Dr. Danyal H. Nawabi, Orthopedic Surgeon, offers his expertise on hip impingement.
What is hip impingement?
Hip impingement, formally known as femoroacetabular impingement (FAI), is a common cause of groin pain in the young, athletic population. It also causes limitation of hip motion and is a well-established cause of osteoarthritis (OA) of the hip. The hip is a ball and socket joint that is formed by the ball at top of the thigh bone (femur) and the socket in the pelvis (acetabulum). The hip joint relies on a perfect spherical morphology for normal motion. FAI occurs due to abnormal contact between the femoral head (ball) and acetabular (socket) rim because of a misshapen non-spherical head (ball) articulating with a spherical acetabulum (socket). This results in injury to the labrum on the acetabular rim and also the cartilage in the acetabulum which, if left untreated, eventually leads to osteoarthritis.
How is it diagnosed?
Making the correct diagnosis is critical in the field of hip preservation. There are many causes of groin pain in a young active adult, and therefore the diagnostic process is complex. It is important for the physician to perform a thorough clinical assessment followed by specialized investigations. These include specific X-rays, MRI, CT scans with 3D modeling, diagnostic injections, and in some cases dynamic computer simulations.
What is involved in the procedure?
Treatment of FAI is targeted at addressing the bony abnormalities, either on the femoral or acetabular sides, to restore the hip joint to its normal shape. This eradicates the abnormal contact that occurs between the femur and acetabular rim, resulting in pain relief, increased motion, and prevention of further damage to the acetabular labrum and cartilage. At the same time, the damaged labrum can also be repaired. The entire procedure can be performed either by hip arthroscopy or open surgical hip dislocation.
What are the risks of surgery?
FAI surgery can be performed arthroscopically or through open approaches. The risks of arthroscopy include scuffing of the cartilage, nerve injury, fluid collection in the abdomen, thrombosis, infection, and heterotopic bone formation. The risks unique to surgical hip dislocation include trochanteric non-union, painful hardware, and wound complications. Although the overall risk of these problems is low, these surgeries are technically demanding and therefore the risks can be minimized by getting treatment from a well-trained surgeon at a high-volume center.
What are some forms of nonsurgical treatment?
Dr. Danyal H. Nawabi is an Orthopedic Surgeon on the Sports Medicine Service at Hospital for Special Surgery. He specializes in the surgical treatment of sports injuries and arthritis of the hip and knee joints. He completed his fellowship training in sports medicine and joint replacement at Hospital for Special Surgery.