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Hip Impingement – Causes, Symptoms and Treatment
Hip impingement is a condition where bones in the hip joint rub against each other, causing pain and restricted movement.
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Hip impingement is a condition where bones in the hip joint rub against each other, causing pain and restricted movement.
What is Hip Impingement?
Hip impingement, medically known as Femoroacetabular Impingement (FAI), is a common condition affecting the hip joint. It occurs when there is abnormal contact between the femoral head (the ball of the thigh bone) and the acetabulum (the hip socket). This repeated mechanical conflict damages the cartilage and the joint lip (labrum acetabuli), and can lead to hip osteoarthritis over time if left untreated.
Causes
Hip impingement is caused by structural abnormalities of the hip joint, which can be congenital or develop over time. There are three main types:
- Cam impingement: The femoral head is not perfectly round but has a bony prominence at its junction with the femoral neck. When the hip is flexed, this prominence pinches against the acetabulum.
- Pincer impingement: The acetabulum covers too much of the femoral head, causing the labrum to be crushed during movement.
- Combined impingement: Both cam and pincer impingement occur simultaneously, which is the most common presentation.
Contributing factors include intensive sport participation during adolescence, occupations involving frequent squatting or bending, and genetic predisposition.
Symptoms
The typical symptoms of hip impingement include:
- Groin pain, often triggered by hip flexion and rotational movements
- Pain after prolonged sitting or during physical activity
- Reduced range of motion in the hip
- Occasional clicking or catching sensation in the joint
- Pain in the outer hip or buttock area
Symptoms often develop gradually and worsen over time.
Diagnosis
Diagnosis of hip impingement involves a combination of:
- Clinical examination: The physician assesses range of motion and pain provocation. A typical finding is a positive FADIR test (Flexion, Adduction, Internal Rotation).
- Imaging: X-rays reveal bony abnormalities. An MRI scan (Magnetic Resonance Imaging), often performed with contrast agent (MR arthrography), provides detailed images of the cartilage and labrum.
Treatment
Conservative Treatment
For mild to moderate symptoms, conservative management is recommended first:
- Physiotherapy to strengthen the hip muscles and improve joint mobility
- Modification of physical activities to reduce joint stress
- Pain-relieving and anti-inflammatory medications (e.g., NSAIDs)
- Intra-articular injections (e.g., corticosteroids) to reduce inflammation
Surgical Treatment
If conservative treatment does not provide sufficient relief, or if there is already significant damage to the cartilage or labrum, surgical intervention may be necessary. The gold standard is hip arthroscopy (keyhole surgery):
- Reshaping of bony prominences (osteoplasty)
- Reconstruction or reattachment of the damaged labrum
- Treatment of cartilage damage
In severe cases, open surgery or total hip replacement (total hip arthroplasty) may be required.
Prognosis and Prevention
With early diagnosis and treatment, the prognosis is generally good. Many patients are able to return to sport and physical activity after successful treatment. Without intervention, there is a risk of progressive cartilage damage and the development of hip osteoarthritis. Regular strengthening exercises for the hip muscles and avoiding overloading the joint can help reduce the risk of developing impingement.
References
- Griffin, D. R. et al. (2016): The Warwick Agreement on femoroacetabular impingement syndrome. British Journal of Sports Medicine, 50(19), 1169-1176.
- Ganz, R. et al. (2003): Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, 417, 112-120.
- National Institute for Health and Care Excellence (NICE): Hip impingement - clinical guidance. www.nice.org.uk
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