Bilateral femoroacetabular impingement: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Bilateral femoroacetabular impingement Introduction (What it is)

Bilateral femoroacetabular impingement is a hip condition where both hip joints have abnormal contact during movement.
It happens when the ball-and-socket parts of the hip do not fit or glide together smoothly.
This can contribute to hip or groin pain, stiffness, and reduced range of motion.
The term is commonly used in orthopedics, sports medicine, and physical therapy when evaluating hip pain in active and non-active people.

Why Bilateral femoroacetabular impingement used (Purpose / benefits)

Bilateral femoroacetabular impingement is not a device or a single treatment. It is a clinical diagnosis that helps clinicians describe a specific pattern of hip joint mechanics and related symptoms in both hips.

The purpose of identifying Bilateral femoroacetabular impingement is to:

Explain symptoms with a hip-joint–based mechanism. Many people report groin pain, pain with bending, or deep hip discomfort that can be difficult to localize. Naming the pattern can help structure the evaluation.
Guide appropriate testing and imaging. When clinicians suspect femoroacetabular impingement (FAI), they often focus the exam on hip range of motion, provocation tests, and imaging that shows bone shape and joint health.
Support care planning and communication. The diagnosis helps align discussions among clinicians (orthopedics, radiology, physical therapy) and patients using consistent terms.
Clarify why both sides may matter. Symptoms can be worse on one side, but mechanics, bone shape, or movement patterns may involve both hips, which can influence rehabilitation planning and return-to-activity decisions.
Frame risk to joint structures. In some cases, repeated abnormal contact is discussed as a possible contributor to labral or cartilage injury. Whether and how much this matters varies by clinician and case.

In plain terms: the “benefit” of the label is that it organizes the problem—what is likely being pinched or overloaded in the hip—and helps clinicians decide what to evaluate next.

Indications (When orthopedic clinicians use it)

Orthopedic and sports medicine clinicians may consider Bilateral femoroacetabular impingement in scenarios such as:

Hip or groin pain reproduced by hip flexion (bending), twisting, or squatting movements
Reduced hip internal rotation or general stiffness, often noticed during sports or daily activities
Pain with prolonged sitting, getting in/out of a car, or climbing stairs (varies by person)
Mechanical symptoms such as catching, clicking, or a sense of “pinching” in the front of the hip (not specific to FAI)
Imaging or prior reports suggesting FAI-related bone morphology on both sides
Athletes or active individuals with hip pain during cutting, pivoting, skating, or deep flexion positions
Persistent hip symptoms after an initial period of rest or activity modification, prompting more structured evaluation

Contraindications / when it’s NOT ideal

Bilateral femoroacetabular impingement is a diagnosis, so it is not “contraindicated” the way a medication is. However, applying the label—or focusing treatment primarily around FAI—may be less helpful when other problems better explain the symptoms or when different approaches are typically prioritized.

Situations where another explanation or approach may be more appropriate include:

Clear signs that pain is coming from outside the hip joint (for example, certain spine-related patterns), depending on clinician assessment
Primary pain located at the outer hip consistent with some tendon or bursa-related conditions (diagnosis varies by clinician and case)
Acute fracture, infection, inflammatory arthritis flare, or other urgent causes of hip pain (these require different clinical pathways)
Advanced hip osteoarthritis on imaging, where joint degeneration may be the dominant issue and impingement correction may be less central
Symptoms that do not correlate with hip motion or do not reproduce on exam maneuvers typically used for hip joint provocation
Incidental imaging findings: FAI-type bone shapes can be seen in people without symptoms, so imaging alone is not enough to confirm clinical relevance

How it works (Mechanism / physiology)

At a high level, femoroacetabular impingement describes abnormal contact between the top of the thigh bone (femur) and the hip socket (acetabulum), especially during hip flexion, rotation, or combined motions.

Core biomechanical principle

The hip is a ball-and-socket joint designed to move smoothly with a large range of motion.
In FAI, the shape of the femoral head/neck region, the acetabular rim, or both can reduce clearance during movement.
When clearance is reduced, the bones can contact earlier than expected, which may increase stress on nearby soft tissues.

Relevant anatomy and tissues

Key structures often discussed in relation to Bilateral femoroacetabular impingement include:

Femoral head and neck: The “ball” and its transition zone. Subtle shape changes here can matter during rotation and flexion.
Acetabulum (hip socket): The “cup” portion of the pelvis. Socket orientation and rim coverage influence joint mechanics.
Labrum: A ring of cartilage around the socket that helps with stability and joint sealing. Labral changes can be associated with hip pain, though symptoms vary widely.
Articular cartilage: The smooth lining on the ball and socket. Cartilage health is often assessed because it relates to joint longevity.
Capsule and surrounding muscles: Hip flexors, deep rotators, gluteal muscles, and the capsule may contribute to symptoms, compensation patterns, and functional limitations.

Bilateral considerations

“Bilateral” means both hips are involved. This can mean:

Similar bone morphology on both sides, with symptoms on one or both sides
Asymmetry: one hip may be more symptomatic despite similar imaging
Movement and load-sharing changes where one painful hip alters how the other hip is used

Onset, duration, and reversibility

Bilateral femoroacetabular impingement is generally discussed as a structural/mechanical issue (bone shape and joint mechanics). Bone morphology itself does not rapidly “reverse.” Symptoms, function, and movement tolerance may change over time depending on many factors, including activity demands, hip conditioning, coexisting labral or cartilage findings, and overall health. The course varies by clinician and case.

Bilateral femoroacetabular impingement Procedure overview (How it’s applied)

Bilateral femoroacetabular impingement is not a single procedure. It is a diagnosis used to guide evaluation and, when appropriate, a range of non-surgical and surgical management options. A typical high-level workflow may look like this:

Evaluation / history – Symptom location (groin, front of hip, side of hip, buttock) – Triggers (squatting, sitting, running, pivoting) – Functional impact (sports, work, sleep, daily activities) – Prior injuries, prior hip problems, and overall health context
Physical exam – Hip range of motion (especially flexion and internal rotation) – Provocation maneuvers that load the hip joint in positions that may reproduce symptoms – Gait, pelvic control, and basic strength assessment (varies by clinician)
Preparation for testing (if needed) – Selection of imaging based on symptoms and exam findings
– Discussion that imaging findings must be interpreted alongside symptoms and function
Intervention / testing – Imaging: Often begins with X-rays to assess bone shape and joint space; MRI (sometimes MRI arthrogram) may be used to evaluate labrum and cartilage; CT may be used for detailed bony anatomy in select cases. – Diagnostic injection (in some cases): A clinician may use an injection to help determine whether pain is coming from inside the joint versus surrounding tissues. Use varies by clinician and case.
Immediate checks – Correlate imaging with symptoms and exam findings – Identify whether one or both hips are clinically relevant – Screen for other contributors (spine, pelvic mechanics, tendon conditions), depending on the presentation
Follow-up planning – Non-surgical management may be considered first for many patients (education, activity modification concepts, and structured rehabilitation approaches) – If symptoms persist and imaging supports clinically significant impingement with treatable structural findings, surgical consultation may be discussed (commonly hip arthroscopy in selected cases) – Ongoing reassessment focuses on function, symptom behavior, and activity tolerance rather than imaging alone

Types / variations

Bilateral femoroacetabular impingement typically refers to FAI morphology and mechanics present in both hips. Common variations include:

Cam type FAI
The femoral head-neck junction is less spherical, which can reduce clearance during hip flexion and rotation.
Often discussed in relation to higher-demand hip motion, though it can occur in many populations.
Pincer type FAI
The acetabulum may provide more coverage or have an orientation that leads to earlier contact at the rim in certain positions.
Clinicians may discuss focal versus global overcoverage depending on imaging patterns.
Mixed type
Features of both cam and pincer are present, which is common in clinical practice discussions.
Symptomatic vs asymptomatic morphology
Some people have FAI-type bone shapes on imaging without pain or limitation.
“Bilateral” may describe imaging findings even when only one hip is symptomatic.
FAI with associated findings
Labral changes/tears: Often reported on MRI; clinical relevance varies.
Cartilage wear: May range from minimal changes to more established degeneration.
Capsular laxity or instability features: Not the same as impingement, but may influence symptoms and surgical decision-making in certain cases.

Pros and cons

Pros:

Helps explain a pattern of hip pain linked to motion and joint mechanics
Provides a common language for patients, therapists, radiologists, and surgeons
Guides targeted physical exam and imaging choices
Encourages side-to-side assessment when both hips may be involved
Supports structured decision-making about non-surgical versus surgical pathways
Can clarify why certain movements predictably provoke symptoms

Cons:

Imaging findings can be present without symptoms, so the label can be overapplied if not correlated clinically
The diagnosis may not fully explain pain when multiple conditions coexist (spine, tendons, pelvic floor, sports hernia-type conditions, etc.)
“Bilateral” can sound more severe than it is; symptom impact may still be mild or one-sided
The term may lead some people to focus on bone shape rather than modifiable contributors like strength, movement strategy, and activity dose (interpretation varies)
Management options and expected recovery timelines vary widely by clinician and case
Some patients may have persistent symptoms despite appropriate evaluation and treatment, particularly when cartilage degeneration is significant

Aftercare & longevity

Because Bilateral femoroacetabular impingement is a condition rather than a single intervention, “aftercare” depends on what management path is used (monitoring, rehabilitation-focused care, injections, or surgery). In general, factors that commonly affect outcomes and durability of improvement include:

Severity and location of symptoms: Pain intensity, frequency, and functional limits can influence how quickly someone progresses through rehabilitation.
Hip morphology and joint health: The combination of bone shape, labral condition, and cartilage status is often discussed when considering prognosis. The relevance of each factor varies by clinician and case.
Movement demands and activity exposure: Sports with deep hip flexion and rotation may be harder to tolerate during symptom flares.
Rehabilitation consistency and follow-up: Outcomes often depend on gradually rebuilding hip strength, control, and tolerance to specific tasks, with periodic reassessment.
Coexisting conditions: Low back pain, core or pelvic issues, tendon problems, and generalized joint hypermobility can influence symptom persistence and return to activity.
If surgery is performed: Longevity can be influenced by the specific findings addressed (bone reshaping, labral repair vs debridement, cartilage status), adherence to post-operative restrictions, and rehab progression. Exact protocols vary by surgeon and case.
Lifestyle and general health factors: Sleep, overall conditioning, and body weight can influence joint load and recovery capacity, but effects differ between individuals.

Alternatives / comparisons

Bilateral femoroacetabular impingement is part of a broader differential diagnosis for hip pain. Alternatives are not “competitors” so much as other reasonable pathways or explanations that may fit a person’s symptoms.

Common comparisons include:

Observation / monitoring vs active rehabilitation
Monitoring may be reasonable when symptoms are mild or intermittent.
Active rehabilitation is often used when symptoms affect function, focusing on strength, mobility, and activity tolerance. Exact exercise selection varies by clinician and case.
Medication-based symptom control vs addressing mechanics
Anti-inflammatory or analgesic medications may be used for symptom relief in some patients, typically as part of a broader plan. Whether they are appropriate depends on individual health factors.
Mechanical contributors (hip motion patterns, strength, activity dose) are often addressed through physical therapy approaches.
Injection approaches vs rehabilitation
Injections can be used diagnostically (to localize pain source) or therapeutically (to reduce inflammation/pain for a period). Type and expected duration vary by medication and case.
Rehabilitation aims to improve capacity and movement tolerance, which may have longer-term functional benefits for some patients.
Hip arthroscopy vs non-surgical management
Arthroscopy may be considered when there is a strong correlation among symptoms, exam findings, and imaging, and when non-surgical management does not provide adequate improvement.
Non-surgical pathways may be preferred initially in many cases, especially when symptoms are manageable or when joint degeneration is more advanced.
Imaging options (X-ray vs MRI vs CT)
X-ray is commonly used to assess bony morphology and joint space.
MRI evaluates soft tissues such as labrum and cartilage; interpretation is clinical-context dependent.
CT provides detailed bone anatomy and may be used selectively, including preoperative planning in some settings.

Bilateral femoroacetabular impingement Common questions (FAQ)

Q: Does bilateral mean both hips will hurt the same way?
Not necessarily. “Bilateral” means both hips show a pattern consistent with impingement mechanics or morphology, but symptoms can be one-sided or different side to side. Pain depends on activity, tissue sensitivity, and any associated labral or cartilage findings. Clinicians typically correlate imaging with symptoms and exam findings.

Q: Where is the pain usually felt with femoroacetabular impingement?
Many people describe pain in the groin or front of the hip, especially with bending or twisting. Others notice side or buttock discomfort, which can overlap with different diagnoses. Pain location alone is not specific, so clinicians use history plus exam maneuvers and imaging when needed.

Q: Can Bilateral femoroacetabular impingement cause clicking or catching?
It can be associated with mechanical sensations such as clicking, catching, or a “pinching” feeling, particularly in flexed positions. These symptoms are not exclusive to FAI and can occur with tendon movement, labral changes, or other hip issues. Clinical evaluation helps interpret what the sensation may represent.

Q: How is it diagnosed?
Diagnosis typically combines symptom history, a targeted physical exam, and imaging. X-rays are commonly used to evaluate hip shape and joint space, while MRI may be used to look at the labrum and cartilage. Many clinicians emphasize that imaging findings must match the clinical picture to be meaningful.

Q: What treatments are commonly considered?
Management often starts with non-surgical options such as activity modification concepts and structured rehabilitation to improve hip strength and movement tolerance. Some cases include diagnostic or therapeutic injections. Surgical options (often arthroscopy) may be discussed when symptoms persist and findings suggest a treatable structural cause; suitability varies by clinician and case.

Q: How long do results last if symptoms improve?
Duration varies by person, activity demands, and joint health. Some people do well long term with rehabilitation and pacing strategies, while others may have recurrent symptoms with certain activities. If surgery is performed, durability depends on multiple factors such as cartilage status and adherence to rehabilitation, and varies by clinician and case.

Q: Is it safe to keep exercising with this condition?
Safety and appropriate activity level depend on symptom behavior, joint status, and the specific activities involved. Many people remain active by adjusting intensity, range, or movement selection, but what is appropriate is individualized. A clinician can help interpret which patterns suggest excessive joint irritation versus tolerable training load.

Q: What is the cost range for evaluation and treatment?
Costs vary widely by region, insurance coverage, imaging choices, and whether care involves physical therapy, injections, or surgery. Out-of-pocket expenses can differ substantially between clinics and hospital systems. Asking for an itemized estimate is commonly helpful when planning.

Q: Will I need surgery if it’s bilateral?
Not automatically. Bilateral findings do not guarantee that both hips need treatment, or that surgery is necessary at all. Decisions typically depend on symptom severity, functional limitation, response to non-surgical care, and imaging findings such as cartilage condition; recommendations vary by clinician and case.