Hip Impingement Surgery

Many patients come to Orthopedic Specialists of Seattle for treatment of hip impingement. Our surgeon, Phil Downer, MD, provides specialized care in hip restoration and replacement, and has a special interest in hip impingement conditions.

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.

The lack of room may originate from deformaties of the femur, acetabulum, or as a result of a combination of the two. The lack of clearance causes the neck and rim of the socket to jam together as the hip is flexed (as in sitting or running) – and this contact leads to damage of the contacting structures.

Damage may include a tear of the cartilage around the socket (acetabular labrum) to more advanced cartilage damage and degenerative arthritis of the hip.

Hip impingement may originate at birth, and may also develop from wear over time which can stimulate new bone to be laid down on the front of the femoral neck. Most experts believe that it’s a combination of one’s genetics and environment.

Symptoms of Hip Impingement

Patients may have hip impingement for years before diagnosis because it’s rarely painful in its early stages. Early diagnosis is important, however, because if hip impingement is left untreated, it can cause cartilage damage and osteoarthritis.

Once hip impingement becomes more advanced, patients generally feel stiffness in the groin or front of the thigh. Patients may also have an inability to flex their hip, and after flexing their hip during activities such as running, jumping, or sitting, they often feel pain in the groin region.

Hip Impingement Treatment Options

Hip impingement can progress to the point where it interferes with the normal activities in life. Generally, a first approach would be to try to control the pain with anti-inflammatory medications and Tylenol. 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.