Hip Impingement

Options to relieve hip pain caused by femoral acetabular impingement.

Your hip is a ball-and-socket joint that has two main parts:

• The acetabulum, or the socket portion of the joint
• The femoral head, or the ball portion of the joint

When your hip functions normally, the femoral head glides in the hip socket. But if there’s abnormal contact between the femoral head and the rim of the hip socket, we call that hip impingement (also known as femoral acetabular impingement or FAI). This can damage the cartilage that surrounds the hip and lead to arthritis.

Our orthopedic surgeons treat hip impingement with a variety of surgical options.

What causes hip impingement?

There are several possible causes for hip impingement. One is abnormalities in the shape or position of either the hip socket or the femoral head, which can cause contact in the joint where there should be none. Treatment for hip dysplasia also can cause hip impingement in some cases.

Other conditions that can cause hip impingement include:

• Legg-Calvé-Perthes disease, a rare disease that occurs when the femoral head doesn’t get enough blood
• Osteochondromatosis, a rare disease in which joint-lining tissue called synovium grows abnormally and produces cartilage within the hip joint
• Slipped capital femoral epiphysis (SCFE), a condition in teens and preteens that involves the femoral head slipping off the femur (thighbone)

What are the symptoms of hip impingement?

Symptoms of hip impingement depend on how much damage has been done to the hip. Your symptoms may include:

• Clicking, locking, or snapping of the hip joint
• Difficulty crouching, squatting, sitting for long periods, walking, and/or sleeping in certain positions
• Dull pain in the lower back, side of the hip, or thigh
• Pain in the buttocks, groin, knee, or thigh
• Loss of hip motion

How do I know if I have hip impingement?

Your doctor will start with a thorough examination to evaluate hip function and pain. Your doctor may order diagnostic tests to gather more information, including:

• Anesthetic arthrogram, which we may use to confirm that the hip joint is the source of pain
• Magnetic resonance imaging (MRI) arthrogram, which lets us see the shape of the femoral head and neck and the soft tissue of the hip’s cartilage using a high-contrast imaging dye
• X-rays, which let us evaluate the shape, size, and orientation of the hip
• Ultrasound, which we use to evaluate the hip’s motion and the femoral neck

What are my treatment options for hip impingement?

If your hip impingement is causing pain or deterioration of the hip cartilage, we have to perform surgery to correct it. Our orthopedic surgeons will restore the hip’s normal function, remove any torn tissue, and prevent the joint from continuing to deteriorate. This usually involves removing bone from the head and neck of the femur or from the rim of the hip socket to improve the hip’s mobility.

Your doctor will discuss the surgical options and help you choose the best one. Your options may include one or a combination of these procedures:

• Hip arthroscopy, a minimally invasive option for patients whose hip impingement isn’t severe
• Surgical dislocation of the hip, a traditional open surgical procedure that provides full access to the hip for more severe cases
• Periacetabular osteotomy, a procedure we use for hip dysplasia that may be necessary if the hip socket is either shallow or out of alignment