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Femoroacetabular Impingement Treatment - Houston, Cypress, Beaumont

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion. The femoral head and acetabulum rub against each other creating damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket) during normal movement of the hip. The articular cartilage or labral tissue can fray or tear after repeated friction. Over time, more cartilage and labrum is lost until eventually the femur bone and acetabulum bone impact on one other. Bone on bone friction is commonly referred to as Osteoarthritis.

FAI impingement generally occurs as two forms: Cam and Pincer.

CAM Impingement: The Cam form of impingement is when the femoral head and neck are not perfectly round, most commonly due to excess bone that has formed. This lack of roundness and excess bone causes abnormal contact between the surfaces.

PINCER Impingement: The Pincer form of impingement is when the socket or acetabulum rim has overgrown and is too deep. It covers too much of the femoral head resulting in the labral cartilage being pinched. The Pincer form of impingement may also be caused when the hip socket is abnormally angled backwards causing abnormal impact between the femoral head and the rim of the acetabulum.

Most diagnoses of FAI include a combination of the Cam and Pincer forms.

Symptoms of FAI

Symptoms of femoroacetabular impingement can include the following:

  • Groin pain associated with hip activity
  • Complaints of pain in the front, side or back of the hip
  • Pain may be described as a dull ache or sharp pain
  • Patients may complain of a locking, clicking, or catching sensation in the hip
  • Pain often occurs to the inner hip or groin area after prolonged sitting or walking
  • Difficulty walking uphill
  • Restricted hip movement
  • Low back pain
  • Pain in the buttocks or outer thigh area

Risk Factors

A risk factor is something that is likely to increase a person’s chance of developing a disease or condition. Risk factors for developing femoroacetabular impingement may include the following:

  • Athletes such as football players, weight lifters, and hockey players
  • Heavy laborers
  • Repetitive hip flexion
  • Congenital hip dislocation
  • Anatomical abnormalities of the femoral head or angle of the hip
  • Legg-Calves-Perthes disease: a form of arthritis in children where blood supply to bone is impaired causing bone breakdown.
  • Trauma to the hip
  • Inflammatory arthritis

Diagnosis

Hip conditions should be evaluated by an orthopedic hip surgeon for proper diagnosis and treatment.

  • Medical History
  • Physical Examination
  • Diagnostic studies including X-rays, MRI scans and CT Scan

Treatment Options

Conservative treatment options refer to management of the problem without surgery. Nonsurgical management of FAI will probably not change the underlying abnormal biomechanics of the hip causing the FAI but may offer pain relief and improved mobility.

Conservative treatment measures

  • Rest
  • Activity Modification and Limitations
  • Anti-inflammatory Medications
  • Physical Therapy
  • Injection of steroid and analgesic into the hip joint

Surgical treatment

  • Hip arthroscopy to repair femoroacetabular impingement is indicated when conservative treatment measures fail to provide relief to the patient.

Femoroacetabular impingement, also known as FAI, hip impingement or labral impingement, causes your hip bones to have an abnormal shape. This irregular fit results in the hip bones rubbing against each other, causing pain and joint damage. Putting off FAI treatment can result in permanent cartilage damage and osteoporosis. If you believe you have a hip problem like impingement, seeing a doctor will improve your recovery. Fortunately, Dr. Mufaddal Gombera offers medical resources and services for patients who have orthopedic pain.

How Does Femoroacetabular Impingement Happen?

Our hip joints have several parts that work together. When even one of these parts has a different shape or position than usual, your hip doesn't move the way it should. A normal hip has the top of the thigh bone (femoral head) slotted into the pelvis' hip socket. They fit together like a ball and socket and provide a full range of motion thanks to the cartilage around them.

Sometimes, excess bone forms and rubs against or pinches the rest of the bones and cartilage. Three types of hip impingement can occur:

  • Pincer impingement: Extra bone on the hip socket or an abnormally angled hip socket that covers too much of the femoral head and squeezes the surrounding cartilage
  • Cam impingement: Excess bone on the femoral head that grinds against the cartilage inside the hip socket
  • Combined impingement: Symptoms of both pincer and cam impingement

Most cases of FAI involve combined impingement. Hip impingement often occurs due to abnormal bone growth during childhood. It can also happen in people who put repetitive strain on their hip joints, such as athletes. Certain bone conditions also cause impingement.

What Symptoms Does Labral Impingement Commonly Cause?

Labral impingement wears down and tears the cartilage in your hip. As the cartilage gets destroyed, it leaves behind only the femoral head and socket. These bones rub against each other in a condition we know as osteoarthritis. The destruction of cartilage in your hip causes sharp pains or dull aches in the following parts of the body:

  • Groin
  • Front, side or back of hip
  • Lower back
  • Buttocks
  • Inner thigh

This pain may happen after hip activity such as walking or sitting for a long time. FAI can also have symptoms such as:

  • The clicking of the hip joint
  • A feeling of locking or catching in the hip joint
  • Difficulty walking uphill
  • Limited hip movement

Do Certain Risk Factors Increase Your Chance of FAI?

You may have a higher chance of developing labral impingement if you:

  • Have a displaced hip from improper development
  • Do activities that cause you to flex your hip the same way over and over
  • Regularly play sports like football, weightlifting and hockey
  • Have a form of arthritis like Perthes disease or inflammatory arthritis
  • Previously injured your hip
  • Do heavy labor for your job

How Does Dr. Gombera Diagnose Femoroacetabular Impingement?

Orthopedic surgeons and specialists like Dr. Gombera use the following methods to diagnose FAI:

  • Medical history review: Your doctor will want to see if you have any of the risk factors mentioned above.
  • Physical examination: The doctor will talk to you about your symptoms and conduct a general physical exam. As part of this examination, they'll probably perform an impingement test. During the impingement test, the doctor lifts your knee up to your chest and turns it inward. If you feel the same hip pain you came to the doctor for, you likely have impingement.
  • Imaging tests: Tests such as X-rays, MRIs and CT scans let the doctor look at the joint directly. X-rays show excess bone, while MRIs reveal torn cartilage. A CT scan gives the doctor a good look at the overall structure of your hip joint.

What Are Nonsurgical Options for Labral Impingement Treatment?

Dr. Gombera aims to use as little surgical intervention as possible when he works with his patients. Conservative treatment options that don't require surgery are not only less invasive, but they also help you recover faster. When you receive a hip impingement diagnosis, you may undergo treatments such as:

  • Reducing physical activity: Traditional rest or avoiding certain actions puts less strain on your hip and lets the damaged cartilage heal.
  • Physical therapy: Certain physical therapy exercises strengthen the muscles in your hip so that they can support your joint more effectively. The muscles take on some of the stress that strains your cartilage.
  • Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) come in the form of painkillers like ibuprofen. These drugs have prescription-strength forms that offer more relief than over-the-counter varieties.
  • Hip injections: During this treatment, your doctor injects medicine into your hip that reduces inflammation and pain. Doctors sometimes use hip injections to determine where the pain in your hip comes from.

How Does Hip Impingement Surgery Work?

In some cases, you can't avoid getting surgery to manage your FAI. Fortunately, Dr. Gombera has the latest technology for minimally invasive surgeries. He can conduct a hip arthroscopy, a procedure that uses small incisions and a tiny scope. Many doctors don't offer hip arthroscopy, but Dr. Gombera has the tools and training to provide this service. A hip arthroscopy involves the following steps:

  1. The doctor creates two to three tiny incisions between one-quarter and one-half of an inch long.
  2. A small camera called an arthroscope enters the incision and lets the doctor see inside your hip.
  3. Using thin instruments, the doctor repairs and cleans damaged tissue. They may also remove the excess bone causing the FAI.
  4. You can go home the same day of surgery. Post-operative recovery times depend on the patient, but you can stop using crutches within a week or two. Remember to follow the post-operative checklist.

Schedule an Appointment With Mufaddal Gombera, MD

Dr. Mufaddal Gombera helps patients in Houston, Cypress and Beaumont get back to doing what they love by addressing their shoulder, hip and knee problems. His practice at Fondren Orthopedic Group offers care just south of the Texas Medical Center in Houston. He uses his board certification and fellowship training to help athletes and everyone else get back on their feet.

We always accept new patients looking for solutions to their orthopedic issues. Contact us online or call us at (713) 794-3457 to speak with one of our staff members.

 

 


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American Academy of Orthopaedic Surgeons The American Orthopaedic Society for Sports Medicine Arthroscopy Association of North America american shoulder and elbow society international society for hip arthroscopy