Understanding Hip Impingement

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The hip is a ball-and-socket joint, where the femur (ball) fits into the cup-like acetabulum (socket). Both surfaces are lined with a slippery tissue — the articular cartilage — which enables the bones to rotate easily. A strong fibrocartilage, called the labrum, rings the joint and provides stability.

Hip Impingement or "FAI"

Femoroacetabular Impingement or FAI results from an orientation, shape or overgrowth on the femoral head (ball) within the acetabulum (socket) that prevents a full range of motion.

The impingement often causes damage to the joint, such as tearing of the labrum likely to result in joint instability and breakdown of articular cartilage (osteoarthritis), causing pain and restricting movement.

  • Types of FAI

    Pincer Impingement.

    Extra bone extending out over the normal rim of the acetabulum can crush the labrum.

    Cam Impingement.

    If the femoral head is not perfectly shaped for the acetabulum, it won’t rotate smoothly. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum.

    Combined.

    When both pincer and cam impingement are present, it’s called combined impingement.

     

  • Symptoms

    Some people live long, active lives with FAI and never have problems. When symptoms develop, however, it usually indicates damage to the cartilage or labrum — and that the disease is likely to progress. Typical symptoms include one or more of the following:

    • Pain in the groin area.
    • Pain toward the outside of the hip.
    • Sharp stabbing pain (or dull ache) with turning, twisting or squatting.

    When symptoms first occur, try to identify the activity you may have done to cause the pain — and avoid it for a while. Let your hip rest and see if the pain settles down. Over-the-counter anti-inflammatory medicines (ibuprofen, naproxen) may help, too.

    If your symptoms persist, it’s important that you don’t just keep pushing through the pain. The longer painful symptoms go untreated, the more damage FAI can cause. Instead, seek medical advice for a proper diagnosis —
    and recommended solutions.


  • Treatment Options

     

    A proper diagnosis helps determine the best course of action. On the initial visit, the provider will likely do a simple impingement test — bringing your knee towards your chest and rotating it. Further diagnostic tests may also be needed. These may include X-rays, CT or MRI scans or injection of a temporary numbing agent.

    Depending on the type and severity of the impingement identified, your provider may recommend one or more of the following treatments, typically starting with the most conservative approach.

    Activity changes.

    Simply changing your daily routine and avoiding activities that cause symptoms may be all you need.

    Non-steroidal anti-inflammatory medications

    Drugs like ibuprofen can be provided in a prescription-strength form to help reduce pain and inflammation.

    Physical therapy.

    Specific exercises can improve range of motion and strengthen muscles around the hip. While this can relieve stress on injured areas and offer relief from other causes of hip pain, it
    may not be effective for FAI.

    FAI Surgery.

    If tests indicate joint damage caused by FAI, and your pain is not relieved by nonsurgical treatment, surgery may be recommended.

     

  • Surgical Treatment

     

    Many FAI problems can be treated with arthroscopic surgery — with just a few small incisions — to repair damage to the labrum and articular cartilage and to remove the excess bony material from a cam or pincer lesion. More severe cases may require an open operation (larger incisions) or even total hip replacement.

    Correcting the impingement through surgery can prevent future damage to the hip joint. However, not all damage can be completely fixed by surgery, especially if treatment has been delayed and the damage is severe. It is also possible that more problems could develop in the future. Be sure to talk to your orthopedic surgeon about the risks and benefits for your particular situation.

    OPA always recommend starting conservatively, but surgical treatment is often the most effective method of long-term pain relief — and hip perseveration.

     

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FAI Specialists

OPA’s FAI specialists are board-certified orthopedic surgeons who also practice sports medicine and have a keen interest in helping athletes and anyone wanting to return to an active lifestyle. 


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