Hip impingement

Hip impingement is also known as femoroacetabular impingement (FAI) and is seen more often in men. It is caused when the femoral head (the ball-shaped bone at the top of the femur or thigh bone) and the acetabulum (the socket in the pelvis into which the femoral head fits) don’t fit together properly. This is often the result of extra bone in the hip, though it can also be caused by bone deformity. Hip impingement causes friction and abnormal wear and tear on the joint. Overtime, this can lead to osteoarthritis and the need for a hip replacement.

A person with hip impingement may experience:

• Pain in the groin during or after activity or when sitting for long periods of time
• Difficulty flexing the hip beyond a right angle
• Hip stiffness
• Trouble going up stairs
• Limping
• A loss of balance

In many cases, hip impingement can be the cause of hip labral tears – particularly for men. This is a common problem that can cause pain, stiffness, and locking or catching in the hip joint. In fact, a labral tear diagnosis is often what brings men to our Penn Hip Preservation Center. Our specialists perform in-depth evaluations on all patients with labral tears to determine if the cause is an underlying condition, such as hip impingement.

When a labral tear is caused by hip impingement, our specialists treat both conditions to reduce the risk of reinjury and ensure optimal outcomes. This level of attention sets our Center apart and assures patients that they are receiving the comprehensive care they need.

While most impingement occurs within the hip joint itself, there are cases where the source of the problem lies in surrounding, harder-to-reach structures such as the anterior inferior iliac spine. Our specialists at the Penn Hip Preservation Center explore all possible areas of impingement using advanced imaging tests such as MRI and 3-D CT scans, which provide a comprehensive view of the pelvis. Once the source of the hip impingement has been identified, we then develop a treatment plan to address your hip pain, correct the impingement, and preserve the structure and function of your hip joint for the long term.

While most impingements occur within the hip joint and can be treated through hip arthroscopy, there are cases where an open approach is required. Penn Hip Preservation Center specialists offer you the full range of treatment options for hip impingement.

• Hip arthroscopy: During this minimally invasive approach, we insert an arthroscope – a tiny tube with a lens and light source – into the hip joint through a small incision. This allows us to view the hip joint and surrounding structures and treat the problem. With hip impingement, our goal is to remove the extra bone that is causing wear and tear on the joint. Depending upon the location and amount of bone, we will either shave it down or burr it out.
• Surgical hip dislocation: This open approach is used in cases where there is a lot of extra bone or a structural deformity within the hip joint. During surgical hip dislocation, the femoral head is moved away from its normal resting place in the hip socket. This allows us reach the joint more easily to correct the problem. Once treatment is done, the femur is secured back into place with screws.
• Anteverting periacetabular osteotomy (anterverting PAO): This is an open procedure that is used in combination with surgical hip dislocation to correct a form of hip dysplasia known as acetabular retroversion. This occurs when the hip socket (acetabulum) is facing toward the back.
• Femoral osteochondroplasty: During hip arthroscopy or surgical hip dislocation, we use a procedure known as femoral osteochondroplasty to reshape or remove bone from the head and neck of the femur so that it fits more naturally in the hip socket.
• Pincer osteochondroplasty: Following surgical hip dislocation, we use a procedure known as pincer osteochondroplasty to remove excess cartilage from the hip socket so that the femoral head fits more naturally.
• Subspine decompression: The subspine, or anterior inferior iliac spine, is located on the large, cup-shaped bone of the hip. Any excess bone growth in this area can cause impingement and discomfort. A subspine decompression is a procedure to remove the excess bone. It can be performed arthroscopically or as an open procedure.

Depending upon the cause of your hip impingement, you can expect to be on crutches for about two weeks following surgery. At four weeks you can bear weight. You’ll return to normal activities between two- and four-months following surgery.