The hip is a ball-and-socket joint composed of the acetabulum (socket) and femoral head (ball). The labrum is a soft tissue gasket that is located at the edge of the socket. A normal hip joint has a delicate balance between normal range of motion and good stability. This balance comes from the depth of the socket, the shape of the ball, the soft tissue restrains surrounding the joint, and the muscles crossing the joint. Hip Impingement, or more specifically femeroacetabular impingement, refers to an imbalance in the shape of the femoral head and/or the depth of the acetabulum, which can create a conflict between these two structures.
The most common type of impingement is CAM impingement, and refers to an abnormally shaped femoral head. In this type of impingement, the femoral head has extra bone, which can collide with the hip socket and pinch the soft tissue labrum, creating tears over time. The other type of impingement is Pincer impingement, which refers to overgrowth of the socket. A deeper socket can also lead to labral tears over time.
The depth of the socket and shape of the femoral head are determined during childhood and likely have both genetic components and respond to the stresses placed on them while a child’s growth plates are still open.
Individuals who suffer from hip impingement may notice pain within the hip joint with specific activities when they place their hips in certain positions. The most common location of hip pain is in the front of the hip near the groin crease. Some patient will also have pain that radiates into the buttocks. Typically, deeper hip flexion, sitting for long times, and more vigorous sporting activities cause pain. It may be a dull ache at rest. Painful hip impingement is almost always associated with a labral tear.
A standard set of X-rays is the standard way that hip impingement is diagnosed. We measure specific parameters of the femoral head and acetabulum to determine if there is impingement. An MRI will show if there is also a labral tear. Sometimes a CT scan is also used to see the bony impingement in 3D. An ultrasound guided hip injection can verify that the pain is coming from inside the hip joint.
It is important to understand that hip impingement is very common in active individuals and is oftentimes asymptomatic. Just because X-rays show impingement does not mean that your hip needs to be treated. Those patients with pain can benefit from a physician
Strengthening the muscles around the hip and learning appropriate movement patterns can be effective in reducing pain from hip impingement. We always recommend a course of activity modification, home exercises, and as needed anti-inflammatory utilization as first line treatment.
Injections, including cortisone and PRP (platelet rich plasma), can also be utilized to lessen the pain from a labral tear. Injections do not have the ability to heal a tear.
When conservative measures are not relieving the pain in your hip you may be indicated for a surgical procedure. In general, hip arthroscopy is only indicated in patients who have preserved cartilage within the joint. Once the cartilage starts to wear out it may be too late to preserve the hip joint and a hip replacement might be the best solution.
Arthroscopic Treatment of Impingement. Most cases of impingement can be managed surgically with an arthroscopy, in a minimally invasive nature. I look inside of the hip using a special camera, and fix any labral tears at the same time. The area of impingement (CAM and/or Pincer) is then removed with a special burr under X-ray guidance. The idea is to restore a normal contour of the femoral head and neck and to leave a normal socket. Patients are made partial weight bearing for 4 weeks after surgery and can progress to running as early as 3 months post operatively.
Arthroscopic Hip Labral Repair. Labral tears most always occur in conjunction with hip impingement. Most tears are amenable to a repair, where special devices called suture anchors are placed at the edge of the socket and high-strength sutures are used to secure the labrum to the bony attachment. Hip arthroscopy is done on an outpatient basis with patients going home the same day. Patients will use crutches for 4-6 weeks after surgery.
Hip Labral Reconstruction. In cases where there is not enough labral tissue to recreate its normal function we sometimes will perform a reconstruction procedure. The goal of the reconstruction is to make a new labrum inside the hip joint. A piece of cadaver tissue is anchored around the socket to recreate the labrum.
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing hip arthroscopy in the Willamette Valley. He specializes in minimally invasive techniques for a faster recovery after your labral repair and impingement procedure. He uses a post-free hip distraction system to minimize pain and traction related complications.