Femoroacetabular Impingement Quick Links:
In my opinion, it can affect you at any age. I have seen patients in their teens as well as mature adults.
There are two types of patients we see with Femoroacetabular impingement in the surgery those are –
Athletes (of all abilities), usually due to high-intensity use of the joint, which in time degrades the labrum (and the articular cartilage)
Deformities of the bony anatomy resulting in Cam or Pincer shaping causing the labrum and articular cartilage to be “pinched” or damaged whilst moving.
Other conditions that can result in Cam/Pincer impingement are Coxa profunda, Coxa vara, Acetabular protrusio, Acetabular retroversion, Slipped Capital femoral epiphysis.
There are a few structures inside the hip joint; it is a ball and socket. Contact between those two structures results in damage, usually to the shock-absorbing cartilage around the edge of the socket. This cartilage is called the labral cartilage.
Damage is not immediately obvious. Wear and tear continues over quite a period; it can be months or even years until pain presents a problem and patients seek medical guidance.
Signs and symptoms of Femoroacetabular Impingement
Femoroacetabular impingement pain is not necessarily felt in the hip. Sufferers can feel pain in the leg, groin, lower back and even the knees. We call this referral pain. In general, this is due to the brain sending signals to the surrounding area. The brain signals for support for the hip, so the rest of the structure around the hip joint starts working harder to “compensate”. This results in inflammation, fatigue or even failure of that structure. Patients often come into surgery complaining of knee or back pain and do not relate that to problems they may have with their hips. This is why Femoroacetabular impingement is often a missed diagnosis.
In my opinion, it can affect you at any age. I have seen patients in their teens as well as mature adults.
There are two types of patients we see with Femoroacetabular impingement in the surgery those are –
Athletes (of all abilities), usually due to high-intensity use of the joint, which in time degrades the labrum (and the articular cartilage)
Deformities of the bony anatomy resulting in Cam or Pincer shaping causing the labrum and articular cartilage to be “pinched” or damaged whilst moving.
Other conditions that can result in Cam/Pincer impingement are Coxa profunda, Coxa vara, Acetabular protrusio, Acetabular retroversion, Slipped Capital femoral epiphysis.
There are a few structures inside the hip joint; it is a ball and socket. Contact between those two structures results in damage, usually to the shock-absorbing cartilage around the edge of the socket. This cartilage is called the labral cartilage.
Damage is not immediately obvious. Wear and tear continues over quite a period; it can be months or even years until pain presents a problem and patients seek medical guidance.
Signs and symptoms of Femoroacetabular Impingement
Femoroacetabular impingement pain is not necessarily felt in the hip. Sufferers can feel pain in the leg, groin, lower back and even the knees. We call this referral pain. In general, this is due to the brain sending signals to the surrounding area. The brain signals for support for the hip, so the rest of the structure around the hip joint starts working harder to “compensate”. This results in inflammation, fatigue or even failure of that structure. Patients often come into surgery complaining of knee or back pain and do not relate that to problems they may have with their hips. This is why Femoroacetabular impingement is often a missed diagnosis.
Unfortunately, I have seen many patients who have had spinal injections, even some, I am afraid, have had spinal surgery and have not improved.
The problem any medical professional faces is the process of elimination. We start with a consultation, where the patient will describe the pain, including where they are experiencing the pain. From this point, we will start our physical examinations.
An x-ray of patients with very early hip disease can look normal. We can take an MRI scan, but we may miss the issues again if it is not a high-definition 3 Tesla MRI scan.
It is also often the case that very few patients are offered hip surgery when a diagnosis is made. Hip replacement is still “marketed” by many as an extensive, invasive surgery that can be avoided until a later date. When the truth is not all hip surgeons will do a hip replacement; very few do keyhole surgery of the hip because there is an exceptional technique or skill set. So, physiotherapy is usually prescribed, and the patient is sent on their way.
When should I seek help for Femoroacetabular Impingement?
Often, from case to case, our patients will see us when it becomes a problem that affects day-to-day life.
Athletes often approach us at a much younger age, but each case is generally different, with different stages of “deformity” or complaint.
For example, they may get discomfort when sitting down, on long car journeys, or getting in and out of a car.
If you were a long-haul driver, this would present a more significant issue than those who are not.
Or, sitting behind a desk all day causes pain, but you work on an admin team, which results in daily pain that hinders your day-to-day life.
Or a world-famous tennis star who, without surgery, may need to retire.
Each case is different; each patient will have their own needs to be addressed.
Unfortunately, I have seen many patients who have had spinal injections, even some, I am afraid, have had spinal surgery and have not improved.
The problem any medical professional faces is the process of elimination. We start with a consultation, where the patient will describe the pain, including where they are experiencing the pain. From this point, we will start our physical examinations.
An x-ray of patients with very early hip disease can look normal. We can take an MRI scan, but we may miss the issues again if it is not a high-definition 3 Tesla MRI scan.
It is also often the case that very few patients are offered hip surgery when a diagnosis is made. Hip replacement is still “marketed” by many as an extensive, invasive surgery that can be avoided until a later date. When the truth is not all hip surgeons will do a hip replacement; very few do keyhole surgery of the hip because there is an exceptional technique or skill set. So, physiotherapy is usually prescribed, and the patient is sent on their way.
When should I seek help for Femoroacetabular Impingement?
Often, from case to case, our patients will see us when it becomes a problem that affects day-to-day life.
Athletes often approach us at a much younger age, but each case is generally different, with different stages of “deformity” or complaint.
For example, they may get discomfort when sitting down, on long car journeys, or getting in and out of a car.
If you were a long-haul driver, this would present a more significant issue than those who are not.
Or, sitting behind a desk all day causes pain, but you work on an admin team, which results in daily pain that hinders your day-to-day life.
Or a world-famous tennis star who, without surgery, may need to retire.
Each case is different; each patient will have their own needs to be addressed.
Femoroacetabular Impingement caused by traumatic injuries
Classic traumatic injuries usually are direct blows; this might be falling over onto your side, landing directly on the side of your hip, or the hip going into hip extension (“leg behind you”) and causing labral tears.
The examination for Femoroacetabular impingement caused by traumatic injuries is relatively straightforward.
We examine both hips for comparison, and if discomfort is triggered at this early stage, we send our patient for imaging.
We use an x-ray and a 3T MRI scanner with a radiologist who reports for me; this way, I have no bias because the radiologist gives an independent report of their findings.
Once we have made the diagnosis, we can see what is happening in the joint; our aim is to try and calm the joint down and start treatment.
Part of the treatment includes helping you with your hip and pelvic positioning. Most, if not all, patients suffering from Femoroacetabular impingement overcompensate in other areas of the lower back and pelvis. This creates inflammation in those areas resulting in more pain.
To help correct this, we administer cortisone directly into the hip under image control in the operating theatre, which is a quick, pain-free procedure. The procedure is quick, and patients are typically on their way home in a matter of hours. The injection itself takes minutes!
After one or two weeks, we look to start physiotherapy sessions. The physiotherapist will work on what we call a prehabilitation programme or a prehab programme. Prehabilitation includes building strength, building control, and correcting the pelvic plane position to get the pelvis in the correct neutral position for that patient.
This programme can last up to 12 weeks and is solely down to each individual, how well they are coping, and the final result. A tiny percentage of patients might still be struggling with pain on the side of the hip or another structure that is compensating. So, although we can inject that painful site, we try and limit the number of injections given.
This procedure is done not as a treatment but as a diagnostic test. This test is just the start of the recovery plan BUT could also be the end. After three months, we reassess the patient and discuss moving forward. Essentially, we may find that patients who have just had a bit of inflammation because they had overdone it may be cured by the injection. If patients with small tears can get that control, posture, and strength back, they may not need further treatment.
We would suggest a scan be taken after 12 months for those patients so we can make sure the hip is not falling apart silently.
Those who struggle to prevent impingement may need to consider further treatment, such as :
Femoroacetabular Impingement caused by traumatic injuries
Classic traumatic injuries usually are direct blows; this might be falling over onto your side, landing directly on the side of your hip, or the hip going into hip extension (“leg behind you”) and causing labral tears.
The examination for Femoroacetabular impingement caused by traumatic injuries is relatively straightforward.
We examine both hips for comparison, and if discomfort is triggered at this early stage, we send our patient for imaging.
We use an x-ray and a 3T MRI scanner with a radiologist who reports for me; this way, I have no bias because the radiologist gives an independent report of their findings.
Once we have made the diagnosis, we can see what is happening in the joint; our aim is to try and calm the joint down and start treatment.
Part of the treatment includes helping you with your hip and pelvic positioning. Most, if not all, patients suffering from Femoroacetabular impingement overcompensate in other areas of the lower back and pelvis. This creates inflammation in those areas resulting in more pain.
To help correct this, we administer cortisone directly into the hip under image control in the operating theatre, which is a quick, pain-free procedure. The procedure is quick, and patients are typically on their way home in a matter of hours. The injection itself takes minutes!
After one or two weeks, we look to start physiotherapy sessions. The physiotherapist will work on what we call a prehabilitation programme or a prehab programme. Prehabilitation includes building strength, building control, and correcting the pelvic plane position to get the pelvis in the correct neutral position for that patient.
This programme can last up to 12 weeks and is solely down to each individual, how well they are coping, and the final result. A tiny percentage of patients might still be struggling with pain on the side of the hip or another structure that is compensating. So, although we can inject that painful site, we try and limit the number of injections given.
This procedure is done not as a treatment but as a diagnostic test. This test is just the start of the recovery plan BUT could also be the end. After three months, we reassess the patient and discuss moving forward. Essentially, we may find that patients who have just had a bit of inflammation because they had overdone it may be cured by the injection. If patients with small tears can get that control, posture, and strength back, they may not need further treatment.
We would suggest a scan be taken after 12 months for those patients so we can make sure the hip is not falling apart silently.
Those who struggle to prevent impingement may need to consider further treatment, such as :
Frequently Asked Questions
I have compiled answers to several faqs for each procedure: