Hip Impingement

A special interest is in the care of a relatively newly-recognized cause of hip pain, described as hip impingement or femoroacetabular impingement “FAI.”  Impingement occurs when the ball (femoral head) doesn’t have a free, full range of motion in the socket (acetabulum) due to “impingement” of an overhanging part of the socket, called “pincer impingement,” or due to bumps of bone on the femoral head, called “cam impingement.”

Pincer impingement occurs when the socket bumps against the bone just beneath the ball (can be due to “overhang” of the socket) and this  causes damage to the “labrum,” a special padding cartilage around the rim of the socket. Sometimes the labrum can be damaged from a single traumatic impingement of the labrum from a violent movement or from repetitive extreme motions (some sports) without the socket overhanging.  Surgical treatment is aimed at removing the damaged parts of the labrum and the overhanging (crosshatched) bone.

Cam impingement causes damage to the inside of the socket when the bump moves inside the socket and applies excessive pressure to the cartilage there. Surgical treatment is aimed at removing the damaged cartilage inside the socket and the “cam bump” (crosshatched).

Open femoroacetabular impingement surgery is a 2-4 hour procedure that entails making a large incision over the side of hip so that the hip can be carefully dislocated while preserving the blood supply to the head (called a “surgical dislocation”).  Once the femoral head and acetabulum are exposed, the extra bone that is contributing to the impingement can be cut away.  After thorough removal of the impinging bone and damaged cartilage, the hip is reduced.  The patient is usually in the hospital 2-3 days after such surgery and must be on crutches for 1-2 months.  Almost the same surgery can be done arthroscopically. [please see video] Although arthroscopic treatment of hip impingement remains a long procedure of 1-2 hours, the patient can go home that day, does not have to use crutches, and the risks of surgery are much lower. In addition, the patient usually feels better much sooner. Most patients do not feel that this type of surgery completely “cures” their hip because the damaged areas cannot be replaced; only removed. However almost all the patients can be significantly improved.