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Hip Impingement Treatment
Femoroacetabular impingement, commonly abbreviated as FAI, is a condition where extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. These bones may rub against each other during movement, causing friction that can lead to joint damage and pain.
- Are your symptoms affecting your quality of life? Consult our MOH-accredited hip specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
Types of Femoroacetabular impingement
Femoroacetabular impingement can be classified into three types based on the areas of bone overgrowth. These types are:
- Cam Impingement
Occurs when the femoral head is not round and cannot rotate smoothly inside the acetabulum. This type of FAI is more common in young men and is often related to athletic activities. - Pincer Impingement
Involves excessive bone growth on the rim of the acetabulum. This type of impingement often affects middle-aged women and can be associated with labral tears. - Combined Impingement
This is a combination of both cam and pincer impingements. Individuals with this type experience symptoms and risks associated with both cam and pincer types.
Causes and Risk Factors
The development of femoroacetabular impingement is influenced by various factors, both genetic and environmental:
- Genetic Factors: A predisposition to FAI can be inherited. People with family members who have had hip problems may be more likely to develop FAI.
- Developmental Factors: Abnormalities in hip bone development during childhood and adolescence can lead to FAI. This is often seen in conditions like Legg-Calve-Perthes disease.
- Physical Activity: High-impact sports and activities that involve repetitive hip movements, such as football, ballet, and martial arts, can increase the risk of FAI.
- Age: FAI is more commonly diagnosed in young and middle-aged adults.
- Gender: Males are more likely to develop cam-type impingement, while females are more prone to pincer-type impingement.
Signs & Symptoms of FAI
The symptoms of femoroacetabular impingement can vary, but typically include:
- Pain in the Groin Area - This is the most common symptom, often exacerbated by activities such as walking, sitting for long periods, or playing sports.
- Stiffness - The hip joint may feel stiff, particularly after being in one position for a long time.
- Limited Range of Motion - Difficulty in moving the hip joint to its full extent is a common symptom, affecting activities like bending or turning.
- Limping - Persistent discomfort may lead to changes in walking patterns.
- Clicking or Locking - Some individuals may experience a sensation of the hip 'clicking' or 'locking' during movement.
Diagnosis & Tests
The process of diagnosing femoroacetabular impingement typically includes several steps:
Initial Consultation
During the first appointment, your orthopaedic surgeon discusses the patient’s general health and specific hip symptoms. This conversation is crucial in understanding the patient’s condition and potential causes of their pain.
Impingement Test
As part of the physical examination, your orthopaedic surgeon often performs the impingement test. This involves bringing the patient’s knee towards the chest and then rotating it inward towards the opposite shoulder. A positive result, indicated by the recreation of hip pain, suggests impingement.
Imaging Tests
To confirm the presence of FAI and assess the extent of the condition, various imaging tests are employed:
- X-rays: These provide clear images of bones and can reveal abnormal shapes associated with FAI, as well as signs of arthritis.
- Computerized Tomography (CT) Scans: Offering more detail than X-rays, CT scans help in visualizing the exact abnormal shape of the hip.
- Magnetic Resonance Imaging (MRI) Scans: MRI scans are effective in creating detailed images of soft tissue, helping to identify damage to the labrum and articular cartilage. The use of dye injection during the MRI can enhance the visibility of the damage.
Local Anesthetic Test
Your orthopaedic surgeon may inject a numbing medicine into the hip joint. If this injection provides temporary relief from pain, it helps confirm that FAI is the source of the issue.
These diagnostic methods combined give a comprehensive understanding of the condition, aiding in the formulation of an effective treatment plan.
Treatment Options
Treatment for femoroacetabular impingement (FAI) is tailored to the individual’s condition and the extent of damage. The options fall into two categories: non-surgical and surgical.
Non-Surgical Treatments
- Corticosteroids: These are used to reduce inflammation in and around the hip joint. They are typically administered via injection.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Available in pill form, NSAIDs help in reducing inflammation and managing pain.
- Physical Therapy: Specialized exercises are designed to strengthen the joint and enhance mobility.
- Rest: Limiting certain activities can reduce friction in the hip joint and alleviate symptoms.
Surgical Treatments
In cases where non-surgical methods are insufficient, surgical intervention may be considered:
- Arthroscopic Hip Surgery: This minimally invasive procedure involves repairing or removing damaged bone or cartilage through small incisions.
- Traditional Hip Surgery: For more severe cases, an open operation may be necessary, where a larger incision is made to repair the damage.
Prevention of FAI
Most cases of femoroacetabular impingement (FAI) are not preventable due to their structural and genetic nature. Focusing on prompt treatment and management can play a significant role in preventing further damage to the hip.
Questions to Ask Your Doctor
For individuals diagnosed with femoroacetabular impingement (FAI), asking the right questions can help in understanding and managing the condition effectively:
- How will FAI affect my daily life?
- What type of treatment is best for me considering my lifestyle and the severity of my condition?
- Can you discuss the risks and benefits of having surgery for FAI?
- What modifications do I need to make to my usual activities, and are these adjustments temporary or permanent?
When to Seek Medical Advice
Consult a hip specialist if you experience any of the following:
- Persistent Hip Pain: Ongoing or recurrent pain, particularly if it interferes with daily activities.
- Reduced Mobility: Noticeable difficulty in performing movements that were previously manageable, such as bending or walking.
- Pain During or After Activity: Discomfort associated with physical activities or persistent pain after such activities.
- Changes in Gait: Any alteration in walking patterns, for example, limping, that can be attributed to hip discomfort.
- Clicking or Locking Sensations: Any unusual sensations within the hip joint during movement.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 20 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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38 Irrawaddy Road, #08-62/63
Singapore 329563
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