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Patients may have hip impingement for years before diagnosis because it’s rarely painful in its early stages. Early diagnosis is important; however, hip impingement if left untreated, can cause cartilage damage and osteoarthritis.
Once hip impingement becomes more advanced, symptoms include:
- General stiffness in the groin or front of the thigh.
- Running, jumping or sitting after flexing will also cause pain the groin region
What is hip impingement?
Hip impingement (femoro acetabular acetabular impingement) is a more recently recognized cause of hip pain in the active adult.
Hip impingement is caused by a lack of room or clearance between the neck of the femur and the rim of the socket (acetabulum). In a normal hip, there is a gliding motion of the round femoral head within the socket, but with an impinged hip, the gliding motion is disturbed. Dr. Downer states, “Mechanical problems do not always require surgical treatment; when symptoms affect function and lifestyle then surgery is justified.”
Dr. Downer, provides specialized care in hip restoration and replacement, and has a special interest in hip impingement conditions. Treatment options may include:
- First approach – Trying to control the pain with anti-inflammatory medications – If pain persists, surgical treatment may be necessary.
- Surgical treatment of hip impingement involves removing or correcting the cause of the reduced clearance between the neck of the femur and the rim of the socket (acetabulum). This may require arthroscopic surgery of the hip to remove diseased portions of the acetabulem (labrum) as well as femoral neck.
- In severe cases, it may be necessary to correct the deformity and reshape the femoral neck and/or rim of the socket through a larger incision. In cases of malposition of the socket, a redirecting procedure, called a periacetabular osteotomy (PAO) may be required.
Don’t let a hip impingement slow down your healthy, active lifestyle. Find out treatment options so that you can continue doing the things you love. Call Orthopedic Specialists of Seattle and schedule a consultation with Dr. Downer at (206) 633-8100.
Hip impingement (femoral acetabular impingement) is a disorder of the hip that is becoming more recognized as a cause of hip pain in the active adult. It is also thought to be a previously unrecognized cause of arthritis in the young adult.
Causes of Hip Impingement
Hip impingement is caused by lack of room or clearance between the neck of the femur at the top of the thigh bone, and the rim of the socket (acetabulum). This lack of room may originate on the femoral neck, acetabulum, or both. The head of the femur may not be sufficiently offset from the neck of the femur to allow room when the hip is flexed.
This can be caused by childhood disorders or from wear over time stimulating new bone to be laid down on the front of the femoral neck. The acetabulum may be the cause of the impingement by covering too much of the femoral head in the front of the hip joint. There may also be multiple causes in the same hip.
This lack of clearance causes the neck and rim of the socket to jam together as the hip is flexed (as in sitting or running). This contact between the femoral neck and socket leads to damage of the contacting structures. This damage may be a tear of the cartilage around the socket (acetabular labrum) to more advanced cartilage damage and degenerative arthritis of the hip.
Symptoms of Hip Impingement
Typically the person with hip impingement complains of pain in the groin region during hip flexion activities such as running or jumping. There may also be symptoms after prolonged sitting. During most of these activities, the hip is placed in a flexed position, although pain may also occur with standing and walking when irritation of the hip is more generalized.
The acetabular labrum is a structure attached to the outside rim of the hip socket. This labrum is made of fibrous cartilage, a flexible material present in multiple joints of the body. In the hip, the labrum is thought to act as a gasket, keeping fluid in the joint during the normal loading of the joint that occurs with movement. It also acts as a stabilizer of the joint keeping the head seated in the socket.
Causes of Labral Tears
Various conditions can lead to damage of this labrum. These include traumatic events, degenerative conditions over time, as well as situations where the shape of the hip bones is incorrect. Traumatic events leading to labral tears can occur with multiple activities including motor vehicle accidents as well as common trips and falls. Degenerative labral tears are a component of generalized hip degeneration where the cartilage throughout the hip joint becomes rough and torn.
Conditions where the shape of the hip bones is incorrect are currently falling under the term hip impingement. These conditions involve improper shape of the hip socket, junction of the thigh bone head and neck, and more commonly a combination of both. This improper shape causes the labrum to be pinched or rubbed during normal movement leading to tearing and degeneration.
Treatment of Labral Tears
Treatment of labral tears involves repairing tissue if possible and removing the tissue that is too severely torn. Attention is then directed at correcting any bony abnormalities that have caused the labral tear in the first place. This is usually possible with hip arthroscopy, but may require more invasive procedures to correctly address the underlying bony problem.
Read our answers to Frequently Asked Questions about hip impingement and labral tears.