General Guideline Principles for Femoracetabular Impingement

“Hip Impingement” or Labral Tears for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Femoracetabular Impingement, “Hip Impingement” or Labral Tears.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Introduction of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Diagnostic Criteria for Non-Red Flag Conditions

The evaluation criteria for femoroacetabular impingement or labral tears are summarised in the section that follows.

An overview of the clinical criteria for evaluating femoroacetabular impingement or labral tears is provided below.

Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Introduction of Femoracetabular Impingement, “Hip Impingement” or Labral Tears
The evaluation criteria for femoroacetabular impingement or labral tears are summarised here.

Diagnostic Studies of Femoracetabular Impingement, “Hip Impingement” or Labral Tears for workers compensation patients

  1. MR Arthrogram

    MR Arthrogram is recommended for identifying labral tears or femoroacetabular impingement in individuals with subacute or persistent hip discomfort. Patients with symptoms of subacute or chronic hip pain or those who have a clinical suspicion of femoroacetabular impingement, labral tears, or other issues with the hip joint. Frequency, dose, and duration: Typically, only one arthrogram is required.

    Rationale: MRA is useful in assessing and confirming labral tears or femoroacetabular impingement. Compared to other imaging techniques, enhanced MR arthrogram is advised for diagnosing femoroacetabular impingement since it allows for better labral examination.


  2. MRI

    MRI of Femoracetabular Impingement, “Hip Impingement” or Labral Tear is recommended When there is diagnostic ambiguity regarding the cause of certain patients’ subacute or chronic lateral hip pain, in order to aid in accurate diagnosis.


  3. Ultrasound

    Ultrasound of Femoracetabular Impingement, “Hip Impingement” or Labral Tears is recommended for diagnosing individuals with labral tears or femoroacetabular impingement.

    Indications: Patients whose hip pain is assumed to be caused by labral tears or impingement. Although arthrogram and MRI are typically the primary diagnostic procedures, ultrasonography can be useful in certain situations.

    Frequency/Dose/Duration: Usually just once. The use of ultrasound is advised in order to assess and confirm labral tears or femoroacetabular impingement.

Medications of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are recommended for the treatment of femoroacetabular impingement and labral tears

    Indications –NSAIDs are advised as a treatment for femoroacetabular impingement and labral tears. First, try over-the-counter (OTC) medications to see whether they work.

    Frequency/Duration – Use as necessary may be appropriate for numerous patients

    Indications for Discontinuation – Resolution of femoroacetabular impingement and labral tears, ineffectiveness, or emergence of side effects requiring termination.


  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are used concurrently by individuals who are at high risk of gastrointestinal bleeding.

    Indications – Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.


  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended The first-line treatment options of acetaminophen or aspirin seem to be the safest in terms of cardiovascular side effects. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

    To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.


  4. Acetaminophen for Treatment of Femoroacetabular Impingement or Labral Tears

    Acetaminophen for Treatment of Femoroacetabular Impingement or Labral Tears are recommended for the treatment of femoroacetabular impingement and labral tears, especially in patients who are contraindicated for NSAIDs.

    Indications – All patients, including acute, subacute, chronic, and post-operative ones, who have femoroacetabular impingement pain or labral tears.

    Dose/Frequency – As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

    Indications for Discontinuation – pain, side effects, or intolerance are gone.

    Rationale for Recommendations – Generic ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. One of the other generic drugs should be used as a second-line treatment.

    Although the majority of the research indicates that acetaminophen is only slightly less effective for those with arthrosis, it may still be a viable solution for these patients. There is proof that NSAIDs are less impairing and just as effective at treating pain as opioids (including tramadol).


  5. Opioids of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

    Opioids of Femoracetabular Impingement, “Hip Impingement” or Labral Tears is recommended for patients with femoroacetabular impingement or labral tears for the short term (less than a week).

    Rationale for Recommendations – Opioids have serious side effects, including poor tolerance, constipation, sleepiness, impaired judgement, memory loss, and the potential for overuse or dependency, which has been observed in up to 35% of patients.

    Patients should be warned against using machinery or motor vehicles and aware of these possible side effects prior to receiving an opioid prescription. Opioids should only be used in cases of extreme pain because they don’t seem to be any more efficient than less dangerous analgesics at treating the majority of musculoskeletal symptoms.

    Recommended – for select treatment of patients with postoperative femoroacetabular impingement or labral tears.

    Indications – An opioid should be used for a brief period of time—a few days to no more than one week—to treat post-operative femoroacetabular impingement or labral tears. Following surgery, a small nocturnal dose of opioids may be beneficial.

    Prior to using opioids, the majority of patients should try NSAIDs and acetaminophen for pain relief. It is advised to stop using opioids as soon as possible.

    Frequency/Dose/Duration – Typically, patients only need a few days to a week’s worth of treatment.

    Indications for Discontinuation – Resolution of the pain, adequate pain management with other medications, ineffectiveness, or the emergence of side effects necessitating termination.

Treatments of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Rehabilitation Programs

Rehabilitation (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To aid functional improvements, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

Therapeutic Exercise – Physical or Occupational Therapy

Therapeutic Exercise – Physical or Occupational Therapy is recommended for labral tears or femoroacetabular impingement, especially postoperatively, as well as to make up for any strength deficiencies.

Frequency/Dose/Duration –With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward particular objective functional goals (such as increasing range of motion or improving capacity to conduct work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.

A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Indications for Discontinuation – reduced pain and improved function following surgery, intolerance, ineffectiveness, or non-compliance.

Injection Therapy of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Local Glucocorticosteroid Injections

Local Glucocorticosteroid Injections are recommended for the treatment of labral tears or hip impingement in a subset of individuals.

Indications: NSAIDs and activity restriction are typically not effective over a few weeks of treatment for hip impingement or labral tears.

Frequency/Dose/Duration: Typically, just one injection is made. If there is incomplete improvement (improved function and decreased discomfort), a second injection might be suggested.

Surgery of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

  1. Arthroscopy

    Arthroscopy is recommended for patients who failed conservative therapy and are believed to respond best to arthroscopy, to diagnose and treat patients with hip pain if there is a suspicion of labral tear, intraarticular body, femoracetabular impingement, or there are other subacute or chronic mechanical symptoms.

    Indications: Patients with hip discomfort who may also have subacute or long-term mechanical symptoms, such as an intraarticular body, femoroacetabular impingement, or a labral tear.

    Rationale: Hip arthroscopy is increasingly used to treat a variety of hip conditions, particularly those with mechanical symptoms. Foreign body removal and symptomatic labral tears have both been reported to be successfully treated. Another potential indication is femoroacetabular impingement.


  2. Surgical Repair

    Surgical Repair is recommended for cases of hip impingement or labral tears that don’t respond well to conservative treatment and either don’t respond well to arthroscopic repair or are thought to respond best to an open approach.

    Indications/Rationale: Patients with hip pain who may have a labral tear, an intraarticular body, a femoroacetabular impingement, or other mechanical symptoms are likely to respond well to an open treatment strategy.

Other of Femoracetabular Impingement, “Hip Impingement” or Labral Tears

Walking Aid: Cane / Crutches / Walker

Walking Aid: Cane / Crutches / Walker is recommended for a restricted group of patients with labral tears or moderate to severe femoroacetabular impingement.

Indications: Labral tears or disabling, moderate to severe femoroacetabular impingement may be treated when the benefits of increased mobility outweigh the hazards of advancing senility.

Indications for Discontinuation: Resolution (e.g., post-operative recovery).

Rationale: Crutches and canes may be beneficial for acute injuries during the recuperation and/or rehabilitation phase to improve functional status (e.g., from wheelchair to walker to cane). Crutches may paradoxically exacerbate disability through debility in cases of chronic hip pain.

In those situations, the establishment or upkeep of recommendations for the use of crutches or canes should be carefully weighed against potential dangers.

What our office can do if you have workers compensation Femoracetabular Impingement, “Hip Impingement” or Labral Tears

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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15:02 02 Mar 23
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21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
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20:20 19 Feb 23
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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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19:01 25 Oct 22
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21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
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17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
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19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
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I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
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03:25 09 Apr 22
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Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
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14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
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18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
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17:26 17 Nov 20
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Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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