Hip impingement, formally known as femoroacetabular impingement (FAI), occurs when hip joint bones abnormally contact each other, leading to pinching or rubbing. This friction often causes pain and limits movement. While anyone can develop FAI, it is a common source of hip pain for active individuals and young athletes. If left unaddressed, the condition can hinder daily activities and sports, and may contribute to further joint damage.
What is Hip Impingement?
The hip is a ball-and-socket joint, with the top of the thigh bone (femoral head) fitting into a cup-shaped part of the pelvis (acetabulum). Hip impingement occurs when extra bone growth on either the femoral head or acetabulum causes them to rub during movement. This irregular bone shape prevents the smooth gliding motion of a healthy hip.
There are two primary types of FAI. Cam impingement involves an irregular femoral head that grinds against the hip socket. Pincer impingement occurs when the hip socket has excess bone extending over the femoral head, leading to soft tissue pinching. When both types are present, it is termed combined impingement.
This friction can damage the labrum, a ring of cartilage cushioning the hip socket, and the articular cartilage covering joint surfaces, potentially leading to arthritis.
Symptoms often include pain in the groin area, but can also be felt on the outside of the hip, in the buttock, or radiate to the lower back, thigh, or knee. This pain frequently worsens with activities involving deep hip flexion, such as squatting, prolonged sitting, or twisting movements. Individuals may also experience stiffness, reduced range of motion, or a clicking or popping sensation in the hip. Symptoms may be mild at first but often worsen with increased activity.
Conservative Treatment Options
Non-surgical approaches are often the first treatment for hip impingement, aiming to reduce pain and improve function. Activity modification involves avoiding movements that aggravate hip pain. This might include limiting deep hip flexion, internal rotation, or prolonged sitting, which can increase pressure on the hip joint. Patient education on these positions is important for conservative care.
Physical therapy addresses muscle imbalances and improves hip mechanics. Therapists guide patients through specific exercises to strengthen hip muscles, particularly gluteal and core muscles, which reduce joint stress and improve stability. It also improves flexibility, mobility, and coordination through targeted stretches and movements. These interventions alleviate pain, enhance range of motion, and contribute to joint health.
Pain management techniques complement physical therapy for symptom relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce inflammation and pain in the hip joint. For targeted relief, corticosteroid injections may be administered directly into the hip joint. These injections temporarily reduce pain by decreasing inflammation. While conservative treatments do not change underlying bone structure, they can significantly improve symptoms and function for many, potentially delaying or preventing surgery.
Surgical Solutions
If conservative treatments do not relieve symptoms or if there is significant structural damage, surgery may be considered for hip impingement. Hip arthroscopy is the primary surgical approach, a minimally invasive procedure. During hip arthroscopy, a surgeon makes small incisions around the hip. An arthroscope, a thin instrument with a camera, is inserted through one incision to visualize the joint. Other small instruments are used through additional incisions for repairs.
A main goal of hip arthroscopy for FAI is to reshape the bones (osteoplasty). This involves removing excess bone from the femoral head (cam impingement) or acetabulum (pincer impingement) to create a more normal shape and prevent abnormal contact. The surgeon may also repair a torn labrum or address damaged articular cartilage. This reshaping and repair alleviates pain, restores hip mechanics, and can prevent further joint damage.
Hip arthroscopy is often an outpatient procedure, with patients typically going home the same day. Compared to traditional open surgery, arthroscopy involves smaller incisions, resulting in less tissue trauma, reduced pain, and a quicker initial recovery. Open hip surgery is rare for FAI but remains an option for complex cases, involving a larger incision and longer hospital stay.
Post-Treatment Recovery
Recovery from hip impingement treatment, conservative or surgical, is a phased process focused on restoring hip function and strength. Physical therapy is central to rehabilitation, guiding individuals through progressive exercises to regain mobility, strength, and coordination. Following hip arthroscopy, physical therapy typically begins soon after, often involving initial pain and swelling management. Patients may use crutches for a few weeks, with protected weight-bearing during early recovery.
As healing progresses, rehabilitation includes strengthening exercises for hip musculature and core, along with activities to improve range of motion and stability. The physical therapist designs a tailored program, ensuring exercises are appropriate for healing tissues and do not cause hip pain. Adherence to the rehabilitation protocol is important for optimal outcomes.
Recovery timelines vary depending on treatment type and individual condition. For hip arthroscopy, most recover for daily activities within six weeks to three months, though a full return to strenuous exercise or sports may take three to six months. Light physical activities may resume within two to three weeks post-surgery. For conservative management, consistent physical therapy over several weeks or months can lead to significant improvements in pain and function.