Hip Impingement

person exercising after joint replacement

What is hip impingement?

Hip impingement is a collection of conditions that cause reduced range of motion and pain around the hip.  The most common type of hip impingement is known as femoroacetabular impingement (FAI), in which there is abnormal contact between the femoral head-neck junction (top of the thigh bone) and the acetabulum (socket). This abnormal contact prevents normal hip motion and can damage the labrum and cartilage of the hip joint, causing pain. Over time, impingement can cause severe damage to the hip joint, leading to hip arthritis.

A “labral tear” is usually not an isolated injury. Rather, it is a sign of another hip disorder, including hip impingement, dysplasia, or arthritis. Treatment of a labral tear usually involves diagnosing and treating its underlying cause as well.

What causes hip impingement?

Hip impingement results from irregular contact between the ball and socket of the hip, caused by various factors, including certain sports activities. This abnormal contact blocks normal hip motion. For athletes and dancers who require more hip motion than others, hip impingement can be a significant impediment to optimal athletic performance. The different types of hip impingement are:

  • Cam impingement – excess bone growth or deformity of the femoral head or neckhip-impingement_asm
  • Pincer impingement – excess bone growth or deformity of the acetabular rim
  • Combined – probably the most common form of hip impingement, wherein there is both excess bone growth or deformity of the femoral head/neck and the acetabular rim

What are the symptoms of hip impingement?

Hip impingement often goes unnoticed for years because it is typically not painful in its early stages. When it reaches later stages some common symptoms include:

  • Limited range of motion
  • Groin pain
  • Pain with activity, particular hip flexion and rotation
  • Pain with prolonged sitting
  • Hip pain at night that wakes you from sleep

How is hip impingement diagnosed?

Individuals who experience any of the above symptoms, or who believe they may be suffering from hip impingement should consult with a hip specialist for definitive diagnosis. It is vital to catch hip impingement early, since it can lead to cartilage damage and hip arthritis if left untreated. Evaluation for hip impingement begins with Dr. McLawhorn asking you a series of questions to better understand your current bone and joint health. In addition to a medical history, a thorough physical evaluation will be performed. Imaging will be performed in order to evaluate the health of the joint and determine whether your hip pain is being caused by impingement. The type of imaging recommended may include:

  • X-rays, including several special views
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) in rare cases or before surgery

Hip injections are also useful for both diagnosis and treatment.

How is hip impingement treated & when is hip impingement surgery necessary?

In some cases, hip impingement symptoms may be well controlled with nonsurgical treatments. Dr. McLawhorn is committed to personalized care for all of his patients, using evidence-based methods and nonsurgical treatment options whenever possible.

Patients suffering from symptomatic hip impingement are frequently very active. The mainstay of nonsurgical treatment is physical therapy, focusing on muscle strength, flexibility, range of motion, and reducing inflammation. Other supportive nonsurgical treatments include:

  • Non-steroidal anti-inflammatory medications
  • Hip injections
  • A period of activity modification

For some patients, hip impingement surgery may be necessary. Procedures recommended to treat FAI may include:

  • Hip arthroscopy is a type of less invasive hip surgery that may be used address bony deformities and to repair damage to the labrum and articular cartilage. During arthroscopic hip surgery, your surgeon may trim the outer rim of the acetabulum and/or shave down the bump on the femoral head (osteochondroplasty). Dr. McLawhorn does not perform this surgery. However, when it is required, he will refer patients to a trusted colleague to perform the procedure.
  • Open hip surgery is a reconstructive option that may include reshaping (osteochondroplasty) the femoral head and/or acetabulum or an osteotomy (cutting part of the bone and reorienting it). Specific open hip procedures include periacetabular osteotomy, surgical hip dislocation, and femoral osteotomy. Dr. McLawhorn does not perform these surgeries. However, when one of them is required, he will refer patients to a trusted colleague to perform the necessary procedure.
  • Hip resurfacing is a surgical procedure involving removing the damaged portion of the bone and cartilage in the hip socket (acetabulum) and replacing it with a metal shell. The ball of the existing joint is then resurfaced with a smooth metal covering.
  • Total hip replacement is a surgical procedure involving complete replacement of the hip joint with an artificial joint.

If you believe you may be suffering from hip impingement, it is important to seek advice from an orthopedic hip specialist to accurately diagnose and treat your condition. Dr. McLawhorn is a hip and knee specialist at Hospital for Special Surgery serving patients in New York City, Westchester, and Stamford, Connecticut, with extensive training in diagnosing and treating femoroacetabular hip impingement. Proactive treatment can reduce the chances of hip impingement leading to more serious joint conditions. To learn more, call 203-705-2113 (CT) / 212-606-1065 (NYC) today or schedule an appointment by using the form on this page.

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