Hip (Femoroacetabular) Impingement

A bony growth at the top of the femur, or thigh bone, keeps it from fitting correctly into the socket of the hip bone. Sometimes, this bony growth may occur due to physical activity.

During a child’s development, they may experience extra bone growth in the hip socket. The femoral head (the top of the femur) rubs against the extra growth when the hip flexes, damaging the labrum, a ring of cartilage that helps stabilize the joint.

Combined impingement means both the pincer and cam types are present.

Before your exam, make a list of your symptoms and any previous hip injuries or disorders.

Your provider may ask if you participated in sports as a child and if you currently play sports or participate in other high-intensity activities. You’ll describe the type and severity of your pain and your family history.

During a physical exam, your doctor will look for any physical abnormalities and listen for irregular sounds, including clicking or popping. Your doctor will bend, flex and rotate your hip to evaluate its range of motion. They’ll ask you about which movements or positions cause pain.

Your doctor will likely order diagnostic imaging tests to confirm a femoroacetabular impingement diagnosis. Tests and scans can help your doctor locate abnormalities or signs of damage in the hip joint and identify the source of your discomfort.

• X-ray: Radiographic studies provide detailed images of the bones of the hip joints
• CT scan: These cross-sectional views combine multiple X-rays for a more complete joint picture.
• MRI scan: This radiation-free scan uses magnetic fields to produce images of cartilage, ligaments and tendons.

An impingement test involves a series of movements to check for hip impingement. While lying on your back, your provider will lift your leg toward your chest, then bend your knee at a 90-degree angle and rotate your leg inward. These movements apply light pressure to areas where impingement may occur. If you experience pain during the test, it may indicate FAI. The test may be uncomfortable, but it's safe. Be sure to let your provider know if any movement causes severe pain.

Even though you can’t control the shape of your hip joint, you can make some changes to your daily routine to help alleviate the symptoms. Notice what causes pain associated with your hip impingement and modify these activities to avoid making the condition more severe.

If your discomfort isn’t severe and your femoroacetabular impingement can be treated with nonsurgical methods, your doctor will probably recommend pain-relieving medications. Although these medications don’t address the cause of your impingement, they might be all you need to relieve your pain, letting you move more and get you back to your active life.

• Corticosteroids: These drugs help reduce inflammation and are usually given by injection into the joint.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications reduce discomfort and inflammation. They are typically sold over the counter, but stronger NSAIDs need a doctor’s prescription.

When nonsurgical options don’t effectively relieve symptoms, your provider may recommend a procedure to repair the hip joint. Options include:

• Hip arthroscopy: A doctor uses a camera and small instruments inserted through tiny incisions to remove or repair damaged bone or cartilage caused by impingement. They may repair or clean the labrum and articular cartilage, and correct the FAI by trimming the acetabular rim and shaving down the bump on the femoral head.
• Traditional hip surgery: Some more severe cases may require an open operation where a doctor works through larger incision sites to repair damaged tissues.