Editorial Commentary: Timely Treatment of Femoroacetabular Impingement Syndrome Both Treats Ongoing Hip Symptoms and Mitigates Future Cartilage Damage and Osteoarthritis

Patients with femoroacetabular impingement syndrome (FAIS) present with ongoing symptoms in a painful hip. Insightful patients or family members often express concern about similar pathology, and associated risk of arthritis, in their less or asymptomatic hip, and recent research shows that patients with increased alpha angles are associated with more advanced cartilage damage, particularly in males. The ultimate question, for surgeons and patients, is: Can we predict chondral pathology based on preoperative variables alone, and should we intervene prior to symptoms? Yet, FAIS is multifactorial, not simply anatomic, and cam-type FAI can have a high prevalence in asymptomatic hips in some populations. Thus, today, prophylactic hip preservation surgery cannot be generally recommended, but in the future, an individualized treatment algorithm may result in precise prediction of which patients might benefit from earliest intervention to help reduce the incidence of premature hip osteoarthritis. In the interim, when timely intervention is in the best interest of the patient, insurance denials that delay indicated surgery must not be tolerated. One of the most rewarding and unique aspects of managing FAIS is that we have the opportunity to both treat ongoing hip symptoms and mitigate future pathology, sometimes even in the contralateral hip.