Hip Impingement

What Is Hip Impingement?

Femoroacetabular impingement (FAI) is a jamming of the two joint partners, the femoral head (thigh bone) and the acetabulum (hip joint socket) of the hip joint.

In the more frequently athletically active male patients under 40 and women under 50, dull, diffuse groin pain and thigh and buttock pain usually occur. These begin gradually after athletic exertion (soccer, tennis, jogging) and occur more intensely while sitting and during specific movements.

Symptoms are also often exacerbated by trauma to the hip area, and FAI is not diagnosed until then. On average, patients consult about four specialists, and several years pass before a final diagnosis of FAI is made. Due to uneven wear of the articular cartilage, patients with hip impingement develop osteoarthritis of the hip joint at an earlier age.

Causes and Symptoms

"Excess" of bone tissue at the corresponding joint partners of the hip joint, which usually forms during growth, causes FAI. There are two types:

• Cam impingement increases bone material at the junction from the femoral neck to the femoral head.
• Pincer impingement, with an acetabulum too large for the femoral head.

Mixed forms, in which the femoral head and the acetabulum are increasingly formed, also occur.

In all cases, with increasing age and load duration, there is uneven wear of the articular cartilage and stress on the accompanying joint structures, such as ligaments and labrum.

"Stop-and-go" sports, such as soccer or tennis, therefore lead to increased joint stress and pain in the groin, buttock/hip area, and thigh. Sitting, especially with crossed legs and specific rotational movements, usually triggers typical symptoms, as the corresponding parts of the joint are mechanically irritated.

Treatment for Hip Impingement: Is Surgery an Option?

Once femoroacetabular impingement (FAI) has been diagnosed, the question arises as to the treatment strategy: conservative, with physiotherapy or surgery. Likewise, anti-inflammatory medications may be prescribed by a physician to relieve pain. Due to the anatomical conditions, it must be said that a causal treatment, i.e., removal of the excess bone tissue to solve the entrapment conflict, can only be done surgically. However, studies have shown that milder forms of FAI can also be treated well with physiotherapy. The rule of thumb for this is a therapy period of 6-12 weeks, in which there should be a significant improvement in pain; otherwise, surgery is advised.

Hip Impingement Surgery

Surgical Methods, Procedure, and Aftercare

Two main surgical methods are performed to treat femoroacetabular impingement as a surgical solution.

The conventional method is surgical hip dislocation. In this procedure, the surgeon opens the affected hip joint to have a clear view of or into the joint, which is then dislocated to remove the annoying bone tissue with surgical tools. The advantage of this method is the long experience and the excellent view of the surgeon into the surgical area. Disadvantages are the large skin incision with the corresponding injury to surrounding muscles, tendons, and connective tissue and an increased risk of infection.

Hip arthroscopy is used as a modern method. Hip joint impingement is now one of the most common diagnoses for hip joint arthroscopy. With traction on the affected joint, the surgical tool is inserted through three small incisions in the skin, and the surgeon can see the joint on a screen through an endoscope. The advantage is relatively minor soft tissue damage with small scars and a correspondingly lower risk of infection. Since this surgery is technically more challenging to perform, it should be performed by a doctor with a lot of experience in arthroscopic hip surgery. Unfortunately, there is still little data on long-term success, but the results to date are very promising.

In the aftercare of hip impingement surgery, surgeons use a well-established aftercare regimen. Depending on the surgical method and the extent of the surgery, a partial weight-bearing of the operated leg with crutches is prescribed for about six weeks, which may be increased in operation. In addition, a passive motion splint for independent mobility training is often prescribed in addition to accompanying physiotherapy. Once the full weight-bearing capacity of the operated hip joint has been restored, strengthening exercise is also forced in the therapy to regain full function. The goal is to resume usual sports activities after 6-8 months.

In summary, surgical treatment causally corrects hip impingement. In addition, open surgical hip dislocation and hip arthroscopy show similar excellent results in terms of patient satisfaction and activity after surgery.

Which Doctors and Clinics Are Specialized in Hip Impingement Surgery?

Patients with femoroacetabular impingement who can no longer pursue their usual daily activities or athletic hobbies due to pain should consult specialists. Classically, specialists in orthopedics and trauma surgery or sports physicians are contact persons and clinics or centers for joint-specific diseases or surgeries on the musculoskeletal system.

We help you to find an expert for your disease. All listed doctors and clinics have been reviewed by us for their outstanding specialization in hip impingement and are awaiting your inquiry or treatment request.

Sources:

• Femoroacetabuläres Impingement: Analyse klinischer und radiologischer Parameter als Risikofaktoren für Knorpelschäden, TUM
• IAOM.de
• Wall PDH, Fernandez M, Griffin DR, Foster NE. 2013. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature