Sarah Moummi was a high school freshman on the soccer team when she thought she had torn something in her hip. For Sara Shaner—a former collegiate swimmer who still runs and works out every day—her first indication that something was wrong was when she was only 25 and felt sore and stiff after sitting at work all day in her job as a forensics accountant.
For both young women, the hip discomfort would come and go, a dull ache here, a sharp stab there. But their pain got more intense and persistent as time went by.
That’s the nature of femoroacetabular impingement, or FAI, says William F. Postma, MD, chief of sports medicine at MedStar Georgetown University Hospital’s Department of Orthopaedic Surgery. Especially if you’re active.
“FAI starts off slowly and, in many cases, doesn’t ever cause any significant problems,” says the expert in hip and knee reconstructions, “but in high level athletes, from teenagers to folks in their 40s, it can deteriorate quickly, causing pain and stiffness in the groin and front of the hip.”
The condition is caused by an abnormality in one or both of the major bones in the hip: the neck of the thigh bone (femur) or the socket itself (acetabulum). The two are meant to fit tightly yet smoothly together, lubricated by the synovial fluid within the joint. But with FAI, either bony bumps form on top of the femur, rubbing unnaturally against the socket, or the socket itself is too deep for a smooth fit, with the femur wearing away part of the thick band of cartilage (labrum), which holds the two bones together.
Up to 75 percent of patients have both forms of FAI, often affecting both hips. For symptomatic patients, the first line of offense is typically the most conservative, often involving physical therapy. But if that doesn’t help, surgery’s the answer.
Sara Shaner followed that track, starting with aggressive physical therapy at the MedStar Health Orthopaedic and Sports Center at Lafayette Centre.
“The PT team there was great…very experienced and supportive,” says the DC resident who went to them off and on for a couple of years. “But we reached the point where PT wasn't helping anymore. I asked them for a referral, and they sent me to Dr. Postma.”
After an MRI, Shaner was diagnosed with both forms of FAI on both sides, along with a labral tear. She underwent arthroscopic surgery on her left hip, the worse of the two, in March 2019, followed by the right hip that August.
While it’s a same-day procedure, recovery is a fairly lengthy process, invariably taking six months of phased-in activity for the patient to return to their pre-injury capabilities.
“I thought maybe I’d beat the clock, since I was otherwise young, healthy and in good shape,” Shaner admits. “But nope. It took the full amount of time to get back to where everything felt right. And now I can sit, run, and be as active as I like without giving a thought to my hips. I feel great.”
Likewise, Sarah Moummi also started with physical therapy, with similar results. As her pain worsened, however, the onus of finding the right orthopaedic surgeon for the 17-year-old fell on her mother, Siham.
“I went online to look for the best doctor out there,” she says. “And Dr. Postma’s name kept coming up, with phenomenal reviews! I especially liked what I saw about his experience with this type of surgery.”
On Oct. 9, 2019, Moummi had the first of her two hip arthroscopies, with the second occurring on Dec. 20.
Physicians don’t totally understand the underlying cause of FAI, but suspect a combination of genetics and overuse, particularly in sports that require repetitive movement of the hip. What they do know, however, is that the condition can be a precursor to early-onset osteoarthritis, often leading to a future hip replacement if not treated early on.
“Hip arthroscopy can be very successful for FAI, lasting for a long time and returning patients to their former quality of life,” notes Dr. Postma. “That said, there’s a steep learning curve with this procedure. To get the best results, you really need an experienced orthopaedic surgeon who specializes
Moummi’s mother, Siham, wholeheartedly agrees.
“Dr. Postma has just been amazing with his knowledge and compassion,” she says. “He’s truly one of the best doctors I’ve ever encountered.”
Adds Moummi, “If you have borderline pain from FAI and are active, get it taken care of sooner versus later. I was being stubborn and didn’t want to stop playing soccer or running, so I postponed the surgery. But now I’m so thankful I had it. I’m not in any pain anymore, and that’s huge!”
For more information or to schedule an appointment, call 888-906-7361.
“FAI starts off slowly and, in many cases, doesn’t ever cause any significant problems. But in high level athletes, from teenagers to folks in their 40s, it can deteriorate quickly, causing pain and stiffness in the groin and front of the hip.”
—WILLIAM F. POSTMA, MD