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Hip Impingement – FAI (femoral acetabular impingement)

What is it?

The hip joint is made up of a ball (femoral head) and socket (acetabulum). The femoral head is the upper end of the femur (thighbone) and the acetabulum is part of your pelvis bone. Normally the hip is shaped so that the ball moves freely and smoothly within the socket. This is aided by articular cartilage, a tissue that covers the surface of the ball and socket joint and creates a smooth surface, allowing the bones to glide easily across each other. The acetabulum is surrounded by a strong fibrous cartilage called the labrum, which provides stability to the joint. Hip impingement is caused by lack of room or clearance between the neck of the femur at the top of the thigh bone and the rim of the acetabulum. This lack of room may originate on the femoral neck, acetabulum, or both.

What causes it?

If the head of the femur is not sufficiently offset from the neck of the femur, or if a bump forms along the edge of the femoral head, flexion may be limited. This can be caused by childhood disorders or from wear and tear over time stimulating new bone to form on the front of the femoral neck. The acetabulum may cover too much of the femoral head in the front of the hip joint, causing impingement. Lack of clearance causes the neck and rim of the socket to push up against each other as the hip is flexed, such as with sitting or running. The contact between the femoral neck and the socket eventually causes damage to the surrounding structures. This can result in a tear of the cartilage around the socket (labrum) or lead to more advanced cartilage damage and degenerative arthritis of the hip.

What are the symptoms?

Hip impingement can cause pain in the groin region during hip flexion activities such as running or jumping, or after prolonged sitting. Pain may also begin to occur with standing and walking as irritation of the hip becomes more generalized. Some people experience a sharp stabbing pain with turning, twisting, or squatting, or at times pain may feel like a dull ache.

How is it diagnosed?

Hip impingement is often diagnosed through physical examination, x-rays, and magnetic resonance imaging (MRI). X-rays will show any abnormal shape in your hip joint, along with signs of arthritis. MRI provides a better view of your soft tissues so that damage to the labrum and articular cartilage can be assessed.

What are the treatment options?

Treatment first consists of trying to control the pain with over the counter anti-inflammatory medications and Tylenol, along with activity modification. Physical therapy may be useful to improve range of motion in your hip and strengthen the muscles that support the joint.

If this does not control the pain sufficiently, surgical treatment may be warranted.

What is involved in surgery?

Hip arthroscopy is the most common method of accessing the hip joint. This procedure involves correcting the cause of impingement and dealing with the damage that may have occurred to the labrum as well as the cartilage. Damage to the labrum is addressed with partial removal and possible repair. Removal of a portion of the bone in front of the hip socket may be necessary, along with bone shaping at the junction of the femoral head and neck. X-ray is used during the procedure to ensure the correct amount of bone is removed and to visualize the motion of the hip during bone shaping.

In more severe cases, a redirecting procedure, called a periacetabular osteotomy (PAO), may be required. This is used with severe impingement cases where bone removal alone would not adequately address the problem.

If you believe you are suffering from hip impingement or would like more information on hip arthroscopy, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Labral Tear

What is it?

The hip joint is made up of a ball (femoral head) and socket (acetabulum). The femoral head is the upper end of the femur (thighbone) and the acetabulum is part of your pelvis bone. Normally the hip is shaped so that the ball moves freely and smoothly within the socket. This is aided by articular cartilage, a tissue that covers the surface of the ball and socket joint and creates a smooth surface, allowing the bones to glide easily across each other. The acetabular labrum is a structure attached to the outside rim of the hip socket. It is made of fibrous cartilage, a flexible material present in multiple joints of the body. In the hip, the labrum is thought to act as a gasket, keeping fluid in the joint during normal joint movement. It also acts as a stabilizer of the joint, keeping the femoral head seated in the socket.

What causes it?

Various conditions can lead to damage of this labrum. These include traumatic events, degenerative conditions over time, as well as situations where the shape of the hip bones is incorrect.

Traumatic events leading to labral tears can occur with multiple activities including motor vehicle accidents, falls, or sports injuries. They are commonly associated with sudden twisting maneuvers that cause immediate pain. It is more common for the tears to be degenerative. These are chronic injuries that are the result of wear and tear over time and are also seen in the early stages of hip arthritis. Conditions where the shape of the hip bones is incorrect are currently falling under the term hip impingement. These conditions involve improper shape of the hip socket, junction of the thigh bone head and neck, and more commonly a combination of both. The improper shape causes the labrum to be pinched or rubbed during normal movement leading to tearing and degeneration.

What are the symptoms?

Pain in front of the hip (groin area) is one of the main symptoms reported. This is often accompanied by catching, clicking, locking, and stiffness. There may also be a feeling of instability. Pain may radiate throughout the hip, to the side and buttock area, or down to the knee.

Prolonged standing, sitting, or walking may worsen symptoms. Pain may be constant and severe enough to significantly limit recreational activities and sports participation, and may begin to impact your daily activities.

How is it diagnosed?

Hip labral tears are often diagnosed through physical examination, x-rays, and magnetic resonance imaging (MRI). X-rays provide a visual picture of your hip structure and position and allow diagnosis of bony abnormalities, including signs of arthritis. MRI provides a better view of your soft tissues so that damage to the labrum and articular cartilage can be assessed. Magnetic Resonance Arthrography (MRA) is a highly sensitive and specific test for labral tears. Any irregularity in the joint surface will show up when the dye seeps into areas where damage has occurred. MRAs show the location and extent of the tear, as well as any bony abnormalities that will need to be addressed during surgery.

What are the treatment options?

Treatment first consists of trying to control the pain with over the counter anti-inflammatory medications and Tylenol, along with activity modification. Physical therapy may also be beneficial to strengthen the muscles surrounding the hip joint.

If this does not control the pain sufficiently, surgical treatment may be warranted.

What is involved in surgery?

Treatment of labral tears involves repairing tissue if possible and removing the tissue that is too severely torn. Correction of bony abnormalities that have caused the labral tear is also performed. This is usually possible with hip arthroscopy, but may require more invasive procedures to correctly address the underlying bony problem.

If you believe you are suffering from a labral tear or would like more information on hip arthroscopy, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.