Femoroacetabular Impingement and Hip Labral Tears
Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that forms the hip joint, ultimately giving the bones an irregular shape and inhibiting full range of motion. Once the bone growth occurs, the bones do not fit together perfectly and therefore rub against one another during movement; and this friction ultimately damages the joint, causing pain and limiting activity.
The rate at which hip impingement occurs among people isn’t known, but young and middle-aged athletes are at higher risk for developing pain associated with FAI and labral tears. Athletes involved in running, tennis, soccer, volleyball, golf and dancing are most likely to experience the injury which includes symptoms such as:
- Pain, particularly in the groin after after the hip has been flexed or in the lower back
- A locking or clicking sensation within the joint
- The inability to flex the hip beyond a right angle
In the past, many of these injuries went undiagnosed and untreated, but thanks to new techniques used by a select group of surgeons, including Anthony J. Cerminara, MD, FAAOS a board certified orthopaedic surgeon and sports medicine specialist at South Florida Orthopaedics & Sports Medicine, physicians are able to successfully treat the injury today.
There are 3 different types of FAI:
- Pincer – A pincer impingement occurs because the extra bone extends out beyond the normal rim of the acetabulum. The prominent rim of the acetabulum can crush the labrum.
- Cam – A cam impingement mean the femoral head is not round and cannot rotate smoothly inside the acetabulum. This causes a bump to form on the edge of the femoral head that grinds the cartilage inside the acetabulum.
- Combined – Combined impingement happens when both pincer and cam types of FAI are present
The cause of FAI typically stems from the bones of the hip not forming normally during childhood growth years, and although people with FAI can go through their lives without problems, active individuals tend to experience pain earlier due to working the hip joint more vigorously.
Non-surgical Treatment Options for Femoroacetabular Impingement
Home remedies for FAI may include reducing the activity known to be exacerbating FAI pain, letting the hip rest, or trying over-the-counter anti-inflammatory medicines like ibuprofen or naproxen.
If pain persists beyond home remedy attempts, sufferers should consider seeking the help of an orthopaedic surgeon. The longer painful symptoms go unaddressed, the more damage FAI can cause the hip.
Untreated hip impingement may lead to hip osteoarthritis, and so it is important for patients with hip pain to seek medical advice about their condition as soon as possible.
Beyond home remedies, other nonsurgical treatment options an orthopaedic specialist may suggest include:
- Activity adjustments – A physician may first recommend that changing daily routine and avoiding activities that cause symptoms could be sufficient in preventing further pain.
- Non-steroidal anti-inflammatory (NSAID) medications – NSAIDs like ibuprofen can be provided in a prescription-strength dosage to help reduce both pain and inflammation.
- Physical therapy – Certain exercises can help improve the hip’s range of motion and also help strengthen the muscle that supports the joint.
Surgical Treatment for Femoroacetabular Impingement
Hip arthroscopy is becoming an increasingly popular option for patients requiring surgery for hip pathologies. An analysis published in BMJ Open Sport & Exercise Medicine notes a 365% increase in the number of hip arthroscopy procedures performed between 2004 and 2009 and a 250% increase between 2007 and 2011. A separate review published in the Journal of Hip Preservation Surgery indicated a patient satisfaction rate of 80% among people who underwent hip arthroscopy.
An arthroscopic procedure is minimally invasive and allows the surgeon to use a small camera (arthroscope) to see inside the hip. The procedure is done with small incisions and thin instruments. Through arthroscopy a surgeon can repair or clean out any damage to the labrum and articular cartilage and also shave down the bump on the femoral head or trim the rim of the acetabulum.
Benefits of the arthroscopic hip surgery procedure include:
- Smaller incisions
- Less scarring
- Faster recovery
- Access to areas of the joint that are impossible to access through open surgery
Patients who undergo arthroscopic hip surgery can expect to need crutches for around three weeks following the procedure in conjunction with about six weeks of physical therapy. Things to avoid after arthroscopic hip surgery include:
- Sitting on low, soft surfaces
- Pivoting over the leg that was operated on
- Crossing the legs where the ankle sits on the knee
- Lifting the operated legs straight up for extended periods of time
In most cases, patients can return to their regular activities in three to four weeks, and some athletic events within eight to 12 weeks.