Hip impingement syndrome, also called femoroacetabular impingement (FAI), can interfere with daily living and greatly impact a person’s quality of life. If you’re experiencing this condition, we know it can be painful and concerning. Orthopedic hip experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, see and treat a variety of hip concerns, including hip impingement. With the right diagnosis and treatment, it’s possible to manage hip impingement effectively.
What is hip impingement?
The hip joint is a “ball-and-socket” joint. The hip joint is composed of two bones: the femur (thighbone) and the flat part of the pelvis (acetabulum), located in the middle of the body.
In some people, the ball and socket rub against each other, causing damage to the joint. This is what is called hip impingement, or FAI. Hip impingement can occur due to bone overgrowth or when the joints aren’t shaped correctly because of how they develop in childhood. If it goes untreated, cartilage damage, labrum tears, hip arthritis and other issues can potentially result.
What causes hip impingement?
Hip impingement typically occurs due to anatomical changes that can happen during infancy and childhood as bones develop and grow. Some people have too much bone in certain areas of their hip joints, and sometimes the hip joints aren’t shaped correctly.
There are three main types of hip impingement, including:
- Cam: This occurs when the ball of the joint (femoral head) isn’t entirely round. This causes it to not fit properly in the socket.
- Pincer: This type of hip impingement occurs when bone extends beyond the normal edge of the hip socket.
- Combination/mixed: In many cases, people may have a combination of both pincer and cam impingements.
Over time, this repeated action (friction) causes the cartilage to wear down and can damage the hip joint, leading to different symptoms.
Differences between hip impingement and hip dysplasia
Hip impingement and hip dysplasia are different conditions affecting the hip joint. Both conditions can cause discomfort and impair joint function.
Hip impingement happens when the bones in the hip don't fit together correctly due to anatomical reasons. This causes the bones in the hip joint to rub against each other, causing damage. Hip dysplasia, on the other hand, occurs when the hip socket isn’t deep enough to hold the thighbone properly, which can create some instability.
What are the symptoms of hip impingement?
Hip impingement can cause different symptoms that affect your daily activities.
The symptoms of hip impingement may include:
- Deep pain in the front part of the hip and down into the groin area
- Stiffness in the hip joint
- Pain that radiates toward the deep buttock area
- Catching, grinding and other mechanical-type pain with certain movements
- Pain that worsens with certain activities, such as walking, twisting and getting in and out of a car, or pain that makes these activities difficult.
Not everyone will have the same symptoms, so if you have any concerns you should talk to your doctor. They can help you figure out what might be causing your pain. Early diagnosis is important to ensure optimal treatment outcomes.
How is hip impingement diagnosed?
Determining if hip impingement is the reason for your symptoms will require consultation. Ohio State Sports Medicine hip pain experts will gather a detailed medical history and conduct a physical examination of your hip. During the exam, they’ll see what types of activities and motions seem to cause more pain. They will also check your range of motion and perform specific physical exam maneuvers and tests.
For most cases of hip impingement, diagnostic imaging will be required. Usually, X-rays of the hip are part of the initial evaluation to help determine a diagnosis and rule out other possibilities. Sometimes, ultrasound-guided injections are used for diagnostic and therapeutic purposes when the pain source isn’t clear enough. Magnetic resonance imaging (MRI) is used to look at cartilage, the labrum and soft tissues in the hip, too. In some instances, computed tomography (CT) scans with 3D imaging may also be ordered.
From there, your doctor will be able to determine a diagnosis and if hip impingement is the cause of your symptoms.
How is hip impingement treated?
If you are diagnosed with hip impingement, your doctor will decide the appropriate treatment for you. They may recommend one or more treatment options. Treatments for hip impingement can be either nonsurgical or surgical.
Nonsurgical options may include:
- Rest or modified activity
- Lifestyle modifications, including weight loss
- Physical therapy, conducted at home and with a physical therapist
- Medications to reduce pain and inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or oral steroids
- Cortisone (steroid) injections in the joint
- Orthobiolgics therapies, such as platelet-rich plasma (PRP)
If nonsurgical options don’t work, your doctor may recommend hip surgical treatments. These may include:
- Hip arthroscopy: A minimally invasive diagnostic and exploratory procedure to fix the hip joint
- Labrum repair: A procedure that fixes the cartilage that surrounds the hip socket
- Femoral osteoplasty: A procedure in which the femur is reshaped to fit into the hip socket
- Acetabular rim trimming: A procedure in which the concave surface of the pelvis is reshaped to fit the joint
- Total hip replacement: The replacement of the injured hip joint with man-made materials; used in certain advanced cases.
Why choose Ohio State Sports Medicine for hip impingement treatment?
The Ohio State Wexner Medical Center offers the best treatment options for hip impingement. Our team includes fellowship-trained surgeons, sports medicine doctors, physical therapists, clinic staff and researchers who are experts in hip conditions.
You can also get special treatments, like orthobiologics therapies, or join clinical trials for hip pain if you're eligible. We have many physical therapists who help people with hip problems, like those in our Performing Arts Medicine Program or sports-specific therapy programs.