What is hip impingement?

Hip impingement describes a spectrum of changes in the hips relating to the soft tissue structures, the cartilage and the bony parts of the ball and socket joint. In some patients, there is abnormal bone growth at the front of the neck of the thigh bone or femur and the front of the hip socket or cup. This can cause restricted movement and discomfort, particularly relating to certain activities which involve rotation of the hip. As damage relating to the soft tissue lip at the edge of the joint (labrum) and damage to the bone progresses, early degenerative changes in the cartilage may also start to develop.

There are 2 main sub-types of femoro acetabular impingement:

CAM type impingement involves an abnormal lump of bone on the front of the femoral neck. This is more common in young male patients.

PINCER type impingement involves excess bone on the front part of the cup. This is more common in female patients.

Many patients will have a mixed type of impingement. As noted above, CAM tends to be more dominant in young males and pincer tends to be more dominant in female patients but in a mixed picture, there is often considerable overlap.

What are the symptoms of Impingement?

 

Symptoms of impingement include groin pain with deep seated aching which may be exacerbated by activity. It is common to have sharp or stabbing type pain deep in the groin with activities involving rotational movements of the hip. Following activities that are recognised to aggravate your symptoms, hip pain may be increased for the next 24-48 hours before settling again.

What are the treatment options for Impingement?

Treatment options for impingement include non-operative and operative management. In established impingement, physiotherapy can help in the short-term to reduce symptoms and discomfort. There are studies looking at patient outcomes where there is established impingement. Studies show that physiotherapy alone is not as beneficial as surgical treatment. This is particularly evident if there is a tear of the labrum or associated damage to the cartilage around the joint.

Surgical treatment options for impingement include surgery which is usually carried out using keyhole techniques. Mr Hoad-Reddick does not offer open surgery. Arthroscopic surgery includes correcting the underlying bony abnormality by shaving away the abnormal bone and repairing structures where required. Damaged labrum and damaged cartilage can often be managed using keyhole hip surgery methods, depending on the severity.

 

When should I see my doctor?

 

Once hip and groin pain related to impingement significantly affects day to day activity and enjoyment of sports, please consider visiting your GP for further assessment with a view to orthopaedic referral.

 

What are the next steps?

When groin pain is interfering with day to day activities and enjoyment of sports, I would recommend referral to a specialist orthopaedic surgeon for further investigation. This would initially include plain x-rays and subsequently MR scans. CT scanning with 3D reconstruction may also be recommended as it helps demonstrate the underlying anatomy and the nature of the impingement. It can be very helpful in pre-operative planning where surgery is indicated.