Hip Information

Background

The hip is a ball and socket joint where the femoral head (ball) articulates with the acetabulum (socket). The labrum is a fibrocartilaginous bumper that lines the outer aspect of the hip socket and is important for hip stability and force distribution. 

Some individuals have anatomy that predisposes them to hip impingement, also known as femoroacetabular impingement syndrome or “FAI”. 

FAI may be caused by a bony prominence on the femoral side of the joint (CAM), excessive overhang on the acetabular side (pincer), or both (combined). When the hip is flexed, internally rotated and adducted across the body, this bony anatomy causes pinching of hip joint and labrum. Over time, this may cause pain, loss of motion, labral tearing and cartilage damage. 

The diagnosis of FAI is made by clinical history and exam, and with imaging. X-rays of your hip and pelvis are taken to determine how your bony anatomy is contributing to your symptoms, and will show if you have developed any degree of arthritis (thinning of the cartilage). An MRI is often performed to assess the labrum and surrounding muscles and tendons. In severe cases, a CT scan may be obtained to better evaluate bony anatomy and plan surgery. 

Management

FAI can often be treated non-operatively with hip-specific physical therapy aimed to strengthen surrounding musculature and offload the hip joint. Your therapist will also work with you to find ways to avoid hip positions that cause impingement and pain that are specific to your anatomy. 

Sometimes ultrasound guided hip joint injections may be used for both diagnostic and therapeutic purposes. This may be an injection with local anesthetic, corticosteroid or both. In some cases, biologic injections such as platelet rich plasma may be offered. 

In severe cases of FAI in patients with no or minimal arthritis that have failed to respond to conservative treatment including dedicated hip-specific PT and possibly injections, surgery (hip arthroscopy) may be offered. 

Hip arthroscopy involves accessing the hip joint through multiple small incisions and using a camera to view the inside of your hip joint. During arthroscopy, prominent bone causing impingement can be recontoured to minimize impingement (femoroplasty, acetabuloplasty), and the torn labrum is typically repaired. 

Recovery and Prognosis 

Patients are kept partial weight bearing on crutches for the first 2-3 weeks after hip arthroscopy. Crutches are then gradually weaned and your physical therapist will work with you to normalize your gait pattern by around 6 weeks post-op. Some patients will be recommended to wear a custom-fitted hip brace for support in the early part of their rehab. 

After 6 weeks, you will continue to undergo a detailed hip-specific rehab protocol guided by your physical therapist. My goal is for you to return to most athletic activities by around 4 months post-operatively; however, patients may not return to competitive and high impact sports until 6 months or more post-operatively depending on progress with rehabilitation.

Even with successful hip arthroscopy, it is still possible to develop worsening arthritis in the future that may require additional surgeries; however, most active and motivated patients do very well with minimal limitations for many years after their surgery. 

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