who are not yet surgical candidates or wish to delay arthroscopy【4】.
2.
PRP After Surgery (Adjunct to Arthroscopy)
Postoperative intra-articular PRP may:
- Improve labral healing
- Reduce inflammation and effusion
- Shorten time to return to activity
Supporting Evidence:
- A 2022 randomised controlled trial showed that PRP after hip arthroscopy led to earlier functional improvement and reduced post-op pain compared to controls【5】.
- PRP may help modulate early post-operative inflammation, which is crucial to prevent fibrocartilage degeneration.
🦵 PRP Protocols for Hip Joint Preservation
There is no universal PRP protocol yet, but based on current regenerative principles:
Recommended PRP approach for hip FAI:
- Formulation: Leukocyte-poor PRP (to reduce inflammatory response)
- Dose: 5–15 billion platelets per injection is considered therapeutic
- Guidance: Ultrasound or fluoroscopic guidance to ensure intra-articular delivery
🧠 Clinical Pearls
- Not all PRP is equal: Systems vary in platelet concentration, leukocyte content, and volume delivered. Ensure you’re using a validated system with reproducible output.
- Combine with rehab: Whether pre- or post-surgical, outcomes are superior when PRP is paired with a structured physiotherapy program.
- Monitor with imaging: MRI or ultrasound can help assess synovitis and cartilage health before and after PRP therapy.
- Patient selection is key: Younger patients with early-stage disease and minimal cartilage loss benefit the most.
📈 Future Directions
Emerging orthobiologics such as bone marrow aspirate concentrate (BMAC) or adipose-derived MSCs are also under investigation for joint preservation in FAI, particularly in cases with more advanced cartilage damage. These may offer regenerative potential beyond the anti-inflammatory and anabolic effects of PRP.
Combination therapy (e.g., PRP + HA, or PRP + MSCs) may become more common in personalised protocols.
✅ Conclusion: A New Era in Hip Preservation?
FAI is more than a mechanical problem—it’s a bio-mechanical and inflammatory disorder. While surgery remains the cornerstone for anatomical correction, orthobiologic adjuncts like PRP can help slow disease progression, promote healing, and improve outcomes.
For many patients, particularly younger active individuals, integrating PRP early in the disease course may offer a chance to preserve the native joint for longer—and in surgical cases, enhance recovery and joint health post-operatively.
📚 References
- Agricola, R. et al. (2013). What is femoroacetabular impingement? BJSM, 47(10), 661–664. https://doi.org/10.1136/bjsports-2012-091185
- Beck, M. et al. (2005). The role of osteoplasty in FAI. Clinical Orthopaedics, 417, 73–79.
- Abbas, M. J. et al. (2023). PRP injections in FAI: A systematic review. OJSM, 11(4).
- Domb, B. G. et al. (2016). Conservative vs operative treatment of FAI: A matched-pair study. AJSM, 44(3), 496–506.
- Mardones, R. et al. (2022). Intra-articular PRP after hip arthroscopy: A double-blind RCT. Journal of Hip Preservation Surgery, 9(1), 31–38.