Hip Impingement

Causes

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There are two types of hip impingement:

• Cam impingement: A deformity of the ball at the top of the femur, which causes the femoral head to be jammed into the acetabulum. This can occur during activities such as bike riding or tying your shoes. It pulls or tears the labrum.
• Pincer impingement: A deformity of the socket, which results in frequent contact between the femoral head and the labrum during normal hip flexing movement. Eventually, the labrum tears and causes pain.

There can be a problem with both the ball and the socket, as well.

These problems also can cause hip impingement:

• Coxa vara: This is a rare condition in which a child’s thighbone and femoral head do not grow at the same pace, which results in a deformed hip joint.
• Legg-Calve-Perthes disease: The hip joint receives inadequate blood supply and the bone dies.
• Slipped capital femoral epiphysis: This occurs in children when the femoral head separates from the thighbone at the upper end (growth plate). It is more common when a child is obese.

Symptoms

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Although you can develop FAI at any time between your teen years and middle age, it occurs most often in young athletes, typically after they suffer minor trauma. It is possible to have hip impingement for years without knowing it, because it doesn’t always cause pain in the early stages. At first, you might experience periodic pain in the front of your hip or your groin. If you overburden your hip by exercising or sitting for long periods, your pain could grow worse. Other symptoms can include:

• Trouble walking uphill
• Pain after sitting for a long time
• Pain after exercise or sports
• Pain in the groin, particularly when walking or flexing the hip
• Decreased range of motion
• A chronic dull ache
• A catching or popping sensation

Diagnosis

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Your surgeon at one of our centers in Bergen County, NJ, or Stony Point, NY, will begin by examining your hip, looking for signs of limited range of motion. You also will undergo X-ray and MRI testing. An X-ray can show any excess bone on the acetabular rim, femoral head or femoral neck. An MRI can identify labrum and cartilage tears. Your specialist also may order a CT scan to help determine whether you require surgery.

Treatment

Life’s too short to put up with pain.

We will explore nonsurgical treatments first, including:

• Rest
• Activity modification
• Exercise to strengthen the muscles that support the hip
• Anti-inflammatory and pain medications

If these treatments are not effective, your surgeon may recommend hip impingement surgery. FAI is treated using hip arthroscopy, a minimally invasive procedure in which a lighted scope and thin tools are inserted through small incisions over your hip. Or your situation may require a more invasive surgical procedure.

The type of surgery depends on the cause of hip impingement and the amount of cartilage damage. However, the goal of both approaches is pain relief and hip preservation, which involves repairing damage to preserve the natural hip structures.

During hip arthroscopy, your torn labrum is repaired and the prominent part of the bony malformation of your hip may be decompressed. Femoral acetabular osteoplasty is a more invasive procedure that is done to remove the prominent bony area from the femoral neck. Both procedures restore femoral neck clearance and restore free range of motion in your hip.

Those who are too young for total hip replacement surgery and those with arthritis that hasn’t advanced are good candidates for surgical treatment. However, every patient is unique. You and your surgeon will determine the course of treatment that is best for you. Early diagnosis and surgery improve your chances of a full recovery. However, even surgery performed later can lessen pain and improve range of motion.