Information and Treatment Options

By Dean C. Sukin, MD and Steven J. Klepps, MD

Individuals may have groin pain, or pain towards the outside of the hip as well as snapping or popping. Sharp stabbing pain may be aggravated by turning, twisting, squatting and even sometimes while seated in a vehicle.

At times, over-the-counter anti-inflammatory medications can help. If pain persists, individuals should consider seeing an orthopedic surgeon to determine the etiology.

The longer the pain remains without treatment, the more damage to the hip. Ultimately, if left untreated, this can lead to arthritis of the hip. Femoroacetabular impingement (FAI) may be the cause. Femoroacetabular impingement is a problem where the bones of the hip are abnormally shaped. The bones “impinge” or rub together in an abnormal way.

The hip is a ball and socket joint. The slippery tissue called articular cartilage covers the ball and socket. The socket (acetabulum) has a gasket that surrounds it called the labrum. This gasket creates a water tight seal, simultaneously providing stability.

In FAI, bone spurs develop on the ball (femoral head) or socket side of the hip. This can trigger inching (impingement). Often, this leads to tearing of the labral cartilage.

It can lead to damage of the smooth cartilage and eventually lead to arthritis. Two types of FAI are found. Pincer (socket) and Cam (ball) bone spurs. Some individuals have both types.

X-rays, MRI and CT scans may all be used to provide diagnosis and confirm the orthopedic surgeon’s examination findings.

Treatment of FAI includes activity changes, antiinflammatories, physical therapy and surgery. Your orthopedic surgeon will always try conservative treatment first, but some patients don’t improve to their satisfaction. With superstar athletes such as Alex Rodriguez and Sydney Crosby undergoing and popularizing hip arthroscopy, more and more patients are wanting to discuss this option. As a result, an entirely new area of orthopedic surgery has evolved, known as “hip preservation surgery”.

Surgery should only be considered in patients who fail to improve with the non-surgical measures. In hip preservation surgery, the hip joint is restored to “near normal” without performing a total hip replacement. This Surgery may involve arthroscopic surgery or an open operation or a combination. The orthopedic surgeon uses a camera with small incisions. The labrum may be repaired or trimmed. Bone spurs will also be removed.

Surgery can reduce the symptoms. Removing the bones spurs and fixing the impingement may prevent future damage and arthritis of the hip. However, if severe, more problems may develop despite surgery. Surgery is not a guarantee, but currently is the best way to treat femoral acetabular impingement for those that have failed to improve with all the nonoperative treatments mentioned above.