What is femoroacetabular impingement?
The head of the femur (thigh bone) connects with the socket of the acetabulum (pelvis) to form the ball-and-socket type of hip joint. A white slippery sheath of articular cartilage protects the ends of these bones and enables joint movement with very little friction. This cartilaginous covering can be subject to premature erosion when the bones are not aligned properly. In femoroacetabular impingement (FAI), the femoral head and/or the acetabular socket develop bony overgrowths, called bone spurs, that rub against the articular cartilage preventing seamless joint movement. These bone spurs gradually weaken the articular cartilage leading to osteoarthritis and can also tear the hip labrum surrounding the acetabular socket. This impingement condition can begin as early as childhood and is the leading factor of early-onset degenerative joint disease in young and active individuals. Dr. Ronak Mukesh Patel, orthopedic hip specialist serving patients in Sugar Land, Pearland, and the Houston, Texas area, has the knowledge and understanding as well as substantial experience in treating patients who have experienced femoroacetabular impingement.
Are there different forms of femoroacetabular impingement?
Individuals who experience femoroacetabular impingement (FAI) may be diagnosed with one of two conditions or a combination of the two.
- Cam Impingement: When the femoral head is irregularly shaped then it is unable to rotate properly inside the acetabular socket. Patients with cam impingement have a structural abnormality of this femoral head which leads to excessive rubbing against the articular cartilage and can result in a hip labrum tear. This is also known as a pistol grip deformity.
- Pincer Impingement: Patients with this condition have an extra amount of bone that extends past the standard rim of the acetabulum. Normal hip flexion can cause the femoral neck to knock against this bony protrusion and lead to a crushed hip labrum or articular cartilage damage. This is more commonly seen in females.
- Combined Impingement: This condition is diagnosed when both the cam and pincer types of impingement are present. This is the most common form of impingement.
What are the symptoms of femoroacetabular impingement?
A common complaint of femoroacetabular impingement (FAI) is a constant and sharp pain in the groin area that worsens with internal rotation and flexion of the hip. However, it is important to note that individuals may not report any symptoms until there is damage to the hip labrum and/or articular cartilage. Additional symptoms of FAI can include:
- Hip stiffness
- Decreased range of motion
- Groin pain or pain in the front of the hip
- Pain that radiates to the outer hip
- Abnormal gait
- Pain that fluctuates between a dull ache and intense stabbing
- Pain with sitting for long periods
How is femoroacetabular impingement diagnosed?
Dr. Patel will gather a complete medical history followed by a thorough physical examination. During the exam, Dr. Patel will bring the knee up to the chest and rotate it towards the opposing shoulder in a maneuver known as the impingement test. A positive impingement test is indicated by the re-creation of hip pain with knee rotation. Another positive indicator of FAI is if the hip pain resolves after injection of a local anesthetic with or without steroid into the hip joint. Diagnostic imaging studies are also beneficial for diagnosing FAI. X-rays and computerized tomography (CT) can determine if any bony abnormalities are present. Magnetic resonance imaging (MRI) can identify the extent of damage to the hip labrum and/or articular cartilage as well as evaluate the surrounding soft-tissue structures for additional injury.
What is the treatment for femoroacetabular impingement?
Non-surgical treatment:
Patients that experience mild femoroacetabular impingement (FAI) symptoms may find relief with non-surgical treatment measures. Avoiding activities that exacerbate pain is recommended. A combination of non-steroidal anti-inflammatory medications (NSAIDs) with periodic hip injections can provide long-term pain and inflammation relief. Physical therapy with specific hip/core mobility and strengthening exercises can mitigate the stress on the injured cartilage or labrum.
Surgical treatment:
When non-surgical treatment measures fail to alleviate the symptoms of femoroacetabular impingement (FAI), surgical intervention may be needed. A femoroplasty, a minimally invasive arthroscopic repair using a small camera (arthroscope) and specialized surgical instruments, is preferred by patients and surgeons alike. The injured labrum is repaired and damaged articular cartilage fragments are excised and removed. Depending on the specific type of FAI, the femoral head is reshaped, or the rim of the acetabular socket is trimmed to the normal length. Surgical treatment of FAI is important for preventing further damage to the articular cartilage and/or hip labrum.
Hip Impingement Specialist
Femoroacetabular impingement is a hip condition common in active individuals and people diagnosed with degenerative joint disease. This condition causes bone spurs to develop in the hip socket which rub and cause discomfort with movement. Hip specialist Dr. Ronak Mukesh Patel provides diagnosis and specialized treatment plans for patients in Houston, Sugar Land, and Pearland, TX. Contact Dr. Patel’s team today!
