Hip impingement

Room to move again

Pain in the hip area is often caused as a result of wear and tear to the hip joint. However, in some instances a common cause of hip pain is hip impingement. There are several possible causes of hip impingement, including a misshapen femoral head or neck, or a hip socket that covers too much of the femoral head. The acetabular cup houses the femoral head, which should be round but when it is more of an oval shape, it can cause the bone of the femur to make contact with the edge of the cup (impingement). So essentially when the femoral head and the acetabular cup do not fit together as they should, hip impingement occurs.

Our experienced consultants here at Schoen Clinic specialise in the diagnosis and treatment of hip impingement. If the cause of the pain is determined early, further damage can be avoided, such as subsequent joint wear in the hip.

Impingement of the hip: What types are there?

A distinction is made between two types of hip joint damage:

  • Pincer impingement:
Most common in women between the ages of 30-40, pincer impingement occurs when the femoral neck impinges on the edge of the acetabular cup. This occurs when the head of the femur (which itself may be completely normal in shape), doesn’t align correctly with the acetabular cup. When this happens, the femur reacts by producing additional bone material, which impinges on the rim of the cup with every hip flexion. In turn, this can cause labral damage as well as wear of the cartilage, ultimately resulting in pain with even the smallest of movements.
  • Cam impingement:
Young adults often suffer from this form of hip impingement. In this case, the femur is the cause. Bony thickening, or a "bump" in the area of the femoral neck causes the head of the femur to be pressed into the cup with every movement. The shearing forces experienced during rotational activity sports, such as ice hockey or football, then tear away the cartilage in the acetabular cup. In many cases, the larger or misshapen femoral head also damages the rim of the acetabular cup. If left untreated and ultimately bone rubs against bone, the joint wears away and arthrosis develops. The high forces involved also mean that the cartilage wears away faster than with pincer-type impingement. In most patients, doctors see an interim form of the condition somewhere between cam and pincer impingement.

Symptoms: These symptoms occur with hip impingement

It often begins with a deep-seated pain in the groin which occurs during sport or after long car journeys, for example. The patient is often no longer able to fully flex the thigh and general mobility of the hip can be restricted. Long periods of sitting e.g. at a workstation, often cause pain in the hip region.

Causes: Triggers for hip impingement

  • Structural deformities
  • Performance sports increase the risk of developing the condition
  • Developmental problems and injuries can also sometimes lead to deformities of the hip joint

Diagnosis: How we diagnose hip impingement

To begin with, we carry out an in-depth consultation regarding the pain you are experiencing followed, by a comprehensive physical examination. In addition, we perform imaging procedures such as X-rays and MRI scans.

The MRI scan shows the wear and tear on the cartilage

Using MRI technology, we are able to effectively detect damage to the cartilage and the acetabular rim. Sometimes patients have symptoms that are not directly associated with the joint. To treat these, we are able to inject an analgesic that blocks the relevant nerve endings directly into the joint.

Helping your joint to function again

Exercises and medication can provide short-term relief from your symptoms. If there is no improvement despite intensive treatment, surgery may help in the long-term. Our experts specialise in impingement treatment and use the latest surgical techniques.

Impingement treatment: Treatment without surgery

If the damage to the bone and cartilage is not yet too severe, we will attempt to treat your condition conservatively. This can involve a limit on sporting activities, and treatment with medication. We also add in physiotherapy to strengthen your muscles and to improve your mobility.

Hip impingement surgery

An alternative to more major hip impingement surgery is hip joint arthroscopy, especially in cases of cam impingement. With this procedure, a small incision is made and a probe carrying a camera is inserted into the joint. This documents any damage such as a tear to the acetabular rim. Using minimally invasive surgical techniques, our surgeon is then able to repair the rim. Overgrowth of the cartilage or small deformities of the bone in the pelvis or on the femur can also be removed. The special tools used mean that the surgeon can also remodel the femoral neck to its correct shape, restoring joint function and ease of mobility.

With pincer impingement, the edge of the cup is moved further inwards. The bony ring that occurred at the point of the original joint lip is removed.

Follow-up treatment after hip impingement surgery

Following hip impingement surgery, you must only partially weight-bear on your hip for up to four weeks in order to avoid fracturing the femoral neck. However, for a period of approximately six weeks you should use walking aids so as not to jeopardise the healing process. During this time, your hip will be mobilised and strengthened with treatments such as physiotherapy. Three months after the procedure, your joint should be fully functional again.

Hip impingement: Our specialists

Hip impingement: Our specialised hospital