Anatomy & function
The hip joint consists of the spherical head of the femur (femoral head) and the acetabulum, which covers the head of the femur. Hip impingement (also known as femoroacetabular impingement, FAI for short) describes a clinical picture of the hip joint that can be divided into two subtypes. In the case of hip impingement, bony deformities cause the head of the femur to push against the acetabulum, resulting in a blockage of movement in the hip joint.
Both joint partners can be the cause of hip impingement. The transition from the femoral head to the femoral neck can be thickened(CAM impingement, also known as camshaft impingement), and the hip socket can also be too deeply formed(pincer impingement). As CAM impingement occurs in the vast majority of cases in young male athletes (footballers, ice hockey players, etc.), whereas pincer impingement tends to affect middle-aged people, this section will focus in particular on CAM impingement.
Symptoms & complaints
Signs of CAM impingement can include
- Pain in the hip and groin
- Restricted mobility, e.g. when bending the hip
Hip impingement is typically characterized by pain in the hip and groin. The pain can radiate into the thigh and usually occurs during and after exertion. In more advanced stages, however, pain can also occur at rest.
In addition, the bumping of the femoral head against the hip socket can cause movement restrictions. This usually affects the hip flexion , e.g. when squatting or climbing stairs, and the inward rotation of the hip, e.g. when crossing the legs.
The repeated impact of the femoral head on the acetabulum can result in injuries to the joint labrum (acetabular labrum) and/or the articular cartilage. Hip arthrosis, in which there is irreversible damage to the articular cartilage, is a relevant complication.
Causes
Causes of CAM impingement include
- Competitive sports (soccer, ice hockey, etc.)
The exact causes of hip impingement have not yet been sufficiently clarified. Competitive sports played in youth are a risk factor for the development of CAM impingement. In particular, sports that involve rapid changes of direction, such as soccer and ice hockey, increase the likelihood of this clinical picture.
Diagnosis
Our certified sports physician Dr. med. Tarek Schlehuber will ask you questions about your complaints in a detailed consultation (medical history). This will be followed by a physical examination in which, among other things, the mobility of the hip joint will be checked.
To further confirm the suspicion of hip impingement, a hip impingement test can be carried out. This involves flexing the hip joint and rotating it inwards so that the foot points outwards. If pain occurs here or this movement is not possible, this indicates hip impingement.
In addition, an X-ray is then taken in which the bony deformity of the hip joint is visible. A distinction can now be made between cam and pincer impingement. The condition of the joint labrum and articular cartilage and other accompanying injuries are assessed in an MRI scan.
If there is still uncertainty regarding the correct diagnosis, pain-relieving medication can be injected directly into the hip joint as a local anaesthetic. Pain relief shortly afterwards confirms the suspicion of hip impingement.
Treatment
Conservative therapy:
The following conservative therapies are possible:
- Painkillers
- Relief, sports break
- Physiotherapy
Medication from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used in the short term to reduce pain. These drugs not only relieve pain, but also help to reduce inflammation in the already irritated hip joint.
Furthermore, so-called high-impact sports should be avoided for a certain period of time in order to relieve and protect the hip joint. This includes sports that put a lot of strain on the joints. Instead, those affected should focus on sports that are easy on the joints, e.g. swimming or cycling, during this time and generally protect the hip joint as much as possible.
Physiotherapy can also strengthen the surrounding muscles and reduce the restriction of movement.
Operation:
If conservative treatment options do not lead to the desired success, a surgical method can be considered. The protruding bone can be removed(bump resection) and injuries to the joint lip or joint cartilage can be treated openly or arthroscopically. Arthroscopy is a minimally invasive surgical procedure in which a camera with a light source and a working instrument are inserted into the hip joint through several small incisions in the skin. This allows the hip joint to be precisely assessed and a therapeutic intervention to be carried out at the same time.
Everything at a glance:
- Operation time: 60-120 min
- Anesthesia: General anesthesia
- Clinic stay: inpatient
- Ready for work: after approx. 2-4 weeks
- Return to sports (RTS): after approx. 3 months
Aftercare
In the first two weeks after the operation, partial weight-bearing of the hip joint using crutches is recommended. Physiotherapy can also support the healing process.
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